rt final first semester

temperature

96 to 99.5F

35.5 to 37.5C

pulse

60-90/100 bpm

respiratory rate

12-20 breaths/min

blood pressure

90/60 to 140/90 mmHg

SpO2

90-100%

COPD: 88-92%

Hypoxemia: less than 90%

vesicular bs - normal

low-pitched, heard over most of the periphery. no pause between inspiration and expiration

bronchovesicular bs - normal

combo of bronchial and vesicular sounds, muted inspiration and expiration are the same length. heard over the sternum at the 2nd intercostal space between the scapulae and right apex lung

bronchial bs - normal

loud and higher pitched, expiratory longer than inspiratory. heard over the upper portion of sternum/manubrium

tracheal bs - normal

heard over the trachea, harsh and high-pitched with expiratory lasting longer than inspiratory

crackles - adventitious

coarse or fine, inspiratory and expiratory, lower base of the lungs

coarse: lower-pitched, louder, longer, and more bubbly and wet sounding

fine: high-pitched, short, popping or crackling sounds

wheezes - adventitious

high-pitched, inspiration and expiration, throughout the lungs

rhonchi - adventitious

low-pitched, fluid or secretions blocking the airway. asking the pt to cough can clear it

stridor - adventitious

harsh, high-pitched. medical emergency. inspiratory and expiratory

pleural friction rub - adventitious

2 pleural layers rubbing together, irritation or inflammation, creaking leather

chief complaint

pt’s own words, onset, duration

medical history (past and present)

chronic conditions, surgeries, hospitalizations

medications

prescription, otc, inhalers, allergies

risk factors

smoking, exposures, family history (cancers)

social history

tobacco, alcohol, drugs

appearance

distress, habitus, look at pt’s facial expression, anxiety level , positioning

mental status

alert or confused, level of consciousness- confused, delirious, lethargic, obtunded, comatose

work of breathing

accessory muscles, how hard are they trying to breathe, effort to take a breath or lack of, nasal flaring

positioning

tripod, upright, are they hunched over, slouching, jugular venous distention

skin color

pallor, cyanosis

palpation/percussion

touching or tapping the chest to feel air or fluid

temperature (up and down)

affected by age, time of day, hormones, stress, environment

up: infection, dehydration, exercise, heat

down: shock, cold exposure, some drugs and viruses

pulse (up and down)

affected by gender (males often lower) and medications

up: age, exercise, stress, fever

down: hemorrhage, position change

blood pressure (up and down)

affected by age, weight, emotions, vessel conditions, blood volume, heredity, pain

up: exercise, eating, caffeine, pain, some meds

down: fasting, rest, depressants, hemorrhage

invasive and non-invasive

advanced assessment

abg, capnography, hemodynamic data, ventilator assessment

palpation

if one hand moves more than the other it could be:

consolidation, pleural effusion, atelectasis, pneumothorax

consolidation

airless, fluid-filled uncollapsed lung tissue

pleural effusion

fluid in the pleural space

atelectasis

loss of air in the lung tissue

pneumothorax

air in the pleural space

tactile fremitus

saying 99 while palpating chest

increased: pneumonia, consolidation

decreased: pleural effusion, pneumothorax

percussion - resonant

normal, low-pitched with long duration

percussion - hyperresonant

too much air, loud and low-pitched

percussion - dull

tissue or fluid, medium intensity and pitch with short duration. consolidation, atelectasis, fluid in pleural space

percussion - flat

no air, low amplitude and pitch. pleural effusion

albuterol

proventil, ventolin

sympathetic ns

2.5mg/3ml (0.083%)

bronchodilator saba

side effects: tachycardia, palpitations, tremors, nervousness, headache, hypokalemia

atrovent

ipratropium bromide

parasympathetic ns; blocks acetylcholine

0.5mg/3ml (0.02%)

anticholinergic bronchodilator sama

prevents bronchoconstriction

side effects: dry mouth, blurred vision, throat irritation, worsens glaucoma

duoneb

albuterol (2.5mg/3ml) + atrovent (0.5mg/3ml)

inhaler as other method: combivent

used as a maintenance med

combo bronchodilator

side effects: tachycardia, tremors, dry mouth, sore throat, angina

perforomist

formoterol

not a rescue med

for long-term maintenance

20 mcg BID/2ml

bronchodilator LABA

side effects: tremors, tachycardia, dizziness, diarrhea

tobramycin (tobi)

aminoglycoside antibiotic

300 mg BID (28 day cycle)

use a separate neb because it can crystallize

side effects: tremors, tachycardia, nervousness, palpitations

budesonide

pulmicort

inhaled corticosteroid; LABA

0.25mg/2ml, 0.5mg/2ml, 1.0mg/2ml

side effects: elevated blood sugar, thrush, sore throat, hoarseness

xopenex

levalbuterol

bronchodilator saba

0.31mg/3ml (2-4H), 0.63mg/3mL (4-6H), 1.25mg/3ml (6-8H)

side effects: tremors, tachycardia, nervousness, palpitations

racemic epinephrine

used for people with stridor and upper airway edema

used for kids with croup

reduces airway swelling and improves airflow

faster acting than albuterol

alpha/beta adrenergic agonist

0.5ml of 2.25%/3ml

side effects: tachycardia, tremors, hypertension, dysrhythmia, anxiety

pulmozyme

dornase alfa

mucolytic

should not be in direct sunlight. keep in fridge

breaks down dna (makes secretions easy to cough)

2.5mg daily

use a separate neb

side effects: voice changes/hoarseness, rash, sore throat

pentamidine

used for people with pneumocystic pneumonia and hiv

inhalation

given every 4 weeks

use a separate neb in a negative pressure room

hypertonic saline

3%, 7%, 10%/3-5ml

mucolytic

airway hydrator (pulls water into airway)

side effects: bronchospasm (give with a bronchodilator) and coughing

mucomyst

mucolytic

used for mucus plugs and thick secretions

10% (3-5ml) or 20% (6-10ml) solution/4ml

side effects: bronchospasm, nausea, smells like rotten eggs

sputum

color, amount, consistency

cough

productive

non-productive