Egan Chapter 16 Terms & Definitions for Medicine

Discuss the components of the interview, including the space requirements for conducting

Rapport: helps establish a rapport between clinician and patient

Obtain Information: is an important way to obtain essential diagnostic information

Monitor Changes: ongoing beside interviewing is needed to help monitor changes in the patient’s symptoms and response to therapy

Guidelines: Who you are and what you’re doing

“Social space”; 4-12 feet

Know the components of the drive to breathe

The drive to breathe can increase due to hypoxemia, acidosis, fever, exercise, or anxiety

Our breathing is mainly controlled by the muscles of the diaphragm

Identify the postural elements of difficult breathing

Bad posture or malformations—such as kyphoscoliosis—can cause a difficulty in breathing (mainly through restrictive lung

Fixing bad posture can also improve a symptom such as Crackles

Describe the terms relating to mucus and sputum

Phlegm: mucus from the tracheobronchial tree that has not been contaminated by oral secretions

Sputum: mucus that comes from the lung but passes through the mouth

Purulent: term indicating that the sputum contains pus and suggesting a bacterial infection

Fetid: foul smelling sputum

Mucoid: sputum that is clear and thick and commonly seen in patients with airway disease

Characterize the types of chest pain

Pleuritic

Located laterally or posteriorly

Worsens with deep breath and is sharp or stabbing

Associated with disease that cause pleuritic lining to become inflamed

Pneumonia or pulmonary embolism

Non-Pleuritic

Center of the anterior chest and may radiate to the shoulder or back

Not affected by breathing

Dull ache or pressure

Angina, gastroesophageal reflux, esophageal spasm, chest wall pain, and gallbladder disease

List the causes of pedal edema

Results from right heart failure and gravity dependence

What conditions are commonly associated with diaphoresis?

Fever, pin, severe stress, increased metabolism, or acute anxiety

What are the causes of tachycardia, bradycardia?

Tachycardia: exercise, fear, low BP, anemia, fever, reduced arterial blood oxygen levels, and certain medications

Bradycardia: hypothermic, medications, or certain cardiac arrhythmias

Identify components of body temperature, include monitoring sites and regulatory sites

Sites for Measurement: mouth, axilla, rectum, tympanic membrane, touch-less scan (forehead)

Average: 98.6 degrees F +/- 1 or 37 degrees C +/- .5

Hypothalamus regulates heat loss and respiratory system helps remove excess heat

Explain the components of cardiac output

The amount of blood that circulates per minute (HR x SV)

Identify the components of blood pressure, normal and abnormal

Systolic Pressure: peak force exerted during contraction of the left ventricle

Normal range is 90-140

Diastolic Pressure: force remaining after relaxation of the ventricles

Normal range is 60-90

Normal is 120/80

Hypertension: sustained above 140/90

Hypotension: less than 95/60

Postural Hypotension: patients with hypovolemia stand up

What are some abnormal pulse types

Pulse Deficit: when the heart rate and peripheral rate are not the same

Tachycardia: >100

Bradycardia: <60

What is the advantage of pursed lip breathing

Pursed lip breathing creates a resistance to flow and causes a slight back pressure which keeps small airways from collapsing during exhalation

What causes a tracheal shift

Collapsed lung

Tension pneumothorax

Large pleural effusion

What causes JVD

With elevated venous pressure, neck veins may distend as high as the angle of the jaw even when sitting upright

Distention greater than 3-4 cm above the sternal angle is abnormal

List some common chest wall and spinal deformities

Scoliosis: lateral curvature of the spine

Kyphosis: abnormal AP curvature of the spine

Kyphoscoliosis: a combination of kyphosis and scoliosis that produces a severe restrictive lung defect due to poor lung expansion

Pectus Carinatum: abnormal protrusion of the sternum

Pectus Excavatum: depression of part or all of the sternum, can produce restrictive lung depending on severity

Differentiate between Biot's, Kussmaul's and Cheyne-Stokes breathing

Biot's Respirations

Irregular breathing with long periods of apnea

Kussmaul's Respirations

Deep and fast respirations

Cheyne-Stokes Respirations

Breaths increase and decrease in depth and rate with periods of apnea

Breathing patterns associated with atelectasis, asthma and diabetes

Atelectasis

-Rapid and shallow breathing

Asthmatic breathing

-Prolonged exhalation; obstruction to airflow out of the lungs

Diabetes

-Kussmaul's respirations are associated with

Causes of tactile and vocal fremitus

Vocal Fremitus: vibrations from speech transported down the tracheobronchial tree and through the lung to the chest wall

Tactile Fremitus: when said vibrations are felt on the chest wall

Outline proper auscultation technique

Sit patient upright in a relaxed position

Have them breathe slightly deeper than normal through open mouth

Place the diaphragm directly against the chest wall

Begin at the base comparing sounds from side to side

Include all lobes on the anterior, posterior, and lateral chest

Evaluate one full ventilatory cycle

Differentiate between, crackles, wheezing, stridor and the causes of each

Caused by flowing at a high velocity through a narrow airway from a bronchospasm, mucosal edema, inflammation, tumors, and/or foreign bodies

What is the therapist looking for on an examination of the extremities?

Digital clubbing, cyanosis, pedal edema, capillary refill, and peripheral skin temperature