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List the four critical life functions

Ventilation, Oxygenation, Circulation, Perfusion

Which of these life functions is the first priority

Ventilation

What assessments would determine how well a patient is ventilating? (5 things)

RR, VT, chest movement, breath sounds, PaCO2

How would the therapist determine if a patient has a problem with oxygenation? (5)

HR, color, sensorium, PaO2, SpO2

What information would help the therapist determine if a patient's circulation is adequate? (4)

HR, strength, cardiac output, BP

What changes would indicate that a patient may not have adequate perfusion? (5)

BP, sensorium, temperature, urine output, hemodynamics

Explain signs

Objective information; things you can see and measure

Explain symptoms

Subjective information; things patient tells you

Items that are important to examine when reviewing a patient's chart (5)

Admitting diagnosis, history of present illness, chief complaint, past medical history, current medication

Define an advanced directive

Document of instructions when a patient is unable to make medical decisions

List four types of advanced directives

DNR, DNI, living will, power of attorney

Properly written order for respiratory care should include what factors (4)

Tx, frequency, dose and route, sign

Normal value for urine output

40 mL/hr

What findings might indicate a patient's fluid intake has exceeded his urine output? (4)

Weight gain, electrolyte imbalance, increased hemodynamic pressures, decreased lung compliance

Changes in what value can indicate hypovolemia?

Decreased CVP

Semicomatose

Responds only to painful stimuli

Lethargy/Somnolence

Consider sleep apnea or excessive O2 therapy in patients with COPD

Obtunded

Drowsy state; may decrease cough or gag reflex

When assessing a patient's orientation to time, place and person, what are some factors that could affect cooperation? (4)

Language, medication, hearing loss, fear/anxiety

Define activities of daily living

Basic tasks of everyday life

List the six criteria that ADL are based upon

Bathing, eating, dressing, toileting, transferring, urine/bowel control

ADL are evaluated using the __________ system

Katz scoring system

Orthopnea

Ability to breathe only in an upright position (CHF)

General malaise

Associated with electrolyte imbalance

Dyspnea

Feeling of SOB

Dysphagia

Difficulty swallowing

What are four factors to consider when conducting a patient interview

Open-ended questions, simple language, pictures, identify major problems

Define patient learning needs

Process of influencing patient behavior for health improvements

What criteria is a patient's ability to learn based upon (6)

Culture/religion, emotion, motivation, physical limitation, language, age/education level

What criteria is the patient's nutritional status based on (4)

Food intake, likes/dislikes, appetite, recent weight gain

Peripheral edema

Excess fluid in the tissue, caused by CHF

Ascites

Abnormal accumulation of fluid in the abdomen, caused by liver failure

Clubbing of fingers

Frog fingers, caused by chronic hypoxemia

Venous distention

Enlarged or swollen veins; caused by CHF

Capillary refill

Indication of peripheral circulation

Diaphoresis

Profuse/heavy sweating, caused by heart failure, fever, anxiety, TB (night sweats)

Ashen/pallor skin indicates

Anemia or acute blood loss

Erythema skin indicates

Capillary congestion, inflammation/infection

Cyanosis skin indicates

Blue discoloration, caused by hypoxia from increased amount of reduced hemoglobin

Kyphosis

Convex curvature of the spine (lean forward)

Scoliosis

Lateral curvature of the spine

Barrel chest

Result of air trapping in the lungs for a long period of time

List five underlying pathologies that can contribute to asymmetrical chest movement

Post lung resection, atelectasis, pneumothorax, flail chest, ETT

Cheyne-Stokes cause

Increased intracranial pressure, brainstem injury, drug overdose

Biot's cause

CNS

Kussmaul's cause

Metabolic acidosis, renal failure, diabetic ketoacidosis

What causes hypertrophy of the accessory muscles and what type of patients

COPD

Wasting away of muscles is also referred to as

Paralysis

Retractions are caused by

Severe airway obstruction or respiratory distress

Describe the four neck pathologies that might complicate endotracheal intubation

Short mandible, enlarged tongue, bull neck, limited range of motion

What does paradoxical pulse/pulsus paradoxus indicate?

Pulse/BP pressure varies with respiration; indicates severe air trapping

Tracheal deviation pulled toward affected side (4)

Atelectasis, fibrosis, pneumonectomy, paralysis

Tracheal deviation pushed away of affected side (4)

Pleural effusion, tension pneumothorax, neck tumor, mediastinal mass

What is tactile fremitus

Vibrations that are felt by hand on the chest wall

Tenderness

Avoid

What is meant by crepitus and what condition is it associated with?

Bubbles of air under the skin that can be palpated and indicates subcutaneous emphysema

Flat percussion sound

Heard over sternum, muscle, atelectasis

Tympanic percussion sound

Heard over air filled stomach; indicates increased volume when heard over the lungs

Hyperresonant percussion sound

Heard over pneumothorax or emphysema may be present

What is egophony? What does it indicate?

Patient says E but it sounds like A; indicates consolidation of lung tissue as with pneumonia-like condition

Coarse crackles description/cause

Large airway secretions

Coarse crackles treatment

Instruct to cough

Medium crackles description/cause

Middle airway secretions

Medium crackles treatment

Recommend bronchial hygiene

Fine crackles description/cause

Alveoli, fluid

Fine crackles treatment

O2, positive pressure, positive inotropic agents, diuretics

Supraglottic swelling is

Epiglottitis

Subglottic swelling is

Croup, post extubation

Pleural friction rub description/cause

Inflamed surface of visceral/parietal pleura rubbing together

Pleural friction rub treatment

Steroids, antibiotics

Heart first sound

Normal closure of the bi/tricuspid valves

Heart second sound

Normal and occurs when systole ends

Heart third sound

Abnormal, suggest heart failure

Heart fourth sound

Abnormal, indicates cardiac abnormality

Normal appearance of hemidiaphragms

Rounded

Normal appearance of trachea

Midline, bilateral radiolucency, sharp costophrenic angles

Normal appearance of clavicles

Heads of clavicles should be level

Exposure/Penetration

Will show intervertebral disc spaces thru the shadow of the mediastinum

Underexposed will

Not allow visualization of the intervertebral discs thru the heart shadow

Overexposed will

Show black lung parenchyma without blood vessels

What conditions causes obliteration of the costophrenic angles?

Pleural effusions

What pathology is the diaphragm flattened?

COPD

What pathology would cause crowding of the ribs?

Atelectasis

Placement of pacemaker

Positioned in the right ventricle

Placement of pulmonary artery catheter

Right lower lung field

Placement of CVP

Rest in the SVC/right atrium

Placement of chest tube

Pleural space surrounding the lung

Placement of NG tube

In the stomach 2-5 cm below the diaphragm

Lateral X ray croup

Subglottic, steeple sign

Lateral X ray epiglottis

Supraglottic, thumb sign

What type of radiographs are helpful in locating areas of air trapping?

Inspiratory/expiratory radiographs

Radiolucent description

Dark pattern, air

Radiolucent diagnosis

Normal

Radiodense/opacity description

White pattern, solid, fluid

Radiodense/opacity diagnosis

Normal for bones, organs

Infiltrate description

Any ill-defined radiodensity

Infiltrate diagnosis

Atelectasis

Consolidation description

Solid white area

Consolidation diagnosis

Pneumonia/pleural effusion

Hyperlucency description

Extra pulmonary air