Respiratory Therapy Exam Review

Flashcards covering vocabulary terms from the provided lecture notes.

Bedside assessment

Process of interviewing and examining patient for signs and symptoms of disease and evaluating the effects of treatment.

Diagnosis

Identifying the nature and cause of illness.

Differential diagnosis

Used when signs and symptoms are shared by many diseases and the exact cause is unclear.

Signs

Objective manifestation of illness.

Symptoms

Sensation or subjective experience of some aspect of an illness.

Dyspnea

Sensation of breathing discomfort by patient (subjective feeling)

Orthopnea

Dyspnea in the reclining position; associated with CHF and other cardiac issues

Platypnea

Dyspnea when moved to the upright position

Breathlessness

Unpleasant urge to breathe which can be triggered by acute hypercapnia and acidosis and by hypoxemia

Upper airway cough syndrome (UACS)

Formerly known as “postnasal drip”

Phlegm

Mucus that comes from the lower airways

Sputum

Phlegm when expectorated through the mouth

Purulent

Sputum that has pus cells in it

Fetid

Sputum that is foul smelling

Mucoid

Sputum that is white/clear and thick (asthma)

Hemoptysis

Coughing up blood or blood-streaked sputum from the lungs

Pleuritic chest pain

Located laterally or posteriorly and sharp, and increases with deep breathing (pneumonia and pulmonary embolism)

Nonpleuritic chest pain

Located in center of chest and may radiate to shoulder or arm; it is not affected by breathing. Often caused by angina, gastroesophageal reflux, esophageal spasm, chest wall pain, and gall bladder disease

Pedal Edema

Swelling of lower extremities—most often due to heart failure

Pitting edema

Indentation mark left on skin after applied pressure

Weeping edema

Small fluid leak occurs at point where pressure applied

Cor pulmonale

Patients with chronic hypoxemic lung disease usually develop right heart failure due to pulmonary hypertension

Chief complaint (CC)/ history of present illness (HPI)

Explains current medical problems.

Family/Social/Environmental history

Potential genetic or occupational links to disease and the patient’s current life situation.

Pack-years

Smoking history is often recorded in

Sensorium

Level of consciousness and orientation to time, place, person and situation (oriented x 4)

Hyperthermia or hyperpyrexia (fever) aka“febrile”

Increased temperature

Hypothermia

Decreased temperature

Tachycardia

HR>100 beats/min

Bradycardia

HR<60 beats/min

Tachypnea

20 bpm

Bradypnea

<10 bpm

Hypertension

BP persistently >140/90 (90% cases cause is unknown e.g. IPAH)

Hypotension

Systolic BP <90 mmHg or mean art. pressure <65 mmHg (shock, hypovolemia)

Nasal flaring

Often seen in infants with respiratory distress and an increase in the WOB.

Pursed-lip breathing

Seen in patients with COPD who have obstruction of the small airways and promotes emptying of the lungs

Jugular venous distention (JVD)

Seen in patients with left heart failure (CHF) but most commonly right heart failure (cor pulmonale).

Thoracic configuration

The anteroposterior (AP) diameter of the average adult thorax is less than the transverse diameter

Barrel chest

The abnormal increase in AP diameter associated with emphysema

Pectus carinatum

Abnormal protrusion of sternum

Pectus excavatum

Depression of part or entire sternum, which can produce a restrictive lung defect

Kyphosis

Spinal deformity in which the spine has an abnormal AP curvature

Scoliosis

Spinal deformity in which the spine has a lateral curvature

Kyphoscoliosis

Combination of kyphosis and scoliosis, which may produce a severe restrictive lung defect as a result of poor lung expansion

Diaphragm

The primary muscle of breathing

Retractions

An inward sinking of the chest wall during inspiration

Tracheal tugging

The downward movement of the thyroid cartilage toward the chest during inspiration

Apnea

No breathing causes by cardiac arrest, narcotic overdose, severe brain trauma

Agonal Breathing

Occasional breaths causes by cardiac arrest, stroke

Apneustic breathing

Deep, gasping inspiration with brief, partial expiration causes by damage to upper medulla or pons caused by stroke or trauma; sometimes observed with profound hypoxemia

Ataxic breathing

Completely irregular breathing pattern with variable periods of apnea causes by damage to medulla

Asthmatic breathing

Prolonged exhalation with recruitment of abdominal muscles causes by obstruction to airflow out of the lungs

Biot's respiration

Clustering of rapid, shallow breaths coupled with regular or irregular periods of apnea causes by damage to medulla or pons caused by stroke or trauma; severe intracranial hypertension

Cheyne-Stokes respiration

Irregular type of breathing; breaths increase and decrease in depth and rate with periods of apnea; variant of “periodic breathing” causes most often caused by severe damage to bilateral cerebral hemispheres and basal ganglia (usually infarction); also seen in patients with CHF owing to increased circulation time and in various forms of encephalopathy

Kussmaul breathing

Deep and fast respirations causes by metabolic acidosis

Paradoxical breathing

Abdominal paradox—Abdominal wall moves inward on inspiration and outward on expiration causes by diaphragmatic fatigue or paralysis

Periodic breathing

Breathing oscillates between periods of rapid, deep breathing and slow, shallow breathing without periods of apnea causes most often caused by severe damage to bilateral cerebral hemispheres and basal ganglia (usually infarction); also seen in patients with CHF owing to increased circulation time and in various forms of encephalopathy

Vocal and tactile fremitus

Increased with pneumonia and atelectasis (consolidation)

Vocal and tactile fremitus

Reduced with emphysema, pneumothorax, and pleural effusion

Crepitus

Air leaks into subcutaneous tissues causing sign of subcutaneous emphysema

Decreased resonance

Pneumonia or pleural effusion (consolidation)

Increased resonance

Emphysema or pneumothorax (air)

Tracheal breath sounds

Heard directly over trachea; created by turbulent flow; loud with expiratory component equal to or slightly longer than inspiratory component

Bronchovesicular breath sounds

Heard around sternum; softer and slightly lower in pitch

Vesicular breath sounds

Heard over lung parenchyma; very soft and low pitched

Breath sounds

The normal sounds of breathing

Adventitious Lung Sounds

The abnormal sounds superimposed on the breath sounds (crackles and wheezes)

Bronchial breath sounds

Abnormal if heard over peripheral lung regions and sign of consolidation

Discontinuous

Intermittent crackling

Continuous

Wheezes

Wheezes

Airway walls that are narrowed and consistent with airway obstruction. After bronchodilation expiratory wheezes will decrease in pitch and length

Stridor

Loud, high pitched sound with compromised upper airway that indicates obstruction in the trachea or larynx

Coarse crackles

Airflow moves secretions or fluid in airways and usually clears when patient coughs or upper airway is suctioned. Crackles are heard when airways pop open

Fine LATE inspiratory crackles

Sudden opening of small airways late in the inspiratory phase due to the peripheral airways collapse during exhalation. Heard w/ pulmonary fibrosis, atelectasis, pneumonia, and pulmonary edema

Pleural Friction Rub

Creaking or grating sound with pleural inflammation and sounds similar to coarse crackles not affected by coughing.

Bronchophony

Increased intensity of vocal resonance indicating lung tissue density and occurs in consolidation phase of Pneumonia

Egophony

Long A sounds like long E

Precordium

The chest wall overlying the heart.

S3

Created by rapid filling of a stiff left ventricle and is abnormal in adults

S4

Caused by an atrial “kick” of blood into a noncompliant left ventricle

Murmur

An abnormal heart sound most often heard over the precordium produced by blood flowing through a narrowed opening

Enlarged liver (hepatomegaly)

Consistent with cor pulmonale.

Abdominal paradox

Present when the abdomen sinks inward during inspiration; this is a sign of diaphragm fatigue

Ascites

Excess fluid in the abdominal cavity

Digital clubbing

Seen in a large variety of chronic conditions: congenital heart disease, bronchiectasis, various cancers, and interstitial lung diseases

Peripheral cyanosis

Cyanosis of the digits due to poor perfusion, especially in the extremities

Mixed Venous Partial Pressure of Oxygen (PvO2)

Decrease tissue oxygenation less than optimal due to may Indicate Impairment of Circulation

Carboxyhemoglobin (HbCO)

Indicates quantity of carbon monoxide bound to hemoglobin

Primary goal of nutrition support

Maintenance or restoration of lean body (skeletal muscle) mass

Enteral feeding

The route of choice that is safer, healthier, and easier than parenteral route

Parenteral feeding

Done through peripheral or central vein, Mechanical, infectious, and metabolic complications have been reported