Patho 370 RCP

Heart shadow will be longer than normal on what PA or AP

The heart shows up larger on an AP view

Normal cardio thoracic ratio on PA view

On the PA projection, the ratio of the width of the heart to the thorax( the cardio thoracic ratio) is normally less than 1:2

Width of the heart should be less than 50% of the width of the thorax

Difference between AP and PA radiograph

PA-most preferred method of positioning for CXR

AP- In comparison with PA radiograph, the AP radiograph magnifies the heart, has less resolution and is usually more distorted, hazy, often has extraneous shadows.

Modt CXR are taken during full inspiration or full expiration

Full inspiration

When is lateral decubitus film used?

Useful in the diagnosis of a suspected known fluid accumulation in the pleural space.(Pleural effusion)

What test/diagnostic procedure can determine if pulmonary embolism is present?

First line test for diagnosing suspected pulmonary embolism.

Chest radiograph findings:What do these findings suggest? What disease process?

The diagnosis of lung disorders, the assessment of the extent and location of disease,and the evaluation of the subsequent progress of the disease.

What is pleurodesis?

It is performed to prevent the recurrence of a pneumothorax or pleural effusion.

Injecting number of agents into the pleural space through a chest tube.

What should patient be monitoring for after thoracentesis?

• Pneumothorax

• Post aspiration pulmonary edema

• Infection

• Bleeding

• And organ damage

What is the purpose of diagnostic and therapeutic thoracentesis

• PT may have a pleural effusion

• To remove fluid from the pleural space to relieve shortness of breath or pain by large pleural effusion, to remove air trapped between the lung and chest wall

• To admin medication directly into the lung capacity.

What is thoracentesis?

• A diagnostic and or therapeutic procedure in which a needle is inserted into the chest to remove fluid from pleural space

• Most common pleural disorder that requires a thoracentesis is a pleural effusion

What test is recommended if patient is experiencing rapid fluid loss from vomiting

A electrolyte test

Which test is used to diagnose suspected tuberculosis

• Acid fast smear and culture

Purpose of cytology

Evaluates sputum samples under a microscope for the presence of abnormal cells, which may indicate malignancy samples.

Purpose of culture and sensitivity test

Used to diagnose bacterial infections determine the most effective antibiotics and evaluate the success of the chosen therapy.This test helps guide targeted anti microbial treatment

Purpose of gram stain

Classifies bacteria into gram negative organisms.This rapid test assist in the initial selection of antibiotics.

Purpose of acid fast stain

Identifies acid fast bacilli, such as mycobacterium tuberculosis.For accurate results, a series of three early morning sputum samples is collected and tested.

Blunted costophrenic angles

Plural effusion(accumulation) of excess fluid within the pleural space

Depressed hemidiaphragms

Chronic obstructive pulmonary disease (emphysema) causes gas /fluid to acclimate in the pleural space flatten and depress the normal curvature of the diaphragm

The range for RBC is

4-6 mill/mm

Normal values/ ranges for Hct,Hb, WBC, platelet count

• HCT- hematocrit:40-50%

• HB-Hemoglobin: 12-16 G/ 100ml

• WBC-White blood cells: 5,000-10,000/mm

• Platelet Count:150,000 to 400,000/mm

• Platelet count: less than 20,000 is associated with spontaneous bleeding

• Platelet count: greater than 50,000 is not associated with spontaneous bleeding

Sodium Na +

135-145mEq/L

Calcium Ca++

4.5-5.5mEq/L

Glucose

70-105mEq/L

Magnesium Mg++

1.5-2.5mEq/L

Why is low platelet count concerning especially before on invasive procedure

It is associated with spontaneous bleeding prolonged bleeding time and poor clot retraction

Making it not safe for pt to have the procedure

Patient platelet count should be atleast__ before invasive procedure to minimize risk of bleeding?

Greater than 50,000

For patients experiencing severe asthma attack we would expect to see increase in which WBC count?

Eosinophil

In a normal differential white blood cell count, which type of white blood cells would have highest number

Rigid bronchoscopy is used for what?

It’s purpose is to provide open access to pt airways for interventional procedures

Used for large foreign object retrieval or for international procedure such as insertion of airway stents or management of massive hemoptysis

Which type of white blood cells is expected to be increased for viral infection

Lymphoycte

Flexible bronchoscopy is used for what?

• Evaluation of pneumonia or infiltrate of unclear etiology

• Unexplained lung collapse

• Flexible bronchiscopy can obtain small specimens as part of the evaluation for an infectious opportunistic or alternative etiology

• Infiltrates of any size or location,atelectasis, or mass lesion

• Can be used to assist in difficult intubation

• Pneumonia

• Hemoptysis

What TDP is recommended for a patient with lung collapse

Lung expansion therapy protocol

When should aerosolized medication therapy be used

Depends on pt needs and sever therapy may be used to administer short acting bronchodilator-long acting bronchodilator, anti- inflammatory

What should oxygen therapy be used?

Used when hypoxemia associated with respiratory diseases and help decrease the pt work of breathing and myocardial work

Incentive spirometer belongs to what TDP

lung expansion therapy protocol

ER DOCTOR NOTES

• ABC way to intervene, get control of the

• Airway

• Breathing

• Circulation

Chloride CI-

90-106mEq/L

Potassium K+

3.5-4.5MEq/L