Pt assessment Kettering/tutorial

Types of Advances directives

DNR

\-call for help

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DNI

\-NIV instead

Pack years formula

Packs per day \* years smoked

Urine intake and output range and meaning?

normal= 40 ml/hr (1L per day)

What measurements measure fluid balance and whats the range and waht treatment when its out of wack?

CVP

range=2-6

Medication Reconciliation?

Confrims Pt order and drug are appropriately matched

Cachectic

Refers to the condition of the muscles. In this case it means muscle wasting syndrome

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associated with Nueroproblem

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Whats Associated with “Euphoria” and how does the patient present with it?

Euphoria= is assoicated with drug overdose

Pt presents with: Excessively and inappropraitely happy

how does a Obtunded present and whats the risk

Obtunded presents with : difficult to arouse

risk: reduced gag reflex= high risk of aspiration

Lethargic/Somnolent sign and associations

Lethargic/Somnolent = sleepy

Associations= Sleep Apnea or excessive O2 therapy in COPD Pt

Activites of daily life importance?

important to evaluate if the pt is going to be discharged

Orthopena

Symtoms

Associated with?

pt may describe?

SOB when laying flat (supine)

Associated with CHF

Pt may describe sleeping with >3pillows

General Malise

Electrolyte imbalance

Lvl of dyspnea

The higher the score or # , the more severe the condition is

Whats part of a discharge plan and home care pla (things to evaluate)

1. Social services (who will help the pt)


2. Physical environment(is the environment safe for the pt)

3\.Environmental exposure (any risk for triggering condition)

What type of question should and should never ask the pt?

YOU SHOULD ALWAYS ASK THE PT OPEN ENDED QUESTIONS ( DETAILED)

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NEVER ASK QUESTIONS THAT END WITH AN ANSWER YES OR NO

Health literacy refers to?

How well can the pt understand the information

Noctural diaphoresis means and associations

Meaning: profuse(alot ) sweating during night time

associations:TB

Excessive wt gain can be associated with

Fluid overload (mostly neonates)

Erythermia

Redness or Inflammation due to exposure to heat or cold

Juandice

sign

caused by?

link?

sign:yellow color of the skin and eyes

caused by: excessive amount of bilirubin in the blood

link:Liver failure

Cyanosis

Indicated low amount of HB in the blood

linked: Asphyxia (low o2 )

Skin Integrity

evaluates the appearance of the skin aka trachea care

Skin turgor done by ? and results meanings

Pinching the skin and watching it return to its normal position.

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slow return= associated with dehydration

Each question should be answered in order of?

Order of the life functions

1\.Ventilation

2\.oxygenation

3\.Circulation

4\.Perfusion

Kyphosis

leaning forward

Scoliosis

Side to Side

Kyphoscoliosis

leaning forward + side to side = Restrictive impairment= reduced VT

Asymetrical or unequal movment associations

Both mean one side only

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1)Atelectasis

2)Pneumo

3)Flail chest(Paradoxical movement)

4)Right mainstem intubation

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Hypothermia

When body temp reaches below normal; leading to metabolism rates to decrease, and o2 and co2 production is reduced.

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Describe Cheyne stokes and links

Increased rate and depth of breathing with long periods of apnea

linked: CNS problem , Drug OD, CHF

Biots description and links

Increased rate and depth with irregular periods of apneas.

links: CNS problem

Kussmuals description and linked

Description : Increased rate and depth

linked: Hypoxemia or DKA

Conditions that affect Airway patency

1\.Short Receding Mandile(small jaw)

2\.Marcoglossia( Enlarged tongue)

3\.Class 3 and 4 Mallampati score

Mallampati class and visuals

Class 1. visual = 4

class 2. Visual= 3

class 3. Visual=2(dangerous)

class 4 Visual=1 (dangerous)

when Class 3 and 4 mallampati scores are reached ; waht should the RT recommend?

1)fiberopic broncoscope

2)Video assist intubation

What change in HR is an adverse reaction

Hr increases >20 is an ADVERSE REACTION; stop doing treatment

Emergency terms

1)Paradoxical pulse

2)Profound

3)MArked

4)severe

Pulses paradoxical/paradoxical pulse

description

links

BP and HR vary during inspiration

links: Severe airtrapping

a Trachea deviation(Mediastinum shift) towards the problem means?

Theres an issue inside the alveoli

a Trachea deviation(Mediastinum shift) away from the problem

Issue is outside the alveoli

Tactile fremitus meaning

Increased means

Decreased means

Meaning: vibrations felt by the hand on the chest

Increased fremitus= Pnemonia , Edema

Decreased Fremitus= Pneumo, Aletectasis, Pleural effusion

Tactile Fremitus key concept

Sound better than solid(Pneumonia+ Edema) than air and liquid )non- solid= Pleural effusion , Atelectasis , Pneumo

Rhonchial fremitus

aka palpable rhonchi ; aka palpable vibrations

indicates thick secretions in the airway

Percussion results

Hyperesonance+ tympanic= Too much air

Dull +Full = less air

Normal breath sounds are described as ?

Bilateral visicular breath sounds

bronchovisicular

Egophony and result

pt ask to say “E” and if it says like “A” means there is consolidation in the lung

Coarse crackles and TX

Secretions in the large airway

TX:suction or instruct to cough

Medium Crackes (Bronchi)

Secretions in the bronchi

TX: we need help to mobilze these secretions. Bronchial hygiene therapy (airway clearance technique)

Fine Crepitus or Mosit crepitus or rales

indication

tx?

Fluid inside the alveli

indication of CHF

TX)o2 , PPV , Inotropic(DIGS) , Furesomedine

Wheeze or diffuse wheezing

Bronschospasm

Unilateral wheeze

causes

tx:

wheeze happening in one side only

causes: Foreign body obstrution

TX: Rigid broncoscopy

STIDOR

description

lvls and TX

Descr: Hoarness or high inspiratory sound(inclusive of an upper airway obstruction

lvls

mild= Topical decongestant (Raci epi)

mod =Bronchoscopy for foriegn body

severe or profound= intubation

Stertor

descr

tx

descrip: low pitched snoring sound or low inspiratory sound

tx: Recommend sleep study ( causes are most likely OSA)

Pleural friction rub

descr

casues

tx

descr: Grating or coarse raspy or crunchy sound due to inflammed surface of the pleural spaces

casues: Pleurisy , TB,Cancer, Pneumonia

TX: Steroid and Antibiotic

S1 and S2 sounds

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and what makes each sound and when does it happen

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S1 and S2= normal heart sounds

S1=closeure of the AV valves (Tri/Mitral)

occurs at the beginning of ventricular contraction

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S2=closure of the Semilunar valves (Pulmonic/ Arothic valves) Happens when systolic ends and ventricles relax

S3

Abnormal heart sound caused heart failure

S4

Abnormal heart sound caused by uncontrolled hypertension or aorthic stenosis

Murmur

Caused by turbulent blood flow through an abnormal opening(when the heart valves do no close tightly)

ex) Open DA or Open PDA

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What to do when any abnormal heart sound is heard?

Do a echocardiogram (ultra sound of the heart to see if theres any openings)

Hypertension BP

systolic?

diastolic ?

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and what does it indicate?

Systolic >140

Diastolic >90

Indicative: Of Cardaic stress

TX:oxygen

Hypotension

systolic

diastolic

indication of?

Systolic=< 90

diatolic=

Normal systolic and Diastolic blood pressure range

Systolic = 90-140

diastolic- 60-80

Ascites

Serious accumlation of fluid in the abd. causes obtruction to blood flow.

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cause: Liver cirrohosis

TX:Sodium restriction( too much sodium leads to more fluid to be build up) and Dieurtics (furosemedine

Capillary refil

assessment of circulation

longer times to refill= reduced circulation = reduced QT

Cold extremities importance

gives us a indication of cardiac output ; cold means poor circulation and perfusion

Proper Quality of a chest x-ray includes? and the meaning of each one

1)Head of Clavicles level’d

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2)Good Exposure =Intervertebral discs should be visible through the heart shadow (mediastinum)

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What the issue?

Clavicles isnt aligned = pt was rotated; this will mess up the views of the structures

Underexposed film

1\.Lung will appear whiter

2\.Intervertbral discs will not show through the heart or shawfows

Over exposed film

1\.Lung parachymla with no visble blood vasculature

Xray position for pts who are unable to stand (bed ridden)

Anterior-Posterior

where film is placed on the pts back

PA FILM

film touching chest ;

ALWAYS recommended because there is less visual of the anterior structure of the heart.

Lateral Decubitus XRAY purpose and position (why is the position important)

Purpose : Detects the diagnose pleural effusions or pnemonia

Positions: affected side down. (to see the movement of the fluid)

Apical Lordotic

Xray from the apices to detect TB

Costhophrenic angles

obliterated

blunted

blurred

meaning?

pleural effusion

Crowding of the ribs means?

Straight or horizontal ?

crowding of the ribs= atelectasis less air

straight or horizontal= Air-trapping( hyper inflation)

Position of the Et tube or trach on CXR should be?

2-6 cm above carina

or

same lvl as the aorthic knob or arhc

Lateral Neck xray detects ?

used to detect

1)CROUP

2)EPIGGLOTIS

Radiolucent

normal

Radiodense/Opacitiy

links

white pattern

linked with solid and fluid

The denser something is on xray what will happen

the less xray will pass through and the xray will look more white (radiodense)

infiltrate

links

radiodense/opacity area

links= atelectasis

Consolidation xray term

links

A solid white area

links:Pneumonia , Pleural effusion

Hyperlucency term

Too much air

Diffuse term and links

term: Spread out

links: Atelectasis/Pnemonia

Opaque

white area that is radio dense (fluid or solid)

Vascular markings descrip

links when increase or decrease

Descrip: branches of vessels

increased= fluid overloaded

decreased= Pneumothroax

Fluffy infiltrate

batwing

Butter fly

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condition:

links

tx

Condition: Pulmonary edema and non cardiogenic pulmonary edema

Links: CHF

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TX:furesemedice , DIGS

Patchy infiltrates

Platelike infiltrates

crowded pulmonary vessels

scattered densities

tx?

Atelectasis

tx:Lung expansion therapy

Ground class appearance

honeycomb

reticulogranular

links

tx

links:ARDS or IRDS

TX:02 , Low Vt, Low PiP ARDS proto call ; CPAP/PEEP

Blunting/obiltergation

mensisous basilar infiltrate

concave border

Pleural effusion

AirBroncograms

Pnemonia

Wedge on xray

links?

TX?

Links: PE

TX:herapnin, stretokinease

Cavity formation on CXR

links:TB

TX:antitubucular drugs

(IREPTB)

CT or spiral CT (Computerized Tomography) purpose

1\.Diagnose PE

2\.Confirm Bronchiectasis (Signet ring)

another name for MRI and its purpose

another = ligaments

purpose: determines positions of soft tissues abnormailities

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what kind of tanks to be used in MRI

Aluminum tanks

V/Q scan

how does it work

scan for?

results appear ?

works by: inhalation of xenon gas

scan for:PE !

Results appear: normal ventilation with abnormal perfusion = PE (V/Q msimatch)