RSP 119 Quiz #2 (Fall 2023)

Apnea

absence of breathing/no breathing

Cheyne-Stokes

abnormal breathing pattern characterized by normal breathing, rapid and deep breathing, then apnea; usually seen in patients who are declining (dying)

Purulent Sputum

pus filled sputum

Hyperoxemia

increased amount of oxygen in arterial blood

ABG

arterial blood gas; a test used to measure pH and O2 and CO2 in the blood (performed on radial artery)

Core Pulmonale

Right side heart failure

PaO2

Indicates how well oxygenated someone is

Indications for Increased Work of Breathing (WOB)

-Increased respiratory rate

-Change in tidal volume

-Accessory muscle use

CBC (Complete blood count)

A measurement of all the major blood elements including RBCs, WBCs, and platelets

Normal Hb (Hemoglobin)

12-16 g/dl

Low: anemia

High: polycythemia

Normal Na (Sodium) level

135-145 mEq/L

(Ion is controlled by the kidneys)

Hypernatremia

Elevated sodium levels; usually due to dehydration

Hypokalemia

Decreased levels of K; usually caused by metabolic alkalosis, renal loss, and vomiting

Creatinine

-Excreted by the kidneys; levels are used to evaluate kidney function

-Normal Range: 0.7-1.3 mg/dL

Normal BUN level

8-25 mg/dL

**(often combined with creatine to evaluate kidney function)**

Sputum C&S (culture and sensitivity)

Test used to determine whether an organism is gram+ or gram-; results then determine the proper antibiotics to be given (before results are obtained a broad spectrum antibiotic is administered)

Acid-Fast Testing

Used after a gram stain to detect acid-fast bacterium, usually TB

Electrolyte Disorders

These cause muscle weakness and have a profound impact on pulmonary function

ABG Values

PH

PaCo2

PaO2

HCO3-

BE

Sa02

Normal PaO2

80-100 mmHg

Normal temperature

98.6 F or 37 C

Febrile

fever

Afebrile

no fever

Hyperthermia

abnormally high body temperature

Hypothermia

abnormally low body temperature

Tachycardia

fast heart rate (greater than 100 bpm)

Bradycardia

slow heart rate (less than 60 bpm)

Normal Pulse

60-100 bpm

Normal Respirations (Adult)

12-20 breaths/min

Normal PulseOx

95-100%

Tachypnea

rapid, labored, breathing

Bradypnea

slow breathing

Dyspnea

difficulty breathing, subjective (varies patient to patient)

Pursed Lips

seen in patients with COPD will often exhale this way in order to keep airways open longer and allows the patient to push air out slowly; also due to anxiety

Hyperventilation

fast breathing

Hypoventilation

slow breathing; usually seen in drug overdose

Kussmaul's

rapid, deep, and fast breathing; often associated with diabetic patients experiencing DKA (diabetic ketoacidosis)

Normal Blood Pressure

120/80 mmHg

Systolic

heart is contracting, squeezing blood out of the ventricles

Diastolic

heart is relaxed (at rest), waiting to be filled with blood

Hypertension

high blood pressure; greater than 140/90 mmHg

Hypotension

low blood pressure; less than 95/60 mmHg

MAP

mean arterial pressure; will increase or decrease as BP increases or decreases

Sign

objective evidence of an illness (ex: you see a rash on someone)

Symptom

subjective perceptible change in the body or its function that indicates disease (ex: "My chest hurts")

The 5 Vital Signs

Blood Pressure

Body Temperature

Respirations

Heart Rate

Pulse Oximetry

Expectoration

coughing or spitting material out of the lungs

Sputum

material expelled from the lungs by coughing

Hypoxemia

deficient amount of oxygen in arterial blood

Paroxysmal Nocturnal Dyspnea

Periodic, nighttime, difficulty breathing; typically seen in asthma and CHF (congestive heart failure) patients; usually wake up between

1-3 am with shortness of breath

SOB

Abbreviation for shortness of breath

Hemoptysis

Coughing or spitting up blood; MUST be reported to the nurse and physician; patient needs a chest X-ray; may indicate lung cancer, TB, pneumonia, and for those with a tracheotomy tube it can indicate too much suctioning

Oriented x3

-Person: what's your name?

-Place: Do you know where you are?

-Time: What is the date?

Glasgow Coma Scale (GCS)

used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients, measured on a scale of 1-14

HEENT

-Head

-Ears

-Eyes

-Neck

-Throat

A-P Diameter

Anterior to posterior chest diameter. Increased diameter = Barrel Chest, seen in COPD patients

Peripheral Edema

Swelling in the hands and feet that indicates poor perfusion (bad vascular perfusion)

JVD (jugular vein distention)

When veins buldge out of the neck while the patient is sitting up; indicates right side heart failure

Accessory muscle use

-ex: pectoralis, SCM, scalene, internal and external intercostals

-indicates increased work of breathing, uses a lot of energy and O2

Clubbing

Misshapen nail beds caused by severe hypoxemia and seen in Cf patients

Tracheal Position

-should be midline and center

-will shift away from pneumothorax (collapsed left lung —> trachea shifts to the right)

Hyperresonance

Hollow sound heard during percussion of the chest that indicates COPD or emphysema

Dullness

Sound heard during percussion of the chest that indicates a tumor

Rhonci

-Def: low pitched, loose secretions moving through the airways

(Think: Thick sound of mucous like a milkshake)

Crackles/Rales

-Def: bubbling, crackling sounds

(Think: Rice Crispies: snap, crackle, pop)

Wheezes

-Musical sounds can be heard on both inspiration and expiration, indicates a narrowed airway

Stridor

-Upper airway obstruction, loud, high pitched sounds, emergent in nature

(Indicates air way is closing, may lead to intubation)

Tidal Volume (VT)

Volume of gas you breathe in with every breath; important especially when weening patients off of treatment; based on height and weight

PaCO2

Indicates how well a patient is ventilating; normal range is 35-45; chronically high in COPD patients

Normal Urine Output

30-100 mL/hr

Paradoxical breathing

Flail chest: the chest moves in on inspiration and out on respiration

Kyphosis

Concave curvature of the spine; hunchback

Scoliosis

lateral curvature of the spine that can impair the lungs

Kyphoscoliosis

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

Barrel Chest

increased AP diameter, often accompanies chronic COPD

Accessory Muscles

-scalene

-sternoclidalmastoid

-pectoralis muscles

Pectus Carinatum (pigeon breast)

Sternum protrudes forward

Pectus Excavatum (funnel chest)

Sternum is depressed inward

Normal breath sounds

vesicular, bronchovesicular, bronchial

4 critical life functions

Ventilation: air in and out of the lungs

Oxygenation: getting oxygen into the blood

Circulation: moving the blood through the body

Perfusion: getting blood and oxygen into the tissues

Confused

Incoherent thoughts

Delirious

Agitated, hallucinations

Lethargic

Sleepy, arouses easily

Obtunded

Awakens with difficulty

Stuporous

Does not awaken, responds to painful stimuli

Comatose

Unconscious, no response to stimuli

Normal RBC count

4-6 million

Polycythemia

Elevated RBC count normally seen in COPD and emphysema patients (accompanies an increased Hb and Hct count)

Anemia

Decreased RBC count; can be caused by blood loss, or Sickle Cell in African Americans

Normal WBC count

5,000-10,000

Leukocytosis

Elevated WBC count; usually indicates a bacterial infection (along with/ yellow/green mucus, fever, increased HR and RR)

Leukopenia

Decreased WBC count; usually indicates a viral infection

Types of WBCs

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

**(Remember: Never Let Monkeys Eat Bananas)**

Amount of O2 carried for every gram of Hb

1.34 ml

Normal Hct (Hematocrit)

40-50%

Low: anemia

high: polycythemia

Hemorrhage

excessive loss of blood

Threshold for Blood Transfusion

Hb is at or below 7 g/dL or Hct of 21%

Hyponatremia

Decreased Na level; usually due to diuretics, vomiting, diarrhea, fluid gain in CHF, and IV

Normal K (Potassium) level

3.5-4.5 mEq/L

(Important for acid base balance; also maintains the contractility of the heart)

Hyperkalemia

Elevated levels of K; usually caused by kidney failure