311 FINAL EXAM Flashcards
What would cause a sputum specimen to be rejected as saliva?
Less than 25 pus cell or no pus cells and numerous epithelial cells
Expiratory Reserve Volume (ERV)
Maximum volume of additional air that can be expired from the end of a normal expiration
Tidal Volume (TV or VT)
Amount of gas inspired or expired with each breath
Inspiratory Reserve Volume (IRV)
Maximum amount of air that can be inspired from the end of a normal inspiration
Total Lung Capacity (TLC)
Volume of air contained in the lungs at the end of a maximal inspiration
*Sum of all 4 basic lung volumes
Residual Volume (RV)
Volume of air remaining in the lung after a maximal expiration
*Only volume that cannot be measured with Spirometry
Vital Capacity (VC)
Maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration
*Largest volume that can be measured with spirometry
Inspiratory Capacity (IC)
Maximum volume of air that can be inspired from end expiratory position
*Least clinical significance than other 3 capacities
Functional Residual Capacity (FRC)
Volume of air remaining in the lung at end of a normal expiration
How would a Pneumothorax appear on a chest radiograph?
Visceral pleural line may be present with an area without vascular markings outside the line. Pleural air will collect in the pleural space. It will appear as a rim of air (dark streak). Increased radiolucency or areas without any vascular markings, pulmonary vessels, bronchial markings, pulmonary parenchyma.
Tension Pneumothorax will have trachea and mediastinum shift away from affected lung.
If the endotracheal tube is inserted too far into the airway, where does it usually go?
Down into the right mainstem bronchi
Describe how a pleural effusion would appear on an CXR.
There will be blunting of the costophrenic angle(s). Small meniscus sign will be present-where fluid starts to track up the side of the chest wall.
Name the 3 things that must be observed to indicate the CXR is of good quality.
- Correct exposure conditions
- Correct positioning of the patient and the x-ray beam
- Adequate inspiratory effort
How do you know if your patient has taken a good breath when looking at a CXR?
By counting the ribs above the diaphragm. A good inspiratory effort will show at least 10 or sometimes 11 ribs above the level of the diaphragm
Name the indications and what can be assessed using a CXR.
- Outpatient indications are unexplained dyspnea, severe persistent cough, hemoptysis, fever, sputum production, acute severe chest pain, positive tuberculosis skin test.
- The inpatient indications are placement of endotracheal tube, placement of pulmonary artery catheter, placement of central venous pressure catheter, sudden onset of dyspnea or chest pain, sudden drop in Sp02 ,and elevated plateau pressure during mechanical ventilation.
Explain the significance of the Silhouette Sign.
This is used to determine the anterior or posterior position of an infiltrate based on the appearance of the heart
*Any infiltrate that obliterates the heart border must be located in the anterior segments
**Any infiltrate that appear to overlap the heart border on the film but do not affect its sharpness are located in posterior segments
Durable Power of Attorney for Healthcare.
Another kind of advanced directive. DPA states whom the patient has chosen to make healthcare decisions for them
Lack of visualization of the vertebral bodies through the heart shadow indicates what?
Inadequate exposure of the CXR
Kyphosis
Spinal deformity where the spine has an abnormal anteroposterior curvature
Scoliosis
Spinal deformity where the spine has a lateral curvature
Kyphoscoliosis
Combination of kyphosis and scoliosis
*Defect may cause severe restrictive lung defect as a result of poor lung expansion
Radiolucent
Less dense structures absorb fewer x-rays allowing more to reach and develop on film.
*Shows on a radiograph as Dark structures
Radiopaque
Structures that absorb virtually all of the x-rays appear lightest on a radiograph.
*Shows on a radiograph as Light structures
Pectus Excavatum
Depression of part or all of the sternum.
- “Funnel Chest”
Pectus Carinatum
Abnormal protrusion of the sternum
- “Pigeon Chest”
Retractions
Intermittent sinking inward of the skin over the chest wall during inspiration
Bronchial Breath Sounds
Heard when there is consolidation of lung tissue with bronchi that open into the consolidation, such as occurs with atelectasis and pneumonia
Coarse Crackles
These are associated with movement of secretions through the airways. Can be heard with inspiration and expiration, and often clear when the patient coughs
*Rhonci
Early Inspiratory Crackles
Caused by sudden opening of proximal bronchi
*Scanty, not affected by cough
**Bronchitis, emphysema, and asthma
Late Inspiratory Crackles
Caused by sudden opening of peripheral airways
*Diffuse, fine, occur initially in the dependent regions
**Atelectasis, pneumonia, pulmonary edema, CHF, and CF
Name the four radiographic densities.
- Bone
- Water
- Fat
- Air
Correct positioning of endotracheal tube is how far from the carina on a CXR?
4-6 cm above the carina
Living Will
A type of advanced directive. A written, legal document that describes the kind of medical treatments or life-sustaining treatments a patient would want if the were seriously or terminally ill.
Advanced Directive
Tells the doctor what kind of care the patient would like to have if they become unable to make medical decisions
Define HCT. What does it indicate?
High-resolution Computed Tomography
This is ideally suited for evaluating diffuse parenchymal lung disease like interstitial lung disease, emphysema, and bronchiectasis
Anemia
An abnormally low RBC count.
*Suggests that either RBC production by bone marrow is inadequate or excessive loss of blood has occured
**A decrease in RBC count, hemoglobin, and hematocrit
Polycythemia
An abnormally elevated RBC count.
*Occurs when bone marrow is stimulated to produce extra red blood cells in response to chronically low blood oxygen levels (chronic hypoxemia)
**An increase in RBC count, hemoglobin, and hematocrit
Normal Glucose levels in the blood
70-105 mg/dL
Normal White Blood Cell (WBC) count range
Between 4500- 11,500 mm^3
What tests are used to determine a patient’s blood clotting ability?
- Bleeding time-measures ability of small skin vessels to constrict and evaluates function of platelets
- Platelet count
- APTT- assesses predominantly the intrinsic system by measuring the length of time required for plasma to form fibrin clot once intrinsic pathway is activated
- Prothrombine time (PT)- provides additional information about clotting ability of blood
Sweat Chloride Test
Usually used with patients who have CF. These patients have increased levels of chloride in their sweat due to there inability to reabsorb it.
Dull/flat percussion note is found with what conditions?
Atelectasis, Pleural effusion, and can be heard on opposite side of a pneumothorax
Describe the conditions found with a hyperresonant percussion note.
Diseases that cause the patient to hyperinflated-emphysema, asthma, pneumothorax
Explain when tactile fremitus would be increased.
When consolidation is present in the lung
*Pneumonia, atelectasis, lung tumors and fibrosis
Apnea
Absence of spontaneous ventilation
Eupnea
Normal rate and depth of breathing
Bradypnea
Less than normal rate of breathing
Tachypnea
Rapid rate of breathing
Hypopnea
Decreased depth of breathing
Hyperpnea
Increased depth of breathing with or without increased rate
Sighing Respiration
Normal rate and depth of breathing with periodic deep and audible breaths
Intermittent Breathing
Irregular breathing with periods of apnea
Treopnea
Dyspnea in one lateral position but not in the other lateral position
Platypnea
Dyspnea caused by upright posture and relieved by a recumbent position
Orthodeoxia
Arterial oxygen desaturation (hypoxemia) that is produced by assuming an upright position and relieved by returning to a recumbent position
Air Hunger
A grave sign indicating the need for immediate trasnfusion
Biot’s Respiration
Episodes of rapid, uniformly deep inspirations, followed by long periods of apnea.
*Commonly seen in patients suffering from meningitis or increased intracranial pressure
Cheyne-Stokes Respiration
Irregular type of breathing: breaths increase and decrease in depth and rate with periods of apnea
*Some causes are diseases of the central nervous system or CHF
Kussmaul’s Respiration
Deep and fast respirations
*Seen with metabolic acidosis and also associated with diabetic acidosis
Apneustic Breathing
Prolonged inspiration
*Can be caused by brain damage
Paradoxical Respiration
Part or all of the chest wall moves in with inhalation and out with exhalation
*Causes are: diaphragm paralysis, chest trauma, muscle fatigue
Asthmatic Breathing
Prolonged expiration
*Caused by obstruction to airflow out of lungs