311 FINAL EXAM Flashcards

1
Q

What would cause a sputum specimen to be rejected as saliva?

A

Less than 25 pus cell or no pus cells and numerous epithelial cells

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2
Q

Expiratory Reserve Volume (ERV)

A

Maximum volume of additional air that can be expired from the end of a normal expiration

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3
Q

Tidal Volume (TV or VT)

A

Amount of gas inspired or expired with each breath

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4
Q

Inspiratory Reserve Volume (IRV)

A

Maximum amount of air that can be inspired from the end of a normal inspiration

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5
Q

Total Lung Capacity (TLC)

A

Volume of air contained in the lungs at the end of a maximal inspiration

*Sum of all 4 basic lung volumes

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6
Q

Residual Volume (RV)

A

Volume of air remaining in the lung after a maximal expiration

*Only volume that cannot be measured with Spirometry

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7
Q

Vital Capacity (VC)

A

Maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration

*Largest volume that can be measured with spirometry

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8
Q

Inspiratory Capacity (IC)

A

Maximum volume of air that can be inspired from end expiratory position

*Least clinical significance than other 3 capacities

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9
Q

Functional Residual Capacity (FRC)

A

Volume of air remaining in the lung at end of a normal expiration

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10
Q

How would a Pneumothorax appear on a chest radiograph?

A

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.

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11
Q

If the endotracheal tube is inserted too far into the airway, where does it usually go?

A

Down into the right mainstem bronchi

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12
Q

Describe how a pleural effusion would appear on an CXR.

A

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.

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13
Q

Name the 3 things that must be observed to indicate the CXR is of good quality.

A
  1. Correct exposure conditions
  2. Correct positioning of the patient and the x-ray beam
  3. Adequate inspiratory effort
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14
Q

How do you know if your patient has taken a good breath when looking at a CXR?

A

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

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15
Q

Name the indications and what can be assessed using a CXR.

A
  • 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.
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16
Q

Explain the significance of the Silhouette Sign.

A

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

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17
Q

Durable Power of Attorney for Healthcare.

A

Another kind of advanced directive. DPA states whom the patient has chosen to make healthcare decisions for them

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18
Q

Lack of visualization of the vertebral bodies through the heart shadow indicates what?

A

Inadequate exposure of the CXR

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19
Q

Kyphosis

A

Spinal deformity where the spine has an abnormal anteroposterior curvature

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20
Q

Scoliosis

A

Spinal deformity where the spine has a lateral curvature

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21
Q

Kyphoscoliosis

A

Combination of kyphosis and scoliosis

*Defect may cause severe restrictive lung defect as a result of poor lung expansion

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22
Q

Radiolucent

A

Less dense structures absorb fewer x-rays allowing more to reach and develop on film.

*Shows on a radiograph as Dark structures

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23
Q

Radiopaque

A

Structures that absorb virtually all of the x-rays appear lightest on a radiograph.

*Shows on a radiograph as Light structures

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24
Q

Pectus Excavatum

A

Depression of part or all of the sternum.

  • “Funnel Chest”
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25
Q

Pectus Carinatum

A

Abnormal protrusion of the sternum

  • “Pigeon Chest”
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26
Q

Retractions

A

Intermittent sinking inward of the skin over the chest wall during inspiration

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27
Q

Bronchial Breath Sounds

A

Heard when there is consolidation of lung tissue with bronchi that open into the consolidation, such as occurs with atelectasis and pneumonia

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28
Q

Coarse Crackles

A

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

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29
Q

Early Inspiratory Crackles

A

Caused by sudden opening of proximal bronchi

*Scanty, not affected by cough

**Bronchitis, emphysema, and asthma

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30
Q

Late Inspiratory Crackles

A

Caused by sudden opening of peripheral airways

*Diffuse, fine, occur initially in the dependent regions

**Atelectasis, pneumonia, pulmonary edema, CHF, and CF

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31
Q

Name the four radiographic densities.

A
  1. Bone
  2. Water
  3. Fat
  4. Air
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32
Q

Correct positioning of endotracheal tube is how far from the carina on a CXR?

A

4-6 cm above the carina

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33
Q

Living Will

A

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.

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34
Q

Advanced Directive

A

Tells the doctor what kind of care the patient would like to have if they become unable to make medical decisions

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35
Q

Define HCT. What does it indicate?

A

High-resolution Computed Tomography

This is ideally suited for evaluating diffuse parenchymal lung disease like interstitial lung disease, emphysema, and bronchiectasis

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36
Q

Anemia

A

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

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37
Q

Polycythemia

A

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

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38
Q

Normal Glucose levels in the blood

A

70-105 mg/dL

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39
Q

Normal White Blood Cell (WBC) count range

A

Between 4500- 11,500 mm^3

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40
Q

What tests are used to determine a patient’s blood clotting ability?

A
  1. Bleeding time-measures ability of small skin vessels to constrict and evaluates function of platelets
  2. Platelet count
  3. APTT- assesses predominantly the intrinsic system by measuring the length of time required for plasma to form fibrin clot once intrinsic pathway is activated
  4. Prothrombine time (PT)- provides additional information about clotting ability of blood
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41
Q

Sweat Chloride Test

A

Usually used with patients who have CF. These patients have increased levels of chloride in their sweat due to there inability to reabsorb it.

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42
Q

Dull/flat percussion note is found with what conditions?

A

Atelectasis, Pleural effusion, and can be heard on opposite side of a pneumothorax

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43
Q

Describe the conditions found with a hyperresonant percussion note.

A

Diseases that cause the patient to hyperinflated-emphysema, asthma, pneumothorax

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44
Q

Explain when tactile fremitus would be increased.

A

When consolidation is present in the lung

*Pneumonia, atelectasis, lung tumors and fibrosis

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45
Q

Apnea

A

Absence of spontaneous ventilation

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46
Q

Eupnea

A

Normal rate and depth of breathing

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47
Q

Bradypnea

A

Less than normal rate of breathing

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48
Q

Tachypnea

A

Rapid rate of breathing

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49
Q

Hypopnea

A

Decreased depth of breathing

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50
Q

Hyperpnea

A

Increased depth of breathing with or without increased rate

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51
Q

Sighing Respiration

A

Normal rate and depth of breathing with periodic deep and audible breaths

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52
Q

Intermittent Breathing

A

Irregular breathing with periods of apnea

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53
Q

Treopnea

A

Dyspnea in one lateral position but not in the other lateral position

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54
Q

Platypnea

A

Dyspnea caused by upright posture and relieved by a recumbent position

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55
Q

Orthodeoxia

A

Arterial oxygen desaturation (hypoxemia) that is produced by assuming an upright position and relieved by returning to a recumbent position

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56
Q

Air Hunger

A

A grave sign indicating the need for immediate trasnfusion

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57
Q

Biot’s Respiration

A

Episodes of rapid, uniformly deep inspirations, followed by long periods of apnea.

*Commonly seen in patients suffering from meningitis or increased intracranial pressure

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58
Q

Cheyne-Stokes Respiration

A

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

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59
Q

Kussmaul’s Respiration

A

Deep and fast respirations

*Seen with metabolic acidosis and also associated with diabetic acidosis

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60
Q

Apneustic Breathing

A

Prolonged inspiration

*Can be caused by brain damage

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61
Q

Paradoxical Respiration

A

Part or all of the chest wall moves in with inhalation and out with exhalation

*Causes are: diaphragm paralysis, chest trauma, muscle fatigue

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62
Q

Asthmatic Breathing

A

Prolonged expiration

*Caused by obstruction to airflow out of lungs

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63
Q

Dyspnea

A

Shortness of breath or a difficulty of breathing in which the patient is aware

64
Q

Orthopnea

A

Condition in which the patient can only breath comfortably in the upright position

65
Q

Name the causes and in which direction of a tracheal/mediastinum shift

A

Atelectasis-trachea will shift TORWARD affected lung

Pleural effusion or pneumothorax-trachea will shift AWAY from affected lung

66
Q

Meaning of suffix -philia

A

Increase in

67
Q

Meaning of suffix -penia

A

Decrease in

68
Q

Another name for White Blood Cells

A

Leukocytes

69
Q

Eosinophils

A

Type of WBC usually elevated during an allergic reaction

70
Q

Neutrophils

A

Type of WBC usually elevated with bacterial pneumonia or stress on the body

71
Q

Lymphocytes

A

Type of WBC that is typically elevated with viral infections

72
Q

Name the tests used to measure Kidney (Renal) function.

A

BUN (Blood, Urea, Nitrogen) and Creatinine

73
Q

What causes polycythemia and what effect does it have on the heart?

A

It is caused by patients who chronic lung disease or who live in high altitudes that often experience chronic hypoxemia-which stimulates bone marrow to produce more RBCs

Effects on heart: More RBC increases the bloods viscosity, which increases the workload of the heart

74
Q

Name the problems associated with an AP film.

A
  • There may be poor x-ray exposure (overexposure or underexposure)
  • May not be taken when the patient is in full inspiration
  • Heart shadow appears larger than actual size due closer proximity to the source
75
Q

Test that would be BEST to evaluate the presence of a thromboebolism

A

CT Angiography

76
Q

PA Film View

A

Position : Posterioranterior (Back facing x-ray source)

Most accurate film obtainable from technical point of view

77
Q

Lateral Film View

A

Position: Patient is sideways, left lateral view is preferred- provides less cardiac magnification and a sharper view of the left lower lobe which is partially obscured on PA view by cardiac shadow

78
Q

AP Film View

A

Position: X-ray beam moves from front to back (anteroposterior)

79
Q

Oblique Film View

A

Position: Patient’s body is rotated so that it does not produce either AP/PA or lateral projection (45 degree angle)

*Views are helpful in delineating a pulmonary or mediastinal lesion from structures that overlie it on PA and lateral views

80
Q

Lateral Decubitus Film View

A

Position: Patient lying on right or left side to see whether free fluid is present in the chest

*Helps to diagnose a pleural effusion, if blood is present in pleural space, or pneumothorax because air rises and water falls

  • pneumothorax-lays down on opposite side of affected lung
  • pleural effusion-lays down on side of affected lung
81
Q

Expiratory Film

A

Can cause the heart to appear enlarged and peripheral markings to appear exaggerated.

*Used sometimes to detect a small pneumothorax or unilateral airway obstruction

82
Q

Apical Lordotic Film View

A

Position: Patient leaning back on to film

*Gives closer look at the right middle lobe or top (apical region)of lung.

83
Q

What is the distance between the x-ray sources and the film?

A

Patient should be positioned approximately 6 feet away from source for the conventional CXR examination

84
Q

Hoover’s Sign

A

Inward movement of the lower lateral margins of the chest wall with each inspiratory effort due to low, flat diaphragm as seen in emphysema

85
Q

Autonomy

A

Deals with the ability to govern one’s self.

*Exceptions include children and mentally incompetent

86
Q

Beneficence

A

Means to always do good for those we serve–our patients

87
Q

Confidentiality

A

Means that information entrusted to us in the line of duty should not be revealed to others except when necessary for us to carry out our duty

88
Q

Fidelity

A

An obligation, or faithfulness, to our duty

*Deals with loyalty

89
Q

Justice

A

States that everyone is entitled to equal care

90
Q

Nonmaleficence

A

Means NOT to inflict harm

91
Q

Sanctity of Life

A

Means that life has value and must be preserved

92
Q

Utilitarianism

A

Means that the greatest good should be done for the greatest number of people

93
Q

Veracity

A

Means honesty

  • Applies to the question whether to tell the truth or alter the truth when the fact may be harmful
  • -Ex: When family members request that their loved ones not be told the truth or if the physician decides not to be completely truthful with the patient.

**As an RT, defer questions to attending physician

94
Q

Paternilism

A

Means to protect someone from his or her own judgements

95
Q

Quality of Life

A

Implies that if there is no quality of life, then life is not worth living

96
Q

Reparation

A

Means there is an obligation to repair any harm caused to others either accidentally or intentionally

97
Q

Forced Vital Capacity (FVC)

A

Volume of air that can be maxiamally forcefully exhaled

98
Q

Forced Expiratory Volume (FEV1)

A

Volume of air that is forcefully exhaled in one second

99
Q

FEV1/FVC Ratio

A

Ratio of two values expressed as a percentage

100
Q

Vaules seen from PFT with Obstruction diseases:

A

FVC-Normal
FEV1-Decreased
FEV1/FVC-Decreased

101
Q

Values seen from PFT with Restrictive diseases:

A

FVC-Decreased
FEV1-Decreased
FEV1/FVC-Normal

102
Q

Values seen from PFT with Obstructive diseases with possible restriction:

A

FVC-Decreased
FEV1-Decreased
FEV1/FVC-Decreased

103
Q

What is the best indicator of an obstructive disease?

A

FEV1

104
Q

Explain how to perform auscultation.

A

Start at the bases and use systemic method.

Number of positions:
Front-6
Back-10
Sides-8

105
Q

Congestive Heart Failure CXR

A

Shows a redistribution of pulmonary vasculature to the upper lobes. Fluid collects in the dependent portions of the lungs.

106
Q

Cachetic

A

Physical wasting with loss of weight and muscle mass due to disease

107
Q

Debilitated

A

To impair the strength of (body debilitated by disease)

108
Q

Failure to Thrive

A

Refers to children whose current weight or rate of weight gain is significantly lower than that of other children

109
Q

Ethical Diversity: Females cannot be touched by males

A

Muslim

110
Q

Ethical Diversity: Name som examples of Folk Healers

A

Curanderos- used by latinos who use natural resources to try to heal one’s illnesses

Santeros-healers who will use the power of the “saint” and counsel the one that is sick until they’re relieved

111
Q

Ethical Divesity: The culture that believes an imbalance of life energy causes disease

A

Native Americans

112
Q

If your patient is suffering from hypokalemia, what test should you order for more information?

A

Blood chemistry tests-Electrolyte concentrations, as well as an ECG to see if the cardiac muscles are weakened

113
Q

If your patient presents with metabolic acidosis, what further test should you order?

A

Blood chemistry tests-Electrolyte concentrations

Test for total bicarbonate levels-this could be a sign that total carbon-dioxide level is increased

114
Q

What patient condition would indicae that a sputum culture and sensivity be ordered?

A

A patient who is suspected of having an infection in the lungs or airways to determine the specific microorganism causing the infection

115
Q

After a thoracentesis, what would you order for your patient?

A

A CXR as well as diagnostic sampling of pleural fluid for cell counts, cultures, chemistries, and cytologic examination

116
Q

Indications for Lateral neck x-ray

A

Croup or trauma to the neck. Used in assessing upper airway edema, especially in children

117
Q

Name the most common pleural abnormalities found on a CXR.

A

Alveolar infiltrates, Atelectasis, Interstitial infiltrates, and Silhouette findings

118
Q

Define Gram stain and why is it used?

A

It is a method of differencing bacterial species into two large groups depending on the chemical and physical properties of their cell walls. A gram stain is useful in determining the quality of a sample and the type of organism present.

119
Q

Name the serum electrolyte that is most important to monitor because of its affects on proper functioning of the nerves and heart.

A

Sodium

120
Q

MRI (Magnetic Resonance Imaging)

A

Imaging technique using magneic disturbance of tissue to obtain images.

*Most common uses in chest-mediastinum, large vessels in the lungs, and hilar regions of lungs

121
Q

CT (Computed Tomography)

A

Radiographic technique that produces a film that represents a detailed cross section of tissue structure

*Most common uses in chest-evaluate lung nodules and masses, great vessels of the chest, mediastinum, and pleural disease

122
Q

ECG (Echocardiography)

A

Diagnostic procedure for studying the structure and motion of the heart

123
Q

CT Angiography

A

X-ray visualization of the internal anatomy of the heart and blood vessels after the intravascular introduction of radiopaque contrast medium.

It has been used to detect pumlonary thromboemboli

124
Q

Lung V/P Scanning

A

Evaluates the circulation of air and blood within a patient’s lungs in order to determine ventilation/perfusion ratio. Ventilation test- looks at the ability of air to reach all parts of the lungs, while Perfusion test- evaluates how well blood circulates within the lungs

125
Q

Describe a CXR for Asthma

A

Intercostal difference will be increased bilaterally and unilaterally with a foreign body. If diaphram is flattened, could indicate obstructive lun disease.

126
Q

Describ CXR for Pneumonia

A

Increased radiopacity, air bronchograms may be present. Interstitial infiltrate, will have a honeycomb appearance. Will be diffuse in both lungs and heart border will not be seen.

127
Q

Describe CXR for Atelectasis

A

Excessive markings. Resultant volume loss. Trachea and mediastinum shift towards affected lung. Increased radiopacity, with possible elevation of hemidiaphragm. Absence of air bronchograms

128
Q

Describe CXR for Pulmonary Edema

A

Air bronchograms are often seen. Alveolar infiltrates. Fluid in lungs. Fluffy appearance. Ground glass appearance.

129
Q

AP and lateral neck x-rays are useful to determine what condition?

A

Croup and upper airway obstructions, especially in children. Can be used to assess subglottic stenosis and check proper placement of catheter, tubes and lines.

130
Q

What test is used to determine if a patient has an infection?

A

White Blood Cell Count

131
Q

What is the WBC range for patients with an infection?

A

Above 11,500

132
Q

What sign indicates that your patient has a history of COPD?

A

Early morning headaches-CO2 levels are high

These patients might present with barrel chest, cyanosis, pursed lip breathing, decreased thoracic expansion, increased resonance. Clubbed digits-but not caused solely by COPD

133
Q

What conditions have reduced pleural expansion? (bilateral and unilateral)

A

Bilateral: Kyphoscoliosis, neuromuscular disease, and COPD

Unilateral decrease in expansion occurs in conditions like: Lobar consolidation, atelectasis, pleural effusion and pneumothorax

134
Q

Signs and symptoms of an acute upper airway obstruction.

A

Depends on the causes of the attack they include: cyanosis, dyspnea, changes in consciousness, wheezing, stridor, and panic.

135
Q

List the conditions where you find pedal edema

A

Heart failure which causes increase in the hydrostatic pressure of the blood vessels in the lower extremities. Chronic hypoxemic lung disease leads to right sided heart failure. The failure of the rigt side of the heart leads to a backup of pressure into the venous blood vessels. This promotes high intravascular venous hydrostatic pressures and pedal edema.

135
Q

Values seen from Spirometry that would indicate a Restrictive disease:

A

Decreased VC

Decreased TLC, RV, FRC

136
Q

Values seen from Spirometry that would indicate an Obstructive disease:

A

Decreased VC

Increased TLC, RV, FRC

137
Q

Pulsus Alternans

A

Alternating of strong and weak pulses

138
Q

Pulsus Paridoxus

A

Significant decrease in pulse strength with spontaneous inspiration

139
Q

Name of study with predicted values for PFT testing.

A

NHANES III Study

140
Q

How many usable trials must be obtained during Spirometry?

A

3 trials must be usable

141
Q

Capitation

A

Set amount of money used to treat a patient

142
Q

Co-payment

A

Amount patient pays for treatment

143
Q

Fee-for-service

A

Predetermined amounts for procedures/treatments

144
Q

Reimbursement

A

Amount of money insurance pays for patient’s treatment

145
Q

Name the healthcare stakeholders.

A
  • Purchasers
  • Plans
  • Providers
  • Payers
  • Patients
146
Q

Name the functions of healthcare.

A
  • Financing
  • Insurance
  • Delivery
  • Payment
147
Q

When weaning a patient off a ventilator, what electrolyte needs monitoring and why?

A

Potassium—can cause the diaphragm to weaken

148
Q

Why must RTs document every procedure or treatment?

A

For reimbursement purposes. Insurance companies will try to get out of paying.

149
Q

Where should a Pulmonary Artery (Swan-Ganz) catheter be placed?

A

Right pulmonary artery

150
Q

What is caused by fluid overload?

A

Pedal edema and JVD

151
Q

Bronchial breath sounds

A

Heard over trachea

High and loud sounds

152
Q

Bronchovesicular Breath sounds

A

Heard over upper part of sternum

Moderate sound

153
Q

Vesicular Breath Sounds

A

Heard over peripheral lung areas

Low and soft

*normal

154
Q

Placement of Central Venous Pressure Line

A

The tip should be in the right atrium or superior vena cava

Should be medial to the first anterior rib or beyond