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Yr 2 - Renal > RRAPID > Flashcards

RRAPID Flashcards

1
Q

What is the ABCDE approach?

A 
Airway
Breathing
Circulation
Disability
Exposure
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2
Q

What should you look for in airway examination?

A
  • Chest movements
  • Accessory muscle use
  • Foreign body obstruction
  • Misting of oxygen mask
  • Is airway patent?
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3
Q

What should you listen for in airway examination?

A
  • Abnormal breath sounds

- Absent breath sounds

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4
Q

What should you feel for in airway examination?

A

Airflow on inspiration and expiration

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5
Q

If patient’s airway is not clear due to relaxed tongue blocking, what manoeuvres can be done?

A

Head tilt/chin lift

Jaw thrust

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6
Q

Describe the head tilt/chin lift

A

Finger under chin and tilt head backwards to open airway

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7
Q

Describe the jaw thrust

A

Fingers underneath angle of jaw and pull up towards ceiling to pull tongue forward

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8
Q

What else may be needed if patient airway is not clear / not breathing?

A
  • Oxygen (15L/min via reservoir mask)
  • Suction
  • Remove foreign objects
  • Airway adjuncts
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9
Q

What airway adjuncts are used?

A
  • Nasopharyngeal tube

- Oropharyngeal tube

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10
Q

When would you use a naso tube over an oro one?

A
  • Naso tubes better tolerated

- If oro can’t be used due to oral traumas

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11
Q

How can a naso tube me measured?

A

When held against the side of the face, a correctly sized airway will extend from the tip of the nose to the tragus of the ear.

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12
Q

When are oro tubes used?

A

If patient is unconscious

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13
Q

How can an oro tube be measured?

A

Hold the airway beside the patient’s cheek with the flange at the corner of the mouth. The tip of an appropriately sized airway should just reach the angle of the mandibular ramus.

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14
Q

What should you look for in breath examination?

A
  • Respiratory rate
  • Depth and symmetry
  • Accessory muscle use (respiratory effort)
  • Sweating
  • Cyanosis (lips, under tongue)
  • Ability to clear secretion by coughing
  • Oxygen saturation
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15
Q

What is normal respiratory rate?

A

12-20 breaths per minute

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16
Q

What can asymmetrical expansion of chest suggest?

A

Pneumonia, a large pleural effusion, rib fracture, or pneumothorax.

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17
Q

What is normal oxygen saturation range?

A

95-100%

N.B. this is lower in COPD patients

Below 90% –> hypoxaemia
Below 80% –> chance of organ damage

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18
Q

What should you listen for in breathing examination?

A
  • Ability to talk in complete sentences
  • Coughing/noising breathing
  • Percussion
  • Chest auscultation
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19
Q

What is auscultation?

A

Listening to sounds from the heart, lungs, or other organs, typically with a stethoscope

Chest auscultation can assess airflow through trachea and bronchial tree

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20
Q

What are some upper airway noises?

A
  • Stridor
  • Snoring
  • Gurgling
  • Choking
  • Hoareness
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21
Q

What does stridor indicate?

A

Harsh/high pitched noise on inspiration suggesting obstruction

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22
Q

What does snoring indicate?

A

Partially occluded pharynx

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23
Q

What does gurgling indicate?

A

Secretions in the upper airway

24
Q

What does choking indicate?

A

Mechanical obstruction to the airway with reflexes present

25
Q

What does hoarseness indicate?

A

May be due to irritation or injury of the vocal cords

26
Q

What are some lower airway noises?

A
  • Wheeze
  • Bronchial breathing
  • Crackles
  • Absent breath sounds
27
Q

What do crackles indicate?

A

Fluid or pus in the lung space

Pneumonia, pulmonary oedema, COPD, lung infection, heart failure

28
Q

What can crackles be defined as?

A

Coarse or fine

29
Q

What can wheezes indicate?

A

Narrowing of the small airways

E.g. asthma

30
Q

What can bronchial breathing indicate?

A

Consolidated lung

31
Q

What is bronchial breathing?

A

Tubular, hollow sounds which are heard when auscultating over the large airways (e.g. second and third intercostal spaces). They will be louder and higher-pitched than vesicular breath sounds.

32
Q

What do absent breath sounds indicate?

A

Pleural effusion, collapsed lung, pneumothorax

Conditions that prevent airflow reaching parts of the lung

33
Q

What is normal sound of percussion over healthy lung?

A

Resonant note

34
Q

What does dull or flat sound over lung indicate?

A

Abnormal lung density

Atelectasis, tumour, pleural effusion, lobar pneumonia

35
Q

What does hyperresonant sound over lung indicate?

A

Too much air present in lung tissue

Emphysema, pneumothorax

36
Q

What should you feel for in breathing examination?

A
  • Deviation of trachea
  • Chest expansion
  • Percussion note
37
Q

What can tracheal deviation indicate?

A

Tension pneumothorax, swelling or internal bleeding

Get chest x-ray

38
Q

What is ABG (arterial blood gas)?

A

A blood test that measures the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery.

The test is used to check the function of the patient’s lungs and how well they are able to move oxygen into the blood and remove carbon dioxid

39
Q

When would ABG be taken?

A

If deemed necessary (if patient not very well)

40
Q

If patient is wheezing, what medication can be considered?

A

Nebulised salbutamol

41
Q

What should be investigated during circulation examination?

A
  • Capillary refill time
  • Pulse rate and character
  • Blood pressure
  • Jugular venous pressure
  • Skin turgor
  • Heart sounds
  • Lungs
  • Oedema (sacral/peripheral)
  • Urine output
  • Agitation / reduced consciousness
42
Q

What is normal capillary refill time?

A

Pinch finger, hold down for 5 seconds and should come back to normal in 2 seconds

43
Q

What is JVP?

A

Indirectly observed pressure over the venous system via visualisation of the internal jugular vein

44
Q

What is skin turgor?

A

Taken over clavicle or on back of hand

A decrease in skin turgor is indicated when the skin is pulled up for a few seconds and does not return to its original state. A decrease in skin turgor is a late sign of dehydration.

45
Q

What is peripheral oedema?

A

Oedema in lower legs

46
Q

What is sacral oedema?

A

Oedema accumulates in lower back

47
Q

What is response to circulatory problems?

A
  • Treat underlying problem
  • Blood tests / ECG
  • Fluid challenge
48
Q

What is the fluid challenge?

A

The rapid administration of a bolus of fluid in critically ill patients (usually crystalloids)

Monitor response - can boost blood pressure and increase urine output

49
Q

What is used to assess disability?

A

ACVPU - scale of how conscious patient is

A - Alert (do they remember name, why they’re in hospital)

C - Confusion

V - Voice (is patient responding to voice)

P - Pain (is patient responding to pain, eyebrow push)

U - Unresponsive (not responding to voice or pain)

50
Q

What is the Glasgow Coma Scale (GCS)?

A

Scoring system used to describe the level of consciousness in a person

51
Q

What else should be recognised in disability examination?

A

Pupillary response - size/reactive

Capillary blood glucose (may explain reduced level of consciousness, normal level between 4-7)

52
Q

What is response to low capillary glucose?

A

Give glucose if hypoglycaemic

53
Q

What should be recognised in disability examination?

A
  • Top to toe examination (injury, sources of infection)
  • Adequate exposure
  • Prevent cold / preserve dignity
  • Check temperature
54
Q

What should be followed during exposure examination?

A

BART

B - Bruising / bleeding
A - Abdominal examination
R - Rashes
T - Thrombus (DVT)

55
Q

After completing A-E, should should be done?

A

You will need to reassess patient to evaluate if patient has made clinical improvement (e.g. if giving O2 has brought oxygen saturation up)

56
Q

What is NEWS 2?

A

National early warning score which can indicate deterioration or improvement.

Higher score = sicker patient

57
Q

What is SBARR?

A

Structured way to hand over patients and give clear information to another member of staff.

S – Situation (who I am, where I am, what I think is wrong with patient)
B – Background (when they came in, situation over past couple of days/hours)
A – Assessment (what have I done since being there, results of my assessments)
R – Recommendation (mine) (what I think should be done)
R – Read back/review (get them to read back information to you to double check)

Yr 2 - Renal (16 decks)

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