Ch 16 Bedside Assessment

Question 1

What are the 4 critical life functions?

Answer 1

1. Ventilation: open airways and breathe
2. Oxygenation: increase fio2
3. Circulation: chest compression, difibs drugs
4. Perfusion: increase blood pressure

Question 2

What to do if patient is diaphoretic after given treatment?

Answer 2

Stop and assess

Question 3

What are the definitions of signs and symptoms

Answer 3

Signs: objective info
Symptoms: the sensation or subjective experience of some aspect of an illness

Question 4

What are pack years?

Answer 4

of packs per day x the # of years smoked

Question 5

What is polycythemia?

Answer 5

An excess of hemoglobin characteristics of the COPD patients in response to chronic hypoxemia they have

Question 6

What is cachexia?

Answer 6

Patients are thin, “wasting away”, have general ill health are malnourished and weak

Question 7

What is jaundice and what does it indicate

Answer 7

Yellowing of the skin. Indicates liver failure, look at bilirubin lab

Question 8

What is erythema

Answer 8

Redness of skin

Question 9

Central cyanosis vs. peripheral cyanosis

Answer 9

Central cyanosis- cyanosis of the oral mucosa or trunk

Peripheral cyanosis- observed in the hands, fingertips and nail beds of hands and feet

Question 10

What is digital clubbing

Answer 10

Notice and inspect the angulation of your patients nail bed to assess hypoxemia

Rounded fingernails

Question 11

What is the main cause of hypoxemia

Answer 11

V/Q mismatch

Question 12

Normal values for SpO2, SaO2, PaO2

Answer 12

SpO2: 93-98%
SaO2: 95-100%
PaO2: 80-100 mmhg
60-79 mild hypoxemia
40-59 moderate
<40 severe

Question 13

What is ALOC and AMS

Answer 13

ALOC( altered level of consciousness)
AMS( altered mental status)
Both common descriptors to determine level of consciousness

Question 14

If any adverse reactions to medication, what should you do?

Answer 14

Stop treatment, assess patient and call the doctor with a recommendation for different treatment

Question 15

Is an interview with the patient considered part of the physical assessment?

Answer 15

No it’s not, it’s used to help determine their level of consciousness

Question 16

Orthopnea

Answer 16

Difficulty breathing except in upright position

Question 17

What is the common treatment for CHF

Answer 17

A diuretic like Lasix. You’ll hear fine crackles when auscultating

Question 18

When a patient is SOB, what should you not do

Answer 18

Assume it’s anxiety, find the cause of it

Question 19

What is phlegm

Answer 19

Mucus from tracheobronchial tree that is not contaminated by oral secretion

Question 20

What is sputum

Answer 20

Mucus from lower airways but is expectorated through the mouth

Question 21

Hemoptysis

Answer 21

Coughing up blood or bloody sputum from the lungs

Question 22

What are the 3 things in sputum analysis

Answer 22

1. Amount of sputum
2. Consistency
3. Color

Question 23

Fever( hyperthermia) aka febrile

Question 24

What is normal urine output

Answer 24

40 ml/hr approximately 1 liter/day

Question 25

Decreased CVP vs increased CVP

Answer 25

Decreased CVP: <2 mmhg indicates hypovolemia ( lack of fluid) Increase CVP: >6 mmhg indicates hypervolemia ( excess fluid)

Question 26

Normal heart rate

Answer 26

60-100 bpm Tachycardia- increased HR Bradycardia- decreased HR

Question 27

Normal respiratory rate

Answer 27

12-20 per min for adults Apnea- no respirations Tachypnea- RR greater than 20~ caused by fever, hypoxemia, metabolic acidosis Bradypnea- RR less than 12~ caused by traumatic brain, hypothermia, and meds

Question 28

What is orthostatic hypotension

Answer 28

Postural change which causes a quick decrease in blood pressure

Question 29

Blood pressure

Answer 29

120/80 with range of 140/90 to 90/60

Question 30

With tension pneumothorax, which way does the trachea shift

Answer 30

Shifts away from affected site

Question 31

With atelectasis, which way does the trachea shift

Answer 31

Shifts towards affected site

Question 32

What’s hyper resonant

Answer 32

Found in lungs where pneumothorax or emphysema is present

Question 33

Pleural effusion can be confirmed with CXR if what is present

Answer 33

Blunting of costophrenic angles

Question 34

What are the 4 steps in physical assessment

Answer 34

1. Inspection 2. Palpation 3. Percussion 4. Auscultation

Question 35

Increased resonance vs decreased resonance

Answer 35

Increased resonance: any disease process that has excess air Decreased resonance: any disease that has excess fluid and or lack of air

Question 36

Fine crackles

Answer 36

Sudden opening of small airways Treat with IPPB, diuretics and oxygen

Question 37

Coarse crackles aka rhonchi, rales

Answer 37

Large airways secretions and the patient needs suction

Question 38

Marked stridor

Answer 38

Upper airway obstruction Airway emergency, must intubate

Question 39

What are wheezes

Answer 39

Consistent with bronchospasm( bronchoconstriction)

Question 40

Diminished breath sounds

Answer 40

Occurs when sound transmission cannot occur due to loss of space where gas exchange occurs