1. Increased airway resistance 2. Upper airway obstruction 3. Asthma and other chronic lung diseases 4. Decreased lung compliance 5. Pulmonary fibrosis 6. Pneumothorax 7. Pleural effusion 8. Abnormal chest wall 9. Anxiety state

Ch. 3: Assessment of the Cardiopulmonary Patient Flashcards by Asnathe .

Ch. 3: Assessment of the cardiopulmonary patient

A patient is experiencing cardiac dysrhythmias and muscle weakness. An arterial blood gas determines that the patient is in metabolic alkalosis. Which is the most appropriate value to assess at this this time?

Potassium

Hypokalemia can cause cardiac dysrhythmias and muscle weakness.

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Ch. 3: Assessment of the cardiopulmonary patient

The respiratory therapist is assessing a patient with severe emphysema and observes pedal edema, and jugular venous distention. The therapist and note in the patient’s chart that the signs are most likely the result of:

Right ventricular hypertrophy

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Ch. 3: Assessment of the cardiopulmonary patient

What elevated cardiac biomarker is associated with CHF?

BNP (>500pg/mL)

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Ch. 3: Assessment of the cardiopulmonary patient

A patient is suspected of suffering acute myocardial infarction. What lab value would you expect to be increased in the patient’s blood?

CK-MB

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Ch. 3: Assessment of the cardiopulmonary patient

What is nonproductive coughs caused by? (5)

Irritation of the airway
Acute inflammation of the respiratory mucosal membrane
Presence of a growth
Pleural irritation
Irritation of the tympanic membrane

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What does green foul smelling sputum indicate?

Psuedomonas infection

Commonly seen with bronchiectasis

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What does red sputum indicate?

Contains fresh blood

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What does brown sputum indicate?

Old blood

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What does yellow purulent sputum indicate?

Infection, contains WBCs

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What does white sputum indicate?

Normal mucus

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What does pink frothy sputum indicate?

Pulmonary edema

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The patient’s complaint of difficult or labored breathing

Dyspnea

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Croup or epiglottitis?

Bark-like cough usually indicates ___________.

Croup

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What oxygen delivery device is best suited for patients that are mouthbreathers?

Venturi

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Causes of dyspnea

Increased airway resistance
Upper airway obstruction
Asthma and other chronic lung diseases
Decreased lung compliance
Pulmonary fibrosis
Pneumothorax
Pleural effusion
Abnormal chest wall
Anxiety state

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Define orthopnea.

Dyspnea while laying down

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In what type of patients is orthopnea usually seen?

CHF, Emphysema

Usually see in patients with heart failure and is caused by increased congestion of the lungs while lying down.

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Define paroxysmal nocturnal dyspnea

Sudden onset of SOB after being in bed for several hours

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Where is paroxysmal nocturnal dyspnea typically seen?

Cardiac patients

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Massive hemoptysis is defined as _________ mL of blood-tinged sputum in 3 hours or ____________.

Massive hemoptysis is defined as 400 mL of blood-tinged sputum in 3 hours or as more than 600 mL in 24 hours.

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What are some causes of hemoptysis?

Pneumonia
TB
Bronchiectasis
Lung abscess
Fungal lung infection
Mitral valve stenosis
Trauma
Valvular heart diseases
Neoplasms
Pulmonary embolism

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Define eupnea.

Normal rate and depth of respirations

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Normal respiratory rate ranges

Adults: 12-30 breaths/min
Children: 15-25 breaths/min
Newborn: 35-45 breaths/min

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When may bradypnea be seen?

Respiratory center depression, like head trauma or drug overdose

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Cstat equation

VT/Pplat-PEEP

What x-ray view is used to identify free fluid in the chest (E.g: plueral effusion or blood)?

Lateral decubitus | Also helpful in determining the presence of a pneumothorax. ## Footnote Lay patient on the left, if a right pneumothorax is suspected.

True or false. There will be no tracheal shift if whatever is affecting the lung is **bilateral.**

True

What is the proper terminology for the following description and where is it commonly found? **Bat wings or or butterfly**

Kerley B lines Found in pulmonary edema (CHF)

What are known drugs for increasing cardiac output?

1. Digitalis 2. Digoxin

Define hypopnea.

Shallow respirations (about half of normal depth) with slower than normal respiration rate

In what type of patients is hypopnea known to be normal?

Well-conditioned athletes and is accompanied by a slow pulse rate.

Define hyperpnea

Deep, rapid and labored breathing

What is hyperpnea associated with?

Conditions where there is an inadequate O2 supply.

Where is Kussmual respiration usually seen?

Patients with severe metabolic ketoacidosis

Define Kussmual respiration.

Increased rate and depth of breathing

Irregular breathing pattern characterized by short periods of deep, consistent volumes with periods of apnea. Apnea period may last 10-30 seconds

Biots respiration

What is Biot respiration associated with?

Increased ICP and meningitis

# Identify the following breathing pattern Deep, rapid breathing followed by apnea. Breaths begin slowly and shallowly and gradually increase to above normal volume and rate and then gradually diminish in volume and rate followed by apnea. Apnea period may last 10-30 seconds

Cheyne-Stokes respiration

What is Cheyne-Stokes respiration associated with?

- Respiratory center depression caused by stroke or head injury - PNA in elderly - Drug overdose

An increased A-P diameter is called **barrel chest** and is indicative of what?

Chronic lung disease

Describe Mallampati.

1 is the best, you can see everything. 4 would be the most difficult to intubate, nothing can be seen.

What is digital clubbing the result of?

Chronic hypoxemia

The accumulation of fluid in the subcutaneous tissues of the ankles is called ______.

Pedal edema

What is the equation for the following? Minute Ventilation

VE = RR x VT

What is the equation for the following? Alveolar minute ventilation

VA = (VT - VD) x f

What is the equation for the following? Cdyn

Cdyn = VT/(PIP-PEEP)

What is central cyanosis?

It is present when the oral mucosa and trunk are cyanotic.

What is peripheral cyanosis?

Nail beds are cyanotic

Normal capillary refill time is less than ___________.

3 seconds

Backward curvature of the lumbar spine, resulting in a "swayback" appearance.

Lordosis

Also called pigeon breast and results in the forward projection of the xiphoid process and lower sternum.

Pectus carinatum

Also called funnel chest and results in a funnel shaped **depression** over the lower sternum.

Pectus excavatum

What causes the barrel chest appearance?

Air trapping and subsequent hyperinflation. Loss of lung elasticity causes the lungs to move more outward. Also the increase tone and development of the accessory muscles used during COPD breathing

Muscles normally used for ventilation are the diaphragm and external intercostals, but the diaphragm of COPD patients is flattened, so they use ____________________ during normal ventilation.

Accessory muscles

Vibrations felt on the chest wall as the patient speaks are called ____________________.

Tactile fremitus

When are tactile fremitus vibrations **decreased**?

- Pleural effusion - Fluid - Pneumothorax - Overly muscular or obese patients

When are tactile fremitus vibrations **increased**?

- Lung masses - Atelectasis - PNA

Palpating over subcutaneous air feelings like crackling under the skin and is referred to as what?

Crepitus

Tapping on the chest directly with one finger or indirectly by placing one finger on a chest area and tapping on that finger over different areas of the chest.

Percussion

A loud low-pitched sound of long duration that is produced over areas that contain greater proportion of air than tissue.

Hyperresonance

What are some examples of when you'd hear hyperresonance?

* Air-filled stomach * Emphysema * Pneumothorax

A low-pitched sound of long duration that is produced over areas with equal distribution of air and tissue.

Resonance Example: Normal lung tissue

A drumlike sound

Tymphany Example: Tension pneumothorax

# Auscultation of breath sounds If bronchial breath sounds are heard in other areas than the upper lung, what does it indicate?

Atelectasis or consolidation

# Adventitious breath sounds A bubbling or **crackling** sound that can be heard during inspiration or expiration and that is produced by air flowing through airways containing secretions of fluids.

Crackles

# Auscultation of breath sounds Where are early inspiratory crackles most commonly heard?

Patients with emphysema, chronic bronchitis or asthma

# Adventitous breath sounds When are late inspiratory crackles commonly (4)

* Pulmonary edema * Atelectasis * Pneumonia * Restrictive lung disorders such as pulmonary fibrosis

# Adventitous breath sounds Breath sounds with a musical quality that are produced as air flows through constricted airways

Wheezes

# **WHEEZING** Airways become constricted as a result of __________. (4)

* Bronchospasm * Mucosal edema * Excessive sputum * Presence of foreign bodies

# Adventitous breath sounds Used to describe low-pitched, continous abnormal lung sounds.

Rhonchi | Continous low-pitched coarse crackles is called rhonchi

# Adventitous breath sounds Most common during **inspiration** and produced as air passes through a narrowed upper airway structure such as the glottis.

Stridor

A clickling or grating sound caused by friction that is produced as the parietal and visceral pleura rub against each other during the breathing process.

Pleural friction rub

# Auscultation of heart sounds An abnormal sound heard over the heart, arteries, or veins that is caused by turbulent blood flow is called a __________.

Bruit | pg. 38

# Chest X-ray Interpretation Well-defined, solid-appearing lungs that appear light

Consolidation

# Chest X-ray Interpretation What is a common cause of consolidation?

Pneumonia

# Chest X-ray Interpretation White areas that indicate fluids and solids. (Also referred to as opacity)

Radiopaque

# Chest X-ray Interpretation Give an example of what would cause a radiopaque CXR image.

* Pleural effusion * Pneumonia

# Chest X-ray Interpretation Scattered or patchy white areas

Infiltrates | Caused by inflammatory proccesses that indicate atelectasis or disease

# Chest X-ray Interpretation Dark areas caused by the presence of air

Radiolucency | Hyperlucency = emphysema, asthma or subcutaneous emphysema

# Chest radiograph postions What is the most commonly used x-ray position?

P-A | Back to front!

# Chest X-ray Interpretation This postion is used for portable radiographs in intensive care areas.

A-P | Front to back ## Footnote The heart is more easily seen in this position.

# Chest X-ray Interpretation The image is obtained from the **side** with the patient upright while the X-ray passes through the chest **laterally**

Lateral

# Chest X-ray Interpretation What chest x-ray position allows for visualization of the lung parenchyma behind the heart and the bases of the lungs?

Lateral

# Chest X-ray Interpretation This image is obtained with the patient turned 45 degrees to either the right or left.

Oblique

# Chest X-ray Interpretation Which position is used to help diffrentiate a pulmonary or mediastinal lesion from structures that overlie it?

Oblique | Also used for V/Q scanning

# Chest X-ray Interpretation In an upright position, the patient leans back at a 45-degree angle.

Apical lordotic

# Chest X-ray Interpretation This position moves the shadow of the clavicles out the way for better visualization of the upper lobes of the lungs

Apical lordotic

# Chest X-ray Interpretation This image is obtained with the patient lying on his or her side with the film resting on the posterior surface of the chest.

Lateral decubitus

# Chest X-ray Interpretation Characteristics of an atelectasis X-ray.

* Appears lighter than normal tissue * Elevated diaphragm * Mediastinal shift towards affected side * Decreased volume * Increased density

# Chest X-ray Interpretation Pneumonia

* Appears white * Consolidation of the entire lobe or more may cause mediastinal shift toward affected side

# Chest X-ray Interpretation Pneumothorax

* **NO VASCULAR MAKINGS** * Very dark * Tracheal shift AWAY from affected side

# Endotracheal tube placement The tube should rest ____ above the carina.

2-5 cm

# Endotracheal tube placement On an inspiratory film, the carina is located at the level of the ______ rib.

4th

# Diaphragm Appears white on an x-ray film at the level of the ____ during maximal inspiration.

10th

# Diaphragm The dome of the **right** hemidiaphragm is normally 1-2 cm higher than the lefe because of the space needed for the ___.

Liver

# Diaphragm Elevation of one hemidiaphragm may be the result of ______.

Gas in the stomach or atelectasis

Normal heart rate in an adult

60-100 beats/min

Normal heart rate in a child

80-110 beats/min

What is paradoxical pulse?

A pulse that becomes weaker on inspiration. May be defined as a decrease in systolic pressure of more than 10 mm Hg during inspiration | If seen after chest truma or surgery, suggest cardiac tamponade.

What is pulsus alternans?

An alternating pattern of strong and weak pulses

Where is pulsus alternans commonly seen?

Patients with left ventricular failure and usually indicates PVCs.

The measurement of the pressure within the arterial system

Blood pressure

# **ADULTS** Normal blood pressure range

<120/80

_ is the pressure measured during ventricular contraction.

Systolic pressure

# Diastolic or systolic pressure? The most critical measurement because it is the lowest pressure that the heart and arterial system experience.

Diastolic

What are some factors that affect blood pressure?

* Blood volume * Blood viscosity * Heart's pumping action * Elasticity of blood vessels

Slightly higher temperature in children is normal as a result of ______.

Higher metabolic rate

Define afebrile.

Normal body temperature

Define febrile.

Person with a fever

What does the Glasscow Coma Scale help determine?

Neurological impairment | Less than 8, intubate

# Serum Electrolytes Normal sodium (Na+) range

135-145 mEq/L

An elevated BUN level is indicative of ______.

Renal (liver) failure

# Apnea Test - Just read. Blood gas values need to be normalized before the test. The patient is disconnected from vent and placed on 100% oxygen. | Spontaneous breathing, oxygenation and cardiac status are monitored.

MD will end the test when deterioration is observed or no breathing for **8-10 minutes.**

# APNEA TEST When is a postive apnea test indicated?

ABG values show that the PaCO2 has increased 20 torr above baseline level or reaches a level of 60 torr.

# Serum Electrolytes Normal potassium (K+) range

3.5 to 5.0 mEq/L | Potassium (K+) is the major intracellular cation.

# Serum Electrolytes Normal Chloride (CI-) range

98 to 107 mEq/L | Chloride (CI-) is the major anion in the body

# Serum Electrolytes What is the normal range for calcium (Ca)?

8.6 to 10.5 mmol/ dL

What are the muscles used for normal ventilation?

Diaphragm and external intercostals

JUST KNOW THAT **increased calcium** and **decreased potassium and sodium** can make weaning difficult due to causing muscle weakness!

You're going to pass :)

What is the normal BUN level?

8-23 mg/dL

When the kidneys fail to remove creatinine from the blood, the level increases, indicating what?

Renal (liver) failure

What is normal creatinine level?

0.7-1.3 mg/dL

Increased BUN and creatinine result in ____________ acidosis.

Metabolic

# [](http://) Normal glucose serum level

<100 mg/dL

Normal RBC levels

4 to 6 million/mm3 of blood

Normal Hemoglobin Levels

**Males:** 14.0-18.0 g/dL **Females:** 12-15 g/dL

Normal hematocrit (Hct) levels

**Males:** 40-54% **Females:** 35-49%

Normal level of WBCs

4500-11,500/mm3 of blood

Normal platelet count

150,000-400,000/mm3 | They're the smallest cells in the blood & are essential for clotting

Normal PT (prothrombin time)

11.0-12.5 seconds | Used to determine clotting ability

Normal partial thromboplastin time (PTT)

60-85 seconds | Used to determine clotting ability

What are the cardiac biomarkers? (3)

1. CK-MB 2. Myoglobin 3. Troponin

Normal Urine Output

30 to 40 mL/hour

What Glass Coma Scale numbers indicate moderate coma?

9-12

What Glass Coma Scale numbers does not require ICU admission?

12-15 | They higher the number, the BETTER!

What Glass Coma Scale numbers indicate severe coma?

8-9

# **Important note:** Remember than high FiO2 levels knocks out COPD respiratory drive

LPM should not exceed 4 if its not indicated by a low PaO2/SpO2

**Harsh and high-pitched** sound heard over the trachea. Expiration is slightly higher than inspiration

Tracheal breath sound

Ch. 3: Assessment of the Cardiopulmonary Patient Flashcards

(138 cards)