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Respiratory Care Seminar > Ch. 3 Assessment of The Pulmonary Patient > Flashcards

Ch. 3 Assessment of The Pulmonary Patient Flashcards

1
Q

A patient is experiencing cardiac arrhythmias and muscle weakness. An arterial blood glass determines that the patient is in a metabolic alkalosis. Which of the following is the most appropriate laboratory value to assist at this time?

A. WBC
B. BUN
C. Plasma protein
D. Potassium

A

Potassium

Hypokalemia can cause cardiac dysrhythmias and muscle weakness.

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2
Q

Term used to describe a condition in which a patient has difficulty breathing while in a supine position is which of the following?

A

Orthopnea

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3
Q

Patient enters the emergency department and on initial examination the respiratory therapist observed paradoxical chest movement. Which of the following should the therapist suspect?

A. Pulmonary edema
B. PNA
C. Flail chest
D. Pleural effusion

A

Flail chest

paradoxical chest movement occurs when the chest wall moves IN on inspiration and OUT on expiration. Commonly see in pts with chest trauma, flail chest, or paralysis of the diaphragm

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4
Q

Perfusion in the extremities is determined by which of the following methods?

A. obtaining ABG studies in determining PaO2 levels
B. assessing the patient’s SPO2
C. Assessing capillary refill
D. Palpating brachial pulse

A

Assessing capilary refill

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5
Q

While Palpating the Chest the respiratory therapist determined that there is decreased fremitus over the right lower lobe. This may be a result of which of the following?

  1. Pneumothorax
  2. Pleural effusion
  3. PNA

A. 1 only
B. 2 only
C. 1 and 2 only
D. 2 and 3 only

A

1 and 2 only

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6
Q

Chest x-ray film obtained after intubation shows that the tip of the ET tube is resting at the fourth rib. Which of the following action should be taken?

A. The Tube should be advanced 2 CM
B. Tube should be advancing to equal breath sounds are heard
C. The tube should remain at this level
D. Tube should be withdrawn 3 cm

A

The tube should be withdrawn 3 cm

The carina is located on a chest film at the level of the fourth rib. In this question, the tip of the tube is resting ON the carina. The tube needs to be withdrawn until the tip is resting 2 to 5 cm above the carina

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7
Q

The RT is reviewing the chart of patient suspected of having CHF. This condition would be best indicated with an elevation in which of the following cardiac biomarkers?
A. Troponin
B. Myoglobin
C. Creatine kinase (CK)
D. B-type natriuretic peptide (BNP)

A

B-type natriuretic peptode (BNP)

CHF is indicated if BNP increases above 500 pg/mL. (Myoglobin, CK, and tropnin are biomarkers that indicate ischemic myocardial damage)

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8
Q

A patient is suspected of suffering acute myocardial infarction. Which of the following Lab values will be increased the patient’s blood?

A. Hematocrit
B. CK-MB
C. BNP
D. Albunium

A

CK-MB

CK-MB is a heart-specific isoenzyme that is produced when myocardial damage has occurred

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9
Q

The RT Notes a RR of 36 breaths/min in an adult patient’s chart. The patient’s breathing pattern is best described by which of the following?

A. Hyperventilation
B. Dyspnea
C. Hypoventilation
D. Tachypnea

A

Tachypnea

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10
Q

The RT is assessing a patient with severe emphysema and observes pedal edema and JVD. The therapist should note in the patient’s chart that these are signs most likely the result of?

A. systemic hypertension
B. hypercapnia
C. Pulmonary infection
D. right ventricular hypertrophy

A

right ventricular hypertrophy

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11
Q

What does yellow sputum indicate?

A

infection (purulent sputum)

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12
Q

Green sputum

A

old retain secretions

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13
Q

Green and foul smelling indicates?

A

Pseudomonas infection (bronchietasis)

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14
Q

Brown sputum indicates

A

old blood
(Lung infection)

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15
Q

Red sputum indicates

A

fresh blood
(Hemoptysis: TB, Bronchietsis, lung abscess)

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16
Q

Pinky frothy sputum indicates

A

pulmonary edema (CHF)

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17
Q

Causes of Dyspnea

A
  • 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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18
Q

Paroxsymal nocturnal dyspnea is a

A

sudden onset of breath after being in bed for several hours

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19
Q

Hemoptysis is ________ up blood from the respiratory tract

A

coughing

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20
Q

What is massive hemoptysis defined as?

A

400 mL of blood ting sputum in 3 hours or as more than 600 mL in 24 hours and is considered a life threatening event

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21
Q

Causes of hemoptysis?

A
  • PNA ( rarely on exam)
  • TB*
  • Bronchiectasis*
  • Lung abscess*
  • Fungal lung infection (histoplasmosis)
  • Neoplasms: bronchogeneic carcinoma
  • Pulmonary embolism
  • Valvular heart disease
  • Mitral valve diseases
  • Trauma (massive hemoptysis possible) *
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22
Q

The _______ wall is the most common source of chest pain

A

thoracic

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23
Q

The lung parenchyma is not sensistive to pain

A

Know

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24
Q

The parietal pleura (layer lining the chest wall) is very sensistive to pain is usually the source of pain associated with (3)

A
  • pneumonias
  • pleurisy
  • other inflammatory disease
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25
Q

Eupnea is the

A

normal rate and depth of respirations

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26
Q

Bradypnea is

A

less than the normal RR

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27
Q

Apnea is the

A

asbsence of breathing

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28
Q

Tachypnea is

A

faster than normal RR but with normal depth of breath

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29
Q

Hypopnea is

A

shallow respirations (about half of the normal depth)

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30
Q

Hyperpnea is

A

deep and rapid and labored breathing

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31
Q

Kusssmaul respiration is

A

increased rate and depth of breathing (metabolic acidosis)

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32
Q

Irregular breathing pattern charterized by short periods of deep, consistent volumes with periods of apnea and is associated w/ elevated ICP or meningitis

A

Biots

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33
Q

Deep, rapid breathing followed by apnea and associated with stroke, or head injury, PNA in elderly, CHF, or drug overdose

A

Cheyenne-Stokes respiration

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34
Q

Unequal expansion may indicate: (4)

A
  1. Atelectasis
  2. Pnemothorax
  3. Chest deformities
  4. Flail Chest
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35
Q

What is paradoxical respirations?

A

When the chest moves in on inspiration and out on expiration

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36
Q

Flail chest is the result of (3)

A
  • chest trauma
  • fractured sternum
  • fractured ribs
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37
Q

An increased A-P diameter is called a ________ ________ and is indictive of chronic lung disease

A

barrel chest

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38
Q

Pedal edema refers to

A

an accumlation of fluid in the subcutaneous tissues of the ankles

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39
Q

Cyanosis is refered to as the

A

bluish discoloration of the skin and nail beds resulting from a 5 g/dL decrease in oxygenated hemoglobin (Hb)

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40
Q

This is present when the oral mucosa and trunk are cyanotic and indicates inadequate tissue oxygenation. This is defined as

A

Central cyanosis

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41
Q

Peripheral cyanosis (acrocyanosis) is present when the

A

nail beds are cyanotic and may indicate poor perfusion caused by a decreased CO, hypotension, or cold temperature

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42
Q

Perfusion to the extremities may be determined by accessing capillary refill. This is performed by compressing the patient’s finger nail for a short time then releasing it and observing the time it takes for blood flow to return to the nail bed.

A

KNOW

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43
Q

How long is normal refill time?

A

< 3 seconds

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44
Q

Vibrations felt on the chest wall as the pt speaks are called

A

tactile fremitus

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45
Q

Vibrations (fremitus) are decreased over (5)

A
  • pleural effusions
  • fluid
  • pneumothorax
  • overly muscular
  • obese pts
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46
Q

Vibrations (fremitus) are increased over (3)

A
  • atelectasis
  • PNA
  • lung masses
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47
Q

Palpating over subcutaneous air feels like crackling under the skin , which is referred to as

A

crepitus

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48
Q

What side does the trachea shift to with a pneumothorax?

A

Away or left from the affected aside (opposite of pneumothorax; PUSH)

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49
Q

What side does the trachea shift to with atelectasis?

A

Towards or right the affected side (same side as atelectasis; PULL)

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50
Q

Hyperresonance is a LOUD low-pitch sound of long duration that is produced over areas that contain a greater proportion of AIR than tissue

A

KNOW

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51
Q

What are examples of hyperresonance (4)

A
  • air-filled stomach
  • emphysema (air trapping)
  • pneumothorax
  • COPD
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52
Q

Resonance is a LOW pitched sound of long duration that is produced over areas w/ equal distrubution of air and tissue. NORMAL LUNG TISSUE

A

KNOW

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53
Q

_____________ is a sound of medium intensity and pitch of short duration that is produced over areas that contains a higher proportion of tissue or fluid than air

What are some Examples: (5)

A

Dullness

  • atelectaisis
  • consolidation
  • pleural effusion
  • pleural thickening
  • pulmonary edema
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54
Q

___________ is a sound of low amplitude and pitch that is produced over areas that contain a higher proportion of tissue than air.

What are some Examples:

A

Flatness

  • massive pleural effusion
  • massive atelectasis
  • pneumonectomy
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55
Q

Tympany is a ________ sound

What is an Example:

A

drum-like

Tension pneumothorax

56
Q

This is the most commonly used position for chest xray

A

Postero- anterior (P-A)

57
Q

This position is often used for portable radiographs in the ICU

A

A-P

58
Q

_________ image is obtained w/ the pt turned 45 degrees to either right and left

This position is also used for…

A

Oblique
v/q scanning

59
Q

___________ __________ image is obtained w/ pt lying on his or her side (side-lying position) w the film resting on the posterior surface of the chest

A

Lateral decubitus

60
Q

Lateral decubitus position is used to identify whether

A

free fluid (pleural effusion or blood) is present in the chest

61
Q

Chest radiographs are usually obtained w/ the pt at maximal inspiration, which should show the lungs well aerated and diaphragm descended to about the level of the tenth rib

A

KNOW

62
Q

ETT placement should rest about

A

2 to 5 cm above the carina

63
Q

On an inspiratory film the carina is located at the level of the

A

fouth rib or fourth thoracic vetebra

64
Q

How many ribs can be counted above the diaphragm to determine whether a maximal inspiration is present

A

10 ribs

65
Q

Patients with hyperinflanted lungs (COPD) have flattened diaphragms

A

KNOW

66
Q

Inadequate pumping action of the heart resulting from cor pulmonale, often seen in chronic lung disease, or left- sided heart failure (CHF)

A

Peripheral edema and venous engorgement

67
Q

Sodium (Na+) normal value

A

135 to 145 mEq/L

68
Q

Potassium (K+) normal values

A

3.5 to 5.0 mEq/L

69
Q

Chloride (CI-) normal value

A

98 to 107 mEq/ L

70
Q

Calcium (Ca) normal value range

A

8.6 to 10.5 mol/dL

71
Q

Blood Urea Nitrogen (BUN) normal value

A

8 to 23 mg dL

72
Q

An elevated BUN level is indictive of what ?

A

renal failure

73
Q

Creatinine normal values

A

0.7 to 1.3 mg/dL

74
Q

Glucose normal serum level

A

<100 mg/dL

75
Q

Elevated levels observed in diabetic ketoacidosis; patient compensates w/ alveolar hyperventilation (kussmaul respirations)

A

KNOW

76
Q

Red blood cells (RBC ) is also refered to as ________________, determines the adequacy of O2 transport

A

erythrocytes

77
Q

RBC normal level

A

4 to 6 million/mm3

78
Q

Hb normal level
Males
Females

A

14.0 to 18.0 g/dL in males

12 to 15 g/dL in females

79
Q

Hb is the portion of the RBCs that carries O2 so it is an indicator of the O2 carrying capacity of the blood

A

KNOW

80
Q

Hematocrit (Hct) normal levels
Males
Females

A

40% to 50% in males

35% to 49% in females

81
Q

The Hct is the percentage of the total….

A

blood volume that is RBCs

82
Q

White blood cells (WBCs) determines the presence or absence of _________. WBCs are also referred to as ___________

A

infection;
leukocytes

83
Q

WBCs normal levels

A

4500 to 11,500/mm3

84
Q

An elevated WBC indicates what?

A

infection

85
Q

Platelets normal level

A

150,000 to 400,000/mm3

86
Q

What are platelets essential for?

A

coagulation (clotting)

87
Q

Decreased platelet count may be the result of (2)

A
  • bone marrow diseases
  • disseminated intravascular coagulation (DIC)
88
Q

Prothrombin (PT) is a test to determine the…

A

clotting ability of the blood

89
Q

Normal PT is

A

11.0 to 12.5 seconds

90
Q

Partial thromboplastin time (PTT) normal value

A

60 to 85 seconds

91
Q

Pts w/ decreased platelet counts or increased PT or PTT are at increased risk of

A

hemorrhaging

92
Q

Chemicals such as creatine kinase (CK), myoglobin and troponin that appear in the blood as a result of

A

ischemic myocardial damage

93
Q

B-type natriuretic peptide (BNP) is a biomarker used to help diagnose

A

CHF

94
Q

A BNP level _______ indicates CHF

A

> 500 pg/mL

95
Q

When it comes to excessive muscle use in the COPD pts , what muscles are they referring to?

A
  • pectoralis
  • triclezius muscles
    (Tri-podding)
96
Q

What causes barrel chest?

A

Air-trapping

97
Q

Asymetrical
Example:

A

one side is not expanding like the other. Can be caused by PNA

98
Q

General malaise

A

A sense of being unwell, fatigue, weakness

99
Q

Dysphasia

A

difficulty speaking

100
Q

Dysphagia

A

difficulty swallowing

101
Q

What pt population deals with polycythemia

A

COPD (Emphysema)

102
Q

Atrophy (cachetic)

A

Muscles starts to deteriorate

103
Q

What disease process has cheynne-stokes breathing (3)

A
  • CHF
  • cerabral disorder
  • a bad case of PNA could lead to this
104
Q

Biots breathing happens due to

A

increased ICPs

105
Q

What is Somnolent and what can cause this?

A

Daytime sleepiness (can be caused be apnea during sleeping, or excessive CO2)

106
Q

Ashen or pallor color is a result from

A

Critical hypoxemic

107
Q

Diseases that could cause Hempotysis

A
  • TB
  • Bronchietasis
  • Lung abscess
108
Q

When it comes to excess use of muscles what do COPDers use (2)

A
  • Trapezius
  • Pectoralis major muscles
109
Q

Mallampati classification

A

requires visualization of the hypopharynx

110
Q

Mallampati Class 1

A

full visibility of tonsils, uvula, and soft palate

111
Q

Mallampati Class 2

A

Visibility of the hard and soft palates, upper part of the tonsils and uvula

112
Q

Mallampati Class 3

A

Soft and hard palates and base of uvula are visable

113
Q

Mallampati Class 4

A

Only the hard palate is visible

114
Q

Levels 3 and 4 you are required to do a fiberoptic bronchoscopy or a video assisst device (Gladascope)

A

KNOW

115
Q

Which one is more severe Bradycardia or Tachycardia?

A

Bradycardia

116
Q

What would cause an irregular pulse (threading pulse)?

A

Sever dehydration (imbalance of fluid)

117
Q

A pulse that becomes weaker on inspiration; it may be defined as a decrease in systolic pressure of more than 10 mm Hg during inspiration and may be seen in pts with….

A

Pulsus paradoxus
- severe COPD
- asthma
- pericarditis
- pulmonary embolism
-CHF
- cardiac tamponade

118
Q

Subcutaneous emphysema

A

Extra air in the plueral space (crepitus)

119
Q

Tracheal shifts towards the affective side in what diseases (4)

A

Atelectasis
- pulmonary fibrosis
- pnemonectiamie
- paralyzed diaghram

120
Q

What is egophony

A

“E” sounds like an “A”

121
Q

What diseases will cause an increased fremitus? (3)

A
  • Atelectasis
  • PNA
  • Lung mass
122
Q

What causes decrease fremitus?

A
  • pneumothorax
  • emphysema
  • plerual effusion
123
Q

If a question given talks about an “E” sounding like an “A” then what dieases is that ?

A

PNA b/c of consolidation

124
Q

If the E sound is decreased then it could be due to (3)

A
  • pneumothorax
  • emphysema
  • obstructive bronchi
125
Q

Rememeber crackles can respresent fluid or secretions

A

KNOW

126
Q

Coarse crackles is considered rhonci which indicates

A

excesive amount of secretions.

127
Q

Fine crackles is associated with

A

fluid; pulmonary edema or CHF

128
Q

What can you do to treat coarse crackles /rhonchi? (3)

A
  • suction
  • CPT
  • PEP
129
Q

What can you do with a pt who has fine crackles?

A
  • diuretics
  • pressure
  • oxygen
130
Q

Early Inspiratory crackles happens in what pt pop? (3)

A
  • Emphysema
  • Chronic Bronchitis
  • Asthma
131
Q

Late inspiratory crackles happens in (4)

A
  • pulmonary edema
  • Atelectaisis
  • PNA
  • Pulmonary fibrosis
132
Q

What causes stridor?

A
  • epiglottitis
  • foreign body aspiration
133
Q

Wheezing can be heard in asthma and foreign body obstruction

A

KNOW

134
Q

6 month- 3 years. Subglottic swelling, praying hands, steeple sign, cool mist, barky cough, parainfluzae virus, A-P neck film, Slow onset

A

croup

135
Q

2- 6 y/o. Supraglottic swelling, thumb sign, lateral neck xray, intubation or traching in OR, H influenzae type B, High fever, drooling, low pitched stridor , NO COUGH, rapid

A

epiglottitis

136
Q

CHF is directly related to BNP. If BNP is elevated >500 then the pt has CHF

A

KNOW

137
Q

Tracheal shifts away from the affected side in what diseases? (4)

A

Pneumothorax
- hemothorax
- massive pleural effusion
- Tumor (any large mass)

Respiratory Care Seminar (19 decks)

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