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Flashcards in Clinical Skills Deck (138):
1

Target SaO2 for most people

94-98%

2

What clues might exist there is a respiratory complaint?

peak flows, inhalers, IV drips

3

Where can tar staining also be seen?

around the hair line - yellowing in fringe area

4

Signs of finger clubbing (5)

Change in nail bed angle
Nail bed feels boggy
Sharper angle with cuticle
Distal ends of fingers may appear enlarged or bulging
Nail curves downward

5

When asthma is considered severe, the PEFR is...

33-50%

6

What must you do before assembling and giving nebuliser?

the drug

7

polycythemic patients become cyanosed at ______ SaO2 because there is an increase in the level of the RBCs in the blood

higher

8

How can JVP be assessed if not visible using conventional method?

pressing in the RUQ to circulated more blood from liver

9

What should you ask the patient to do when auscultating?

breath deeply but at a rate normal for them, ask them to take deep breaths when they feel the stethoscope move

10

You take the average of PEFR - true or false?

False
Take the best of all three as given

11

FiO2 of Reservoir mask

60-80%

12

the nasal cannula prevents rebreathing of expired CO2?

true

13

Example of low pitched sound

bowel sounds
heart murmurs

14

When might a spacer be useful

when the patient technique is not great

15

When examining the posterior aspect of the chest for percussion and auscultation, what is best for the patient?

ask them to swing their legs round and sit over the side of the bed

16

Normal Pulse

60-100bpm

17

What does oedema in the legs potentially indicate?

DVT
Pulmonary hypertension/R. Ventricular failure

18

Second step when visiting patient

introduce self, check you have the right patient and confirm details, explain plan and gain consent

23

What does palpation involve?

feeling for the trachea in the neck - should be in the middle of the notch above the sternum
chest expansion

24

Normal SaO2 range for healthy individuals

94-100%

25

Where should you percuss and ascultate?

anteriorly, posteriorly and laterally

26

How loud are bronchovesicular breath sounds?

intermediate

27

When asthma is considered moderate, the PEFR is....

50-75%

28

When asthma is considered life-threatening, the PEFR is

<33%

30

Abnormal breath sounds are...

bronchial

31

How loud are bronchial breath sounds?

loud

32

Patients should bite down around the mouthpiece of their inhaler - true or false?

false
they should form seal with their lips and have the inhaler between their teeth

33

Moving on from hand exam what do you check?

pulse, resp rate, skin

34

bronchial breath sounds are

harsher than vesicular sounds

35

Example of high pitched sound

breath sounds
normal heart sounds

35

palmar erythema

redness of the thenar and hypothenar eminence

37

Location to palpate trachea

supra-sternal notch

39

What side of the bed should you approach the patient

The patients right

40

When asthma is considered mild, the PEFR is...

>75%

41

Diaphragm of the stethoscope is best for hearing _______ pitched sounds

high

41

How might you assess your patients ability to take part?

breathing ability, use of accessory muscles, NEWS, ability to speak in full sentences

42

vesicular breath sounds normally have a shorter expiration than inspiration - true or false?

true

43

Target SaO2 for people who are at risk of Type II respiratory failure

88-92%

45

How do you perform percussion?

left finger lying parallel to the ribs and in between the ribs - tap using middle right finger
need to press firmly into the chest

46

Tracheal breath sounds are?

very loud

47

What can give inaccurate results in SaO2 measurements? (4)

nail polish, strong ambient light, severe anemia, CO poisoning

50

Less common causes of finger clubbing (6)

coeliac
cirrhosis of liver
dysentery
graves disease
overactive thyroid
other cancers

51

Peripheral cyanosis can occur in isolation from central cyanosis - true or false?

true

52

situations where bronchial breath sounds might be heard?

collapse
consolidation
fibrosis

53

The reservoir mask can reach 100% oxygen delivery if used with high flow rates - true or false?

false

54

Type I Respiratory Failure

Low level of O2 without an increase in CO2
Pneumonia, ARDS

56

What should the patient do before taking the inhaler?

big breath out

57

Fine wrist tremor is indicative of...

b-agonist use such as salbutamol

58

Where must you inspect?

the axilla

59

common causes of cyanosis (3, 3;2)

lung diseases - COPD, pneumonia, pulmonary embolis
cardiac diseases - R-> L cardiac shunt
abnormal haemoglobin
methaemoglobinaemia
suflhaemoglobinaemia

60

How long should a patient extend their hands to indicate a tremor?

at least 10 seconds

61

Oxygen must be prescribed - true/false?

true

62

When might the trachea not be in the expected position?

where there is upper lobe pathology i.e. fibrosis, collapse or occasionally tension pneumothorax

63

How do you place your hands to check for chest expansion?

fingers splayed bringing chest towards midline. Have thumbs around the midline but allow them to move - look for equal movement of both thumbs

64

In anemic patients the SaO2 is higher before cyanosis occurs - true or false?

false
the SaO2 is lower because there is decreased levels of haemoglobin and thus longer before 5g/dL deoxyhaemoglobin

67

Tar staining is indicative of....

heavy smokers

69

Where would you hear stridor?

Inspiration

70

Pathologies associated with assymetry in chest expansion

Collapse
Consolidation
Pleural Effusion
Fibrosis

71

When asking patient to do peak flow, what should be checked?

whether the patient has done it before, what their previous best score is, whether the pointer is at 0

72

Signs that may indicate DVT?

calf hot, red with greater girth than the other leg

72

Instructions for PEFR to patient

Ask if they have done it before
If so, what is their best score
Take a deep breath in (as much as possible)
Seal lips around the tube
Blow out as hard and fast as they can
Repeat twice more
BEST of three

73

Steps in taking the inhaler

breath out
tight seal around inhaler
start to breath in and release medication
continue breath in slowly
hold breath for 10s

74

What sort of pulse might be felt in a patient who has used b2-agonists?

tachycardic which may be thready

75

Where should you start your percussion?

apex around the clavicle

76

Normal respiratory rate

12-18 breaths a minute

77

Indications of FiO2

Type II resp. failure and need for exact FiO2

78

Where might a pneumoectomy take place?

from behind in the lung

79

What sort of pulse and characteristics might be seen in a patient with CO2 retention?

bounding pulse and patient may appear drowsy

80

Simple Face Mask

5-10L/min

81

How should the patient be when listening to inspiration and expiration?

have their mouth open

82

Lymph nodes in the face and neck (8)

submental
submandibular
anterior and posterior triangle
pre and post auricle
occipital
supraclavicular

83

How should the patient be positioned if possible for PEFR?

standing

84

Where would you hear a wheeze in the respiratory cycle?

expiration

85

Flapping wrist tremor is indicative of...

CO2 retention

86

What does redness in the face and hands indicate in a respiratory setting?

CO2 retention

87

cyanosis is a ________ __________ of the skin due to __________ blood which typically occurs when the amount of deoxyhaemoglobin is (>)5g/dL and SaO2 is

bluish discolouration, deoxygenated blood, >, 85

87

What is sulfhaemoglobinaemia?

abnormal haemoglobin secondary to drugs i.e. sulfonamides

89

Indications of Simple Face Mask

Short term, low oxygen requirements

90

Why should you not worry about giving a COPD patient a reservoir mask in an acute situation?

not all COPD patients retain CO2 and hypoxia will kill before hypercapnia

91

How does a spacer such as an aerochamber help?

slows down rate of breathing in
can be used to have 2 or 3 normal breaths rather than one big breath

94

Why is it more difficult to examine chest expansion anteriorly on a female?

due to chest tissue - also applies to percussion

95

Indications for Reservoir mask

critical illness

96

Bell of the stethoscope is best for hearing _______ pitched sounds

low

96

What should the patient do when examining the supraclavicular lymph nodes?

tilt their head towards side being examined

97

How much fluid must be leaked before oedema becomes noticeable?

500ml

98

How do you assess JVP?

patient should be lying at 45 degree angle on bed and move their head to opposite side. Should be visible just superior to clavicle

98

FiO2 with simple face mask

variable

99

Nebulising canninster must remain....

upright

102

Ipratropium

medication that opens medium to large airways

104

liquid i.e. pleural effusion, sounds _______ on percussion

stony dull

106

How loud are vesicular sounds?

soft

107

4 aspects of chest examination

inspection
palpation
percussion
auscultation

108

Common causes of peripheral cyanosis in isolation

Reynauds phenomenom
Beta blockers
Reduced cardiac output due to HF or hypovolaemia
Venous obstruction i.e. DVT or obstruction to SVC

109

What do electric nebulisers use?

air

110

How can oedema be assessed?

an imprint may be left if pressed for 5secs - be gentle, as may be painful

111

Abnormal percussion over pneumothorax is...

hyper-resonant

112

Venturi Mask

Controlled oxygen delivery with exact percentage FiO2 delivered as stated on device

113

Upper lobe pathologies leading to tracheal dislocation

fibrosis
collapse
tension pneumothorax

114

How do you prepare a resevoir mask?

allow the bag to fill with air by pressing on the valve, empty the bag and allow to go again

115

plethora

redness in the cheeks

115

FiO2

Fraction of Inspired Oxygen

115

When giving any form of treatment or performing any test, you should...

ask permission
check for questions

116

Signs in general resp. exam in hands (5)

Finger Clubbing
Cyanosis
Palmer Erythema
Tar Staining
Tremor

116

Peak Flow is a good clinical assessment of...

Asthma

117

What should be removed before assessing SaO2?

nail polish

117

Type II Respiratory Failure

Causes a change in O2 and CO2 levels as a result of poor alveolar ventilation due to conditions such as COPD, ankylosing spondylitis

117

Indications of Nasal Cannula

Low oxygen requirements
Patient able to speak and eat freely

117

Typical nebulising drugs?

salbutamol
ipratropium

119

Where else might cyanosis be seen in the face?

under the tongue

119

oxygen cannot be prescribed retrospectively - true or false?

false - in emergency situations oxygen may be prescribed retrospectively

120

Normal breath sounds are...

vesicular

122

What may be noticeable on the skin and why?

thin or easily bruised skin
steroid use

123

Oxygen prescription should contain the following details (6)

patient name
DOB
Unique ID
Drug Name (oxygen)
Route of administration (inhaled)
the target

123

Where should a Peak flow meter tube be discarded?

Orange bin

124

What might a grey and breathless patient have?

anemia - they cannot get enough oxygen as not enough blood to carry oxygen

125

polycythemia

have increased levels of RBCs and a raised haematocrit of >55%
decrease in relative plasma volume or increase in RBC

127

solid material sounds ______ on percussion

dull

128

What should be checked in the face/neck? (5)

cyanosis
plethora
pallor of conjunctiva
pursed lip breathing
lymph nodes

128

Appropriate nebulising flow rate

6-8L/min

128

After checking PEFR what should you do? (3)

tell patient what you have found, check for questions, wash hands

128

How should you check for chest expansion?

grip both hands firmly around the lower rib cage with thumbs in the middle of the chest. Ask patient to breath in and out.
Ask the patient to take a large deep breath

128

Lung consolidation is when....

lung tissue is filled with liquid

129

Reduced breath sounds are common when?

there is damage to alveoli

130

Why might there be asymmetry in chest expansion?

collapse, consolidation, pleural effusion, fibrosis

131

Most common causes of finger clubbing (4, 3:3)

Lung Cancer
Congenital Heart Defects
Chronic Lung Infections
Bronchieotasis
cystic fibrosis
lung abscesses
Infectious endocarditis

131

What is methaemoglobinaemia?

abnormal haemoglobin due to genetic disorder or secondary to drugs i.e. quinones, sulfonamides

132

From what side is a physical examination done?

patients right hand side

132

Bronchial breath sounds have a shorter expiration than inspiration - true or false?

false they have longer expiratory sounds

133

When is PEFR normally lower?

in the morning

133

air filled tissue sounds _____ on percurssion i.e. pneumothorax

hyper-resonant

133

A good fit of nebuliser is important to...

ensure the drugs do not irritate the patients eyes

134

First thing to do when visiting a patient

WASH YOUR HANDS
ya wee dirty

134

FiO2 achieved with nasal cannula

24-50% (variable because of room air and pattern of breathing)

135

Inspection involves

looking around patient area
looking for chest shape and movement
looking for prominent veins
scars from chest drains or surgery

136

Nasal Cannula

2-5L/min - preferably not more than 4

136

Reservoir Mask

Used in critical illness - 15L/min

136

Ascultation is usually done with the bell - true or false?

false
usually with diaphragm

138

PEFR is a measurement of

how hard and fast a patient can exhale after a maximal inspiration