OXYGENATION Flashcards by Carl Laurenz GUINTO

[PHYSICAL EXAMINATION]
area: generalize
tongue: involved
hand: warm
clubbing: present
O2 application: pulmonary cause
application of warming: not improved
mechanism: diminution of oxygen saturation
crt: less than 2 seconds

CENTRAL CYANOSIS

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[PHYSICAL EXAMINATION]
area: localize
tongue: not involve
hand: cold
clubbing: not present
O2 application: not improved
application of warming: improved
mechanism: diminution of blood flow
crt: more than 2 seconds

PERIPHERAL CYANOSIS

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[ASSESSMENT FINDINGS]
- relaxed posture
- normal musculature
- rate 10-18 breaths per minute, regular
- no cyanosis or pallor
-anteroposterior diameter less than transverse diameter

INSPECTION

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[ASSESSMENT FINDINGS]
- symmetric chest expansion
- tactile fremitus present and equal bilaterally

PALPATION

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[ASSESSMENT FINDINGS]
- resonant

PERCUSSION

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[ASSESSMENT FINDINGS]
- vesicular over peripheral fields
- bronchovesicular over sternum and between scapulae
- infant & child: bronchovesicular
- no adventitious sounds

AUSCULTATION

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[NORMAL BREATH SOUNDS]
- soft
- low pitched
- over most lung fields
- inspiration > expiration

VESICULAR

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[NORMAL BREATH SOUNDS]
- medium pitched
- over main bronchus and right posterior lung
- inspiration > expiration

BRONCHOVESICULAR

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[NORMAL BREATH SOUNDS]
- loud
- high pitched
- over manubrium only
- expiration > inspiration (extended in asthma)

BRONCHIAL

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[NORMAL BREATH SOUNDS]
- very loud
- high pitched
- over trachea only
- inspiration > expiration

TRACHEAL

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[ADVENTITIOUS SOUNDS]
- discontinuous
- fine/medium/coarse
- not cleared by coughing
- heard more on inspiration
- heard in atelectasis

CRACKLES/RALES

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[ADVENTITIOUS SOUNDS]
- continuous
- foghorn
- low-pitched
- cleared on coughing

RHONCHI

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[ADVENTITIOUS SOUNDS]
- continuous
- tea kettle high pitch
- usually diffuse and bilateral
- heard diffusely in asthma
- unilateral: foreign body

WHEEZES

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[ADVENTITIOUS SOUNDS]
- pleural sound: leather rubbing together
- caused by inflamed pleura
- come and go depending on amount of fluid in pleural space

RUB

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acute or chronic
RESPIRATORY: bronchospasm, bronchitis, pneumonia, pulmonary embolism, pulmonary edema, pneumothorax, upper airway obstruction
CARDIOVASCULAR: acute myocardial infarction, congestive heart failure, cardiac tamponade, water bottle appearance on CXR

DYSPNEA

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treat the cause
oxygen
pulmonary rehabilitation
treat anxiety

DYSPNEA TREATMENT

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cough that last less than 3 weeks

ACUTE COUGH

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cough that last to 3-8 weeks

PERSISTENT COUGH

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cough that last greater than 8 weeks

CHRONIC COUGH

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CAUSES
- URI
- pneumonia
- aspiration
- pulmonary embolism
- pulmonary edema

FOR SMOKERS: usually low-grade chronic bronchitis
: increased intensity lung cancer

FOR NONSMOKERS:
- postnasal drip, asthma, GERD, or ACE inhibitors

COUGH

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care for underlying cause elimination of irritants

COUGH TREATMENT

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expectoration of blood originating below the vocal cords
usually comes from bronchial arteries

HEMOPTYSIS

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high-pitched whistling sound made while breathing
often associated with DOB
may occur during expiration or inspiration

WHEEZING

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occurs when blood flow to the heart is impaired, leading to oxygen deprivation in the heart muscle

CHEST PAIN: ANGINA

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Possible characteristics: PSCTF Pressure Squeezing Crushing Tearing Fullness S/S Tiredness SOB Light-headed

CHEST PAIN

[DIAGNOSTICS] - non invasive - shows how well the lungs are working - measure lung volume, capacity, rates of flow, and gas exchange - identifies obstructive vs restrictive

PULMONARY FUNCTION TEST (PFT)

[DIAGNOSTICS] - measurement of blood pH, arterial oxygen, and carbon dioxide tensions

ARTERIAL BLOOD GAS ANALYSIS (ABG)

[DIAGNOSTICS] - non invasive - monitor the oxygen saturation of hemoglobin (O2 Saturation)

PULSE OXIMETRY

[DIAGNOSTICS] - involves a sample of sputum to diagnose respiratory disease, identify organism and abnormal cells

SPUTUM ANALYSIS

SPUTUM CULTURE - expectorated from the trachea, bronchi, and/or lungs through the mouth

SPUTUM

SPUTUM CULTURE - suctioned sputum from an endotracheal or tracheostomy tube

ENDOTRACHEAL

SPUTUM CULTURE - wash collected from an area of the lung during a bronchoscopy

BRONCHOALVEOLAR LAVAGE

When to culture? - never, almost always viral

BRONCHITIS

When to culture? - must ask for different culture medium when suspecting anaerobes, atypicals, pertussis, fungi

PNEUMONIA

[STAINS] - too many squamous epithelial cells are indicative of oral mucosal contamination

GRAM STAIN

Gram stain: - indicative of infection

NUMEROUS NEUTROPHILS

Gram stain: - common in fungal, acid-fast, and other atypical bacterial infections

MACROPHAGES

Gram stain: - indicate allergic reaction or parasitic infection

EOSINOPHILS

Gram stain: - indicate direct attack (antibodies and lysosomes) of inhaled bacteria

MUCUS STRANDS

[STAINS] - special stain to look for Mycobacterium - low sensitivity, positive result = treatment

ACID FAST STAIN

[DIAGNOSTICS] - guided by bronchoscopy or CT - small pneumothorax always occurs as a result

LUNG BIOPSY

[DIAGNOSTICS] - is injected beneath the skin

TUBERCULIN SKIN TESTING

Mantoux tuberculin skin test (PPD) - will be negative but will stimulate memory T-cells

FIRST PPD

Mantoux tuberculin skin testing: - the results will be positive

SECOND PPD

[IMAGING STUDIES] - indications: CXR abnormality, lung tumor, mediastinal mass, aortic injury When to use contrast: - not usually needed for pulmonary imaging

COMPUTED TOMOGRAPHY

[IMAGING STUDIES] - examines air flow and blood flow - less radiation than CT - involves inhalation and venous injection of a radiotracer - detects areas of the lung that are being perfused

VENTILATION-PERFUSION SCANS (VQ SCANS)

[IMAGING STUDIES] - can be diagnostic or therapeutic - drain is promptly removed if there is no purulent fluid draining - pleural fluid aspiration for obtaining a specimen

THORACENTESIS

[IMAGING STUDIES] - uses powerful magnetic fields and radio waves to create pictures of the chest - does not use radiation

MAGNETIC RESONANCE IMAGING

[IMAGING STUDIES] - uses x-rays to visualize how lungs are working - uses more radiation than a standard chest x-ray

CHEST FLOUROSCOPY

[IMAGING STUDIES] - used to look at the air passages with a small camera - used to determine location of pathologic lesions

BRONCHOSCOPY

- often used when referring to symptoms of an upper respiratory tract infection by nasal congestion, sore throat, and cough

VIRAL RHINITIS OR COMMON COLD

- referred to a febrile, infectious, acute inflammation of the mucus membrane of the nasal cavity

COLDS

- inflammation and irritation of the mucus membranes of the nose

RHINITIS

RHINITIS MEDICAL MANAGEMENT

- treatment of the cause = antibiotics - decongestant - antihistamine - severe: corticosteroids

- inflammation of sinuses

SINUSITIS

Sinusitis Medical Management

- anti microbial agent: amoxicillin - heated mist or saline irrigation

- inflammation of the sinuses that persists for more than 8 weeks in adult - 2 weeks in children Clinical Manifestations: - facial pain - impaired mucocilliary clearance and ventilation - chronic hoarseness and cough - chronic headache

CHRONIC SINUSITIS

- sudden inflammation of the pharynx - febrile inflammation of throat - lasts up to 3 to 10 days Clinical Manifestations: - fiery red pharngeal membrane and tonsils - fever and malaise - sore throat, hoarseness and cough

ACUTE PHARYNGITIS

Acute Pharyngitis Medical Treatment

- antibiotics: cephalosporin - analgesic for severe sore and antitussive medicstions - nutritional: liquid/soft diet

- persistent inflammation of the pharynx - common in adults who work or live in dusty surrounding, use voice too much, suffer from chronic cough and habitually use alcohol and tobacco

CHRONIC PHARYNGITIS

- infection of tonsils Clinical Manifestations - sore throat, fever, snoring - difficulty of swallowing

TONSILLITIS

Tonsillitis Medical Management

- for recurrent tonsillitis: tonsillectomy - antimicrobial therapy: penicillin/7 days

- inflammation of larynx - often occur as a result of voice abuse or exposure to dust, chemicals, smoke, and other pollutants - cause of infection is almost viral

LARYNGITIS