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RRT Review > Patient Assesment > Flashcards

Patient Assesment Flashcards

1
Q

What are the four critical life functions?

A

Ventilation
oxygenation
circulation
perfusion.

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2
Q

What is ventilation?

A

Been elation is moving air in and out of the lungs.

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3
Q

What is oxygenation?

A

Oxygenation is getting oxygen into the blood.

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4
Q

What is circulation?

A

Circulation is moving the blood through the body.

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5
Q

What is perfusion?

A

Perfusion is getting oxygen into the tissue.

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6
Q

What assessments will determine how well a patient is ventilating, six things

A

Respiratory rate
tidal volume 
chest movement
breath sounds
PaCO2
EtCO2

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7
Q

How would the therapist determine if a patient has a problem with oxygenation?

A

Heart rate
color
sensorium
PaO2
SPO2

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8
Q

How do we measure circulation what are the three vital signs?

A

Heart rate
strength
cardiac output

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9
Q

How do we measure perfusion, what are the five vital signs?

A

Blood pressure
sensorium
temperature
urine output
hemodynamics dynamics

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10
Q

When you have an emergency what are the four priorities list them in order?

A

First priority ventilation
oxygenation
circulation
perfusion

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11
Q

What is the most common problem out of the four life functions?

A

Oxygenation

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12
Q

Patient chart review
What are the five things needed and patience admission notes?

A

Admitting diagnosis
history of present illness
chief complaints
past medical history
current medical history

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13
Q

Patient chart review
What are signs?

A

objective information, Things you can see or measure (example color cause edema blood pressure etc.)

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14
Q

Patient chart review
What are symptoms give some example?

A

Subjective information things the patient must tell you (example dyspnea nausea muscle weakness)

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15
Q

What are the nine things included in patient chart review?

A

Admission notes 
signs and symptoms
occupation employment history or hobbies
allergies or allergic reaction
prior surgery Illness injury
vital signs
physical Examination
tobacco use
advance directive

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16
Q

Calculation for Pack yours ?

A

of packs/day x # of years smoked.

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17
Q

What is the definition for advance directive?

A

Set of instructions documenting what treatment a patient would want if he or she was unable to make medical decisions.

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18
Q

List and describe the four types of advance directives?

A

DNR do not resuscitate
DNI do not intubate
LivingWell
Durable power of attorney

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19
Q

What is a living will define it?

A

Describes treatment patient would want if he or she became Terminally ill.

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20
Q

What are the four things that have to be included in a Respiratory order?

A

Type of treatment
frequency
medicadosage
physician signature

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21
Q

What are the four type patient laboratory reports?

A

ABG
Pulmonary function testing
imaging reports
basic lab assessments

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22
Q

What is normal urine output?

A

40 mL per hour approximately 1 L per day

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23
Q

What is sensible water loss?

A

Urine 
vomiting

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24
Q

What is insensible water loss?

A

Lungs and skin

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25
Q

What findings might indicate that patient’s food intake has exceeded his urine output?

A

Weight gain
Electrolyte imbalance
increased hemodynamic pressure decrease lung compliance (stiff Lung)

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26
Q

What is normal Central venous pressure (CVP)

A

2-6 mm Hg

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27
Q

What does decrease central venous pressure CVP indicate?

A

Hypovolemia (recommended fluid therapy)

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28
Q

Changes in Value you can indicate hypovolemia?

A

Increase CVP recommended fluid therapy

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29
Q

 what are the six activities of daily living ADL

A

Dating
eating
dressing
toilet use
transferring
urine and bowl continents

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30
Q

ADL are evaluating using what system?

A

Katz scoring system

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31
Q

Orthopnea

A

Difficulty breathing except in a preposition example CHF

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32
Q

General malaise

A

Rundown feeling, nausea, weakness, fatigue, headache, example (electrolyte in balance)

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33
Q

Dyspnea

A

SOB, difficulty breathing

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34
Q

Dysphagia

A

Difficulty swallowing and hoarseness

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35
Q

What are the four factors to consider when conducting a patient interview?

A
  1. Asking open ended question
  2. Communicate using simple language(Kiss method)
  3. Utilize picture, diagram
  4. Begin to identify patient major problems
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36
Q

Define patient learning Needs?

A

1. Process of influencing patient behavior and producing the change and knowledge attitude and skills necessary to maintain or improve Health.
2. Assessment of patient and family learning needs to determine what learning needs to occur and how the learning can best occur.

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37
Q

What criteria is a patient’s ability to learn based on?

A
  1. cultural and religious value
  2. Emotional barriers
  3. Desire and motivation to learn
  4. Physical and cognitive limitations
  5. Language barriers
  6. age and educational level
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38
Q

What criteria is a patient’s nutritional status based on?

A

1. usual food intake
2. Food likes and dislikes
3. Appetite

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39
Q

Peripheral edema And pathology associated with and recommend a therapy?

A

Excess fluid and tissue mostly in arms and ankles
Pathology CHF
Recommended Therapy diuretics

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40
Q

Ascities Definition?
Pathology associated with it?

A

Accumulation of fluid an abdomen
Liver failure

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41
Q

Clubbing and pathology associated with it?

A

Angle of fingers and nail beds increased
Pathology chronic hypoxemia, suggesting pulmonary disease

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42
Q

venous distention pathology associated with it?

A

CHF, Syndrome exhalation in patient with obstructive lung disease

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43
Q

Capillary refill?

A

Indication of peripheral circulation

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44
Q

Diaphoresis and pathology associated with it?

A

Heavy sweating
Pathology,
heart failure, Fever infection

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45
Q

Ashen, Pallor indication?

A

Decrease in color, indicates anemia, blood loss

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46
Q

Erythema definition and indication?

A

Redness in skin
Indicates capillary congestion inflammation or infection

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47
Q

Cyanosis definition and indication?

A

Blue or blue gray and color indicates hypoxia reduced hemoglobin

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48
Q

Chess configuration
Kyphosis

A

Leaning forward, convex curvature

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49
Q

Scoliosis

A

Lean side to side, lateral Carracher of the spine

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50
Q

Barrel chest

A

Air trapped in lung for long period of time
COPD
Increase in AP diameter

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51
Q

Describe symmetrical chess movement

A

Bilateral equal chest rise and fall doing breathing

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52
Q

List five underlining pathologies that can contribute to a patient displaying asymmetrical chest movement

A

Post Long resection, post pneumonectomy

Atelectasis-Forward

Pneomthorax-Away

Flail chest-Paradoxical chess movement

Endotracheal tube insertion in right or left main stem bronchi


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53
Q

Eupnea

A

Normal respiratory rate, depth and Rhythm

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54
Q

Tachypnea

A

Increased respiratory rate greater than 20 breaths per minute
Condition
Hypoxia, fever, pain, CNS problem

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55
Q

Bradypnea

A

Decrease woke up breathing less than 12 breaths per minute
Condition
Sleep, drive, alcohol, metabolic disorder

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56
Q

Cheyenne-strokes 

A

Gradual increase then decrease of breathing with 60 seconds of apnea lasting 30 to 180 seconds
Condition
Increased intracranial pressure
Brainstem injury
Drug overdose

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57
Q

Kussmaul’s breathing

A

Increase respiratory rate and depth with a regular rhythm
Condition
Metabolic acidosis
Renal failure
Diabetic keto acidosis

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58
Q

What causes hypertrophy of the accessory muscles what type of patient might this be present in?

A

Increase in muscle size
COPD

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59
Q

Wasting away of muscle is also referred to as?

A

Atrophy
Cachexia

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60
Q

Describe the four neck pathologies the might complicate endotracheal intubation?

A

Short receding mandible
Enlarged tongue
Bulk neck
Limited range of motion of the neck

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61
Q

What is the normal range for a patient’s heart rate?

A

60 through 100 per minute

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62
Q

What times would be used to describe a heart rate of 160 per minute? What would this indicate? Recommendation?

A

Tachycardia
This would indicate
Hypoxemia, anxiety, stress
Recommendation
Oxygen therapy

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63
Q

What terms would be used to describe a pulse of 52 per minute? What would this indicate? Recommended therapy?

A

Bradycardias
Indicates
Heart failure, stroke, code/Emergency
Recommendation
Atropine

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64
Q

What is and what does paradoxical pulse/pulsus Paradoxus indicate?

A

Change in heart rate and blood pressure with every breath
Indicate
Severe air trapping,status asthmaticus, Tension pneumothorax, cardiac tamponade


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65
Q

Tracheal deviation pool to abnormal side(Towards pathology)?

A

A. Pulmonary atelectasis
B. Pulmonary fibrosis
C. Pneumonectomy
D. Diaphragmatic paralysis

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66
Q

Tracheal deviation push to normal side(Away from pathology)

A

A. massive plural effusion
B. Tension pneumothorax
C. Neck or thyroid tumor
D. Large mediastinal mass

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67
Q

What is tactile fremitus?

A

Vibration that has felt by the hand on the chest wall.

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68
Q

What is meant by tenderness?

A

Any place of body that has incision, chest tube, bruises, fractured bone, burns

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69
Q

What is meant by crepitus and what condition is associated with?

A

Bubble under skin
Indicates subcutaneous emphysema

70
Q

Define resonant?

A

Normal air filled long (Gives Hollow sound)

71
Q

Define flat?

A

Normal heard over sternum

72
Q

Define dull?

A

Hurd over fluid filled organ
Ex: Heart, liver
Or
Plural effusion, pneumonia

73
Q

Define tympanic?

A

Normally hurt over air filled stomach
Drums like sound
Indicates volume when heard over the lung

74
Q

Define hyperresonant

A

Booming sound
Pneumothorax
Emphysema

75
Q

What is the difference between vascular and adventitious breath sounds?

A

Vascular breath sounds: Normal breath sounds
Adventitious breath sounds: Abnormal breath sounds

76
Q

What is Kopany and what does it indicate?

A

Says E but sounds like A
Indicates consolidation

77
Q

What breath sounds would be expected in a patient with pulmonary edema?

A

CHF/pulmonary edema

78
Q

Grade one dyspnea?

A

Dyspnea occurs after unusual exertion

79
Q

Grade 2 dyspnea?

A

Breathless, after going uphill or stairs.

80
Q

Grade 3 dyspnea?

A

Dyspnea while walking and normal speed.

81
Q

Create four dyspnea?

A

Dyspnea slowly walking short distance.

82
Q

Grade 5 dyspnea?

A

Dyspnea at Rust, shaving dressing, etc.

83
Q

What is patience, ability to learn based on?

A

Cultural and religious values
Emotional barriers
Desire, motivation to learn
Physical and cognitive limitations
Language barriers
Age and education level

84
Q

What are the five preferred learning styles?

A

Visual
Auditory
Hands-on
Lecture
Discussion

85
Q

What are the four patient/family history?

A

History of present illness
Past medical history
Family history
Social history

86
Q

What does general appearance include in physical assessment of patient?

A

Age, height, weight, nourishment, etc.

87
Q

What are the two types of edema?

A

Peripheral edema, ascities

88
Q

How does peripheral edema present itself?

A

1 presence of excessive fluid in the tissue known as pitting edema
2 occurs primarily in arms and ankle
3 it is caused by either heart failure or renal failure
4 rated as +1 +2 +3

89
Q

What is the recommend therapy for peripheral edema?

A

Diuretic therapy

90
Q

What is ascites?

A

Accumulation of fluid in the abdomen generally caused by liver failure

91
Q

What causes clubbing of fingers?

A

Caused by chronic hypoxia. Presence suggest pulmonary disease.

92
Q

What causes jugular vein distention?

A

1 Venus distention
2 occurs with congestive heart failure
3 seen during exhalation in patients with obstructive lung disease

93
Q

What are the four reasons the patient will become diaphoretic

A

1 heart failure
2 fever infection
3 anxiety, nervousness
4 tuberculosis

94
Q

What is normal skin color?

A

Pink, tan, brown, black

95
Q

Well would cause a patient skin color to be abnormal?

A

Anemia or acute blood loss

96
Q

What causes a person skin color to become jaundice?

A

Increased bilirubin levels in blood and tissue

97
Q

What causes a person skin color to become Erythema?

A

Redness in the skin. Due to capillary congestion, inflammation or infection.

98
Q

What causes her skin color to become cyanosis?

A

Blue or blue gray appearance
Caused by hypoxia from increase amount of reduced hemoglobin

99
Q

What is practice Carinatum?

A

Anterior protrusion of the sternum

100
Q

What is pectus Excavatum?

A

Depression of part of or the entire sternum

101
Q

What is kyphosis?

A

Convex curvature of the spine (lean forward)

102
Q

What is scoliosis?

A

Lateral curvature of the spine (lean side to side like an S)

103
Q

What is Kyphoscoliosis and what does it cause?

A

Combination of kyphosis and scoliosis that causes a restrictive pattern(reduce lung volume)

104
Q

What is barrel chest, what causes it, and what does it do to the A-P diameter of the chest?

A

Resolved of air trapping in the lung for long period of time
Usually do too chronic obstructive pulmonary disease (COPD)
Increases A-P diameter

105
Q

What is symmetrical chest movement?

A

On both side of the chest, move and equal distance at the same time

106
Q

What is asymmetrical chest movement?

A

When the chest does not move at an equal distance at the same time

107
Q

What are the five things that might cause asymmetrical chest movement

A

1 post, lung resection, post pneumonectomy
2 atelectasis
3 pneumothorax
4 fail chest
5 endotracheal tube insertion in right or left main stem bronchi

108
Q

What is Eupnea breathing pattern?

A

Normal respiratory rate, depth and rhythm between 12 to 20

109
Q

What is Tachypnea breathing pattern?

A

Increase respiratory rate greater than 20 bpm

110
Q

What causes tachypnea?

A

Hypoxia, fever, pain, CNS problem

111
Q

What causes bradypnea(oligopnea)?

A

Decrease respiratory rate less than 12
Caused by sleep, drugs, alcohol, metabolic disorder

112
Q

Define apnea?

A

Stop breathing

113
Q

Define hyperpnea?
What are its causes?

A

Increase respiratory rate, increase depths with regular rhythm
Cause metabolic disorder/CNS disorder.

114
Q

Define CHEYNE – STOKES, and it causes?

A

Gradual increasing and decreasing rates and depth in a cycle lasting between 30 to 180 seconds with periods of apnea testing up to 60 seconds
Cause : increase cranial pressure, brain stem injury, drug overdose

115
Q

Define BIOT’s and cause?

A

Increase respiratory rate and depth with an irregular periods of apnea. Each bread has same depth.
Cause : CNS problems

116
Q

Define Kussmaul’s, cause?

A

Increase respiratory rate increase steps, irregular rhythm, breathing sounds labored
Cause : metabolic acidosis, renal failure, diabetic ketoacidosis.

117
Q

Define APNEUSTIC, and cause?

A

Prolong, gasping inspiration, followed by extremely short, insufficient expiration.
Cause : problem with respiratory center, trauma, or tumor.

118
Q

What are the three normal muscles of ventilation?

A

1 diaphragm
2 external intercoastal
3 exhalation is normally passive

119
Q

What are the accessory muscles of ventilation?

A

1 internal intercoastal,scalene, sternocleidomastoid, pectoralis major
2 abdominal muscle(oblique, rectus abdominis, etc.)

120
Q

Define hypertrophy?

A

Increase a muscle size occurs with COPD patients

121
Q

Define atrophy?

A

Muscle wasting

122
Q

What causes nasal?

A

Sign of respiratory distress and infants

123
Q

What does a dry or nonproductive cough indicate?

A

Tumor in the lungs

124
Q

What does a productive cough indicate?

A

Infection or chronic lung disease

125
Q

What are four external evidence of difficult airway?

A

1 short, receding, mandible
2 enlarged tongue(macroglossia)
3 bulk neck
4 limited range of motion of the neck

126
Q

What is normal heart rate?
What is tachycardia rate?
What is bradycardia rate?

A

Normal 60 to 100
Tachycardia greater than 100
Bradycardia less than 60

127
Q

What does tachycardia indicate and what is recommended therapy?

A

Indicates hypoxemia, anxiety, stress
Recommendation oxygen therapy

128
Q

What does bradycardia indicate What are our recommendations?

A

Indicate heart failure, shock, emergency
Recommendation atropine

129
Q

What is paradoxical pulse/pulsus paradoxus?

A

Pulse/blood pressure varies with respiration, may indicate severe air trapping(status, asthmatics, tension pneumothorax, cardiac tamponade.

130
Q

How do you determine tracheal position?

A

Palpation, place index finger in supra-sternal notch compare the space between the left clavicle and the left and border of the trachea.

131
Q

What causes trachea to pull to abnormal side(towards pathology)?

A

Pulmonary atelectasis
Pulmonary fibrosis
pneumonectomy
Diaphragmatic Paralysis

132
Q

What causes trachea to be pushed to normal side(away from pathology)?

A

Massive plural effusion
Tension thorax
Neck or thyroid tumor
Large medicinal mass

133
Q

Define tactile fremitus?

A

Vibration felt by hand on chest wall

134
Q

Vocal fremitus definition?

A

Voice vibration on the wall

135
Q

Plural rub frimitus ?

A

A grating sensation felt on chest wall due to roughened plural surfaces, rubbing together

136
Q

What is rhonchal fremitus (palpable Ronchi)?

A

Secretions in the airway

137
Q

What is crepitus and what does it indicate?

A

Crepitus is bubble or air under the skin that can be palpitated, indicates presence of subcutaneous emphysema.

138
Q

How is percussion performed?

A

Placing middle finger between two ribs and tapping middle finger first joint with the middle finger tip of your opposite hand.

139
Q

When is resonant heard doing percussion?

A

normal air filled lungs
Gives a hollow sound

140
Q

When is flat sound heard during percussion?

A

Over the sternum
muscle
areas of atelectasis

141
Q

When is a dull sound heard during percussion?

A

Normally heard over fluid filled organs such as heart or liver
Plural effusion
Pneumonia will also cause a thudding sound

142
Q

When is the tympanic sound heard during percussion?

A

Normally heard over airfield stomach
Don’t like sound and indicates increase the volume when heard over the lungs

143
Q

When a hyperresident sound heard during percussion?

A

Booming sound heard in areas of the line where there is
Pneumothorax
Emphysema

144
Q

What are normal breath sounds during auscultation?

A

Vesicular

145
Q

When are bronchial breath sounds heard drawing auscultation?

A

Heard over trachea or bronchi, over the lung periphery indicates lung consolidation.

146
Q

Define egophony?

A

Patient says E and it sounds like A
Indicates consolidation of lung tissue (pneumonia like condition).

147
Q

Course crackles indicates (Ronchi that clears with a cough)?

A

Large airway secretion
Recommendation suction patient or encourage cough

148
Q

Medium crackles indicate what and recommendation?

A

Middle airway secretion
Recommend bronchial hygiene

149
Q

Find crackles indicate what during auscultation ?

A

Fluid in the Avioli
Recommend oxygen
Positive pressure therapy
Positive inotropic agents
Diuretics

150
Q

Most common cause of wheezing and recommendation?

A

Caused by bronchial spasm
Recommended therapy bronco dilator therapy 

151
Q

Most common cause of stridor and specific treatments ?

A

Upper airway Obstruction
Treatment : Topical decongestant(recemic epinephrine)
Suctioning/bronchoscopy foreign body aspiration
Intubation for severe swelling and epiglottitis


152
Q

Superaglottic swelling?

A

Epiglottitis

153
Q

Subglottic swelling?

A

Croup, post extubation

154
Q

What is plural fiction rub, what is it associated with, and what are some recommendations for treatments?

A

Course grading, raspy or crunchy sound
Inflamed surface of vascular and partial pleural rubbing together
Associated with pleurisy, pulmonary infraction, cancer
Recommended treatment, steroid and antibiotics

155
Q

What is the first heart sound(s1) created by?

A

Closure of the material and tricuspid valve at the beginning of ventricular contraction

156
Q

When does the second heart sound(s2) occur?

A

Systole ends, ventricles, relax, and the pulmonic and aortic valves close

157
Q

What does S3 heart sound indicate?

A

Heart failure

158
Q

What does S4 heart sound indicate?

A

Uncontrolled hypertension or aortic stenosis

159
Q

What are heart murmur sounds caused by?

A

Turbulent blood flow
Heart valve defect
Congenital heart abnormalities

160
Q

What is bruits causes that sound?

A

Sound made in artery or vain When does Chloe becomes turbulent of flows at abnormal speed.

161
Q

What is normal blood pressure?

A

120/80 mmHg

162
Q

Systolic blood pressure and acceptable range?

A

90 - 140

163
Q

What is diastolic acceptable blood pressure range?

A

60-90mmHg

164
Q

What does increased blood pressure indicate?

A

Cardiac stress-hypoxemia

165
Q

What does decreased blood pressure indicate?

A

Poor perfusion-hypovolemia, CHF

166
Q

Proper exposure of x-ray will show what?

A

Intervertebral disc space through the shadow of the mediastinum

167
Q

Under exposed x-ray image will?

A

Not allow visualization of the introvertebral disc through the heart shadow

168
Q

Overexposure x-ray will ?

A

Show black lung parenchyma without blood vessels

169
Q

When does the A-P diameter increase?

A

COPD
Barrel chest
Hyper inflation

170
Q

When is the costophrenic angle obliterated?

A

Plural effusion

171
Q

Crowding of ribs is associated with?

A

Atelectasis

RRT Review (1 decks)

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