Patient Assessment Flashcards
(136 cards)
1
Q
What are the four life functions
A
Ventilation
Oxygenation
Circulation
Perfusion
2
Q
What is the best bedside assessment to tell if someone isnt oxygenating
A
Their heart rate increases
3
Q
What is the most common problem between the four life functions
A
Oxygenation
4
Q
What can low Urine (less that 40 mL per hour) output indicate
A
Poor perfusion
5
Q
What is sensible water loss
A
Water that can be measured, examples are urine and vomiting
6
Q
What is insensible water loss
A
Cannot be measured, water lost through sweating, lungs
7
Q
What will you observe if fluid intake exceeds fluid output
A
Weight gain, electrolyte imbalance, increased hemodynamic pressures, decreased lung compliance
8
Q
What do changes in the CVP indicate
A
Changes in fluid balance
9
Q
Decreased CVP indicates what? And how is it treated
A
Hypovolemia, treated with fluid therapy
10
Q
Increased CVP indicates what? How is it treated ?
A
Hypervolemia, treated with diuretics
11
Q
What should you associate CVP with
A
Fluid in body
12
Q
Orthopnea
What is it associated with?
A
Difficulty breathing except when in the upright position.
Associated with CHF
13
Q
General malaise
What is it associated with?
A
Run down, nausea, weakness, fatigue, headache
Associated with electrolyte imbalance
14
Q
Dyspnea? How are dyspnea grades measured
A
A feeling of shortness of breath or difficulty breathing.
Grade I - V the highest is V- dyspnea at rest.
15
Q
What kind of questions do you want to ask in a patient interview?
A
Open ended questions.
16
Q
What do you look at in a physical examination
A
General appearance, age, height, weight, nourishment
17
Q
Edema
A
Presence of excessive fluid in the tissue known as pitting edema.
18
Q
Peripheral edema ?
What is it associated with?
A
Swelling of the extremities, often seen in arms and ankles.
Associated with CHF and Renal Failure
19
Q
Ascites?
What is it associated with?
A
Swelling of the abdomen
Associated with liver failure
20
Q
What is clubbing of fingers and what is it associated with
A
Natural curvature of finger nails increases, making them appear large and round. It is due to chronic hypoxemia, usually COPD
21
Q
Venous distention is associated with
A
CHF
22
Q
What is capillary refill used for and how long should it take
A
Indication of peripheral circulation, it should take 3 seconds to come back
23
Q
How is ashen, or pallor described
A
Decrease in color, anemia. Acute blood loss
24
Q
Erythema
A
Redness of skin ]
25
Pectins carinatum
Anterior protrusion of the sternum
26
Precuts excaratum
Depression of the part of or the entire sternum
27
Kyphosis
Convex curvature of the spine (hunchback)
28
Scoliosis
Curvature of the spine, leans to one side
29
Cheyne-stokes breathing
| What is it associated with
-
30
Biots breating
| What is it associated with
-
31
Kussmauls breathing
| What is it associated with
-
32
Apneustic breathing
-
33
Hypopnea
-
34
What is wheezing associated with and how is it treated
Bronchospasm, treated with bronchodilator
35
Unilateral wheeze, how is it treated
Foreign body obstruction, assessed with rigid bronchoscopy.
36
Strider
Upper airway obstruction
37
Strider with supraglottic swelling.
| How to treat it ?
Epiglottitis, racemic epinephrine
38
Strider with subglottic swelling
| How is it treated?
Croup or post extubation. Treated with racemic epinephrine
39
How do you treat marked strider? And what is it?
It’s very severe strider, you intubate immediately
40
What is pleural friction rub? What is it associated with? How is it treated?
Course, grating, raspy, crunchy sound.
Associated with pleurisy, TB, pneumonia, pulmonary infarction, cancer, etc.
Treated with steroids, or antibiotics if infection is present
41
What do you recommend if you hear S3 and/or S4 heart sounds?
Recommend echocardiogram. (Ultrasound of heart)
42
What is the term for increased blood pressure?
What causes it?
How do you treat it ?
Hypertension
Cardiac stress
Give oxygen therapy
43
What is the term for decreased blood pressure?
What is it caused by?
How is it treated?
Hypovolemia
CHF
Fluids
44
When looking at an X-ray, what would crowding ribs indicate?
Atelectasis
45
When looking at an X-ray, what would straight or horizontal ribs indicate?
Air trapping
46
Describe lateral decubitus position in X-ray. What is it valuable for to detect?
Patient lies on the side of the pathology. It is good to use to detect a small pleural effusion because it will move with gravity
47
What does the apical lordotic detect?
T.B. Usually presents on top of the lungs
48
When would you use a lateral neck X-ray?
| How can you tell the difference between the two pathologies?
If croup or epiglottitis are suspected.
Croup= steeple sign/picket fence/pencil point
Epiglottitis= thumb sign. Epi= on top of vocal cords
49
What is hypertrophy and what is it associated with
An increase in muscle size . Associated with COPD
50
What is atrophy and what is it associated with
Muscle weakness
Paralysis
51
What are retractions associated with in both adults and and infants?
Airway obstruction in adults, respiratory distress in infants
52
Mallampati classification system. What does it indicate
A system used to identify how difficult an airway will be to intubate. Works in classes 1-4. Four being the most difficult to visualize. 1 being the best class for intubation. 1 sees all four landmarks.
53
What is the most important thing to palpate in an exam
Pulse.
54
What is indicative of an adverse reaction to a treatment or medication?
A Change in heart rate of 20 beats per minute or more.
55
What is pulses paradoxus
What does it indicate?
What diseases is it associated with
Pulse/blood pressure varies with respiration.
May indicate severe air trapping.
Associated with status asthmaticus, tension pneumothorax, cardiac tamponade.
56
What disease would pull the trachea toward pathology?
Pulmonary atelectasis
Pneumonectomy
Diaphragmatic paralysis
57
When percussing, what does a flat and/or dull note mean?
Less air, atelectasis, pleural effusion, pneumonia
58
When percussing, what does tympanic and/or hyperresonant mean?
Extra air, COPD, pneumothorax.
59
What is egophony
When patient says “E” but it sounds like “A”
Associated with consolidation, pneumonia.
60
What are course crackles and what do they indicate
Rhonchi that clear with cough
Indicate large airway secretions
61
What are medium crackles, what should you recommend for treatment
Middle airway secretions, recommend bronchial hygiene
62
What are fine crackles and how can they be treated
Fluid in the alveoli. CHF/pulmonary edema
Can be treated with oxygen, positive pressure ventilation, positive inotropic agents, diuretics.
63
Describe pulmonary edema in an X-ray
What treatment would you recommend
Fluffy infiltrates, butterfly or batwing pattern.
Diuretics= digitalis, digoxin
64
Describe atelectasis in an X-ray
How is it treated
Patchy infiltrates, plate like infiltrates.
Lung expansion therapy, SMI/IS, IPPB, CPAP, PEEP
65
Describe IRDS/ARDS in X-ray
Ground-glass appearance, honeycomb pattern, diffuse bilateral radiopacity.
Treat with Oxygen, Low Vt, or PIP, PEEP, CPAP
66
Pleural effusion on X-ray
What do you treat it with
Blunting, obliteration of costraphrenic angle, basiler infiltrates with miniscus (curving to top), concave superior interface/border.
Treat with thoracentesis, chest tube, antibiotics, steroids
67
Pneumonia on an X-ray
How is it treated
Air bronchogram, increased density from consolidation and atelectasis
Treat with antibiotics
68
Tuberculosis on X-ray
| How is it treated
Cavity formation, often in upper lobes,
Antitubercular agents — acid fast stain
69
Pulmonary embolus on X-ray
How is it treated
Peripheral wedge-shaped infiltrates (may be normal)
Heparin, streptokinase
70
What is a spiral CT scan with contrast used for
To diagnose pulmonary embolus
71
MRI
Magnetic. Don’t take steel cylinders in, have extra tubing for patient . Non ferrous materials
72
pulmonary ventilation/ perfusion scan (V/Q scan)
Normal ventilation scan with an abnormal perfusion scan indicates
Pulmonary embolism
73
What is an EEG used to monitor
Evaluation of sleep disorders
74
Pulmonary angiography is done only when ______ and ______ is inconclusive because of its high risk , what can it diagnose
V/Q and CT scan is inconclusive and a high clinical suspicion of pulmonary embolism
75
What is an echocardiogram and what are the indications for one
Abnormal heart sounds
Indications= valvular disease/dysfunction, myocardial disease, abnormalities of cardiac blood flow, cardiac anomalies in infant.
76
Therapy to reduce ICP
Hyperventilation— target paco2 is 25-30 torr will temporarily reduce ICP. Discontinue after 48 hours.
Lower jugular venous pressure- avoid neck flexion, head turning or trach ties too tight, minimize straining, retching, and coughing. Minimize PEEP
Sedation— narcotics and benzodiazepines.
1. Mannitol (osmotic diuretic)
2. Hypertonic saline
77
What is exhaled gas analysis used for
Used to monitor the patients response to anti-inflammatory (corticosteroid) treatment.
78
Exhaled carbon monoxide (FEco) testing is measured in smokers.
What are the degrees
```
<7= non smoker
7-10= light smoker
11-20 = moderate smoker
>20 = heavy smoker
```
79
If CVP is increased but nothing else is, what should be suspected
Right heart failure (cor pulmonale)
| Tricuspid valve stenosis
80
If wedge pressure and PAP is increased what should be suspected ?
Left heart failure
Mitral valve stenosis
CHF
81
What would increased PAP and increased CVP indicate
Lung disorders, Pulmonary embolism, pulmonary hypertension, and air embolism
82
Sinus arrhythmia
Sinus rhythm with irregular heart rate
83
Sinus tachycardia
Sinus rhythm with a rate >100
84
Sinus bradycardia
Sinus rhythm with rate lower than 60
| Recommend atropine
85
Atrial flutter
Sawtooth pattern
| Recommend digoxin beta blocker , calcium channel blocker
86
Atrial fibrillation
Recommend digoxin, beta blockers. Calcium channel blockers, anticoagulants, thrombolytics
87
Premature ventricular contractions (PVC)
Oxygen, lidocaine, consider other causes.
| GIVE OXYGEN FIRST
88
Multi focal premature ventricular contractions
Much more dangerous that regular pvc’s. Treat with oxygen lidocaine consider other causes
89
Ventricular tachycardia
V-tach, ventricular rhythm with rate greater than 100
90
Ventricular flutter/fibrillation
V-fib, completely irregular ventricular rhythm.
| Defibrillate, CPR, epinephrine, amiodarone
91
Three stages of a heart attack and what do they mean
1. Ischemia- reduced blood flow to the tissues.
2. Injury- Acute damage to tissue
3. Infarction- necrosis or death of tissue. May be recent or old
92
How Do you treat a heart attack? What acronym helps you remember?
O- oxygen
M- morphine
A- aspirin
N- nitrogen
“O’ man”
93
How is APGAR scored?
1-10. Low score is bad
94
How often is the apgar performed
At 1 minute after birth then every five minutes after that
95
What is an exhaled gas analysis used for
Used to treat the patients response to anti inflammatory(corticosteroid) treatment
96
Why is exhaled carbon monoxide measured (FeCo)
Measured in smokers to see the last time they smoked
97
How to interpret patients smoking status (FeCO)
-non smokers = 0-7%
Light smoker = 7-10%
Moderate smoker = 11-20%
98
What does a CBC measure
Red blood cells and white blood cells
99
How much oxygen does hemoglobin carry
1.34 mL per gram
100
How is hematocrit measured
Spins blood and measures % of RBC in original blood volume
101
What does an increased WBC count indicate
Bacterial infection
102
What does a decreased WBC count indicate
Viral infection
103
What are bands
Bands are immature white blood cells. They are made in response to infection by the body to help fight off infection
104
What are segments
Segments are mature neutrophils.
105
Eosinophils
Type of white blood cell. Associated with allergies and asthma.
106
What is HCO3 also referred to as
Total CO2 content
107
What would general malaise indicate
Low electrolytes or imbalance
108
What is hypokalemia
Low potassium. Metabolic alkalosis. Always recommend potassium.
109
Low T-wave =
Low potassium
110
High T-wave =
High potassium
111
What is the most important lead to monitor
Lead 2. It goes down and to the left.
112
What leads monitor the right heart
V1 and V2
113
What leads monitor the left heart?
V5 and V6
114
What life functions does hemodynamic monitoring cover?
measurement of blood pressure
3rd and 4th life functions.
Circulation and perfusion.
115
What 3 factors control blood pressure and how?
1. Heart- pumps and creates blood pressure
2. Blood- amount of blood in circulation affects B/P
3. Vessels- conditions of blood vessels will cause BP to change.
116
In hemodynamics, if the heart rate drops what drug should you recommend?
Atropine
117
In hemodynamics, if their heart rate increases what drug should you recommend
Atenolol, propanolol, labetolol.
118
If there is an increase in the fluids in the body what should you recommend?
Diuretics
119
If there is low fluid in the body what should be recommended
Blood products, fluids
120
How does vessel constriction affect blood pressure
Increases blood pressure, treat with vasodilators such as nitroprusside, hydralazine, milrinone
121
If vessels dilate what should you recommend for treatment
Vado constrictors such as epinephrine, phenylephrine, dopamine, and dobutamine
122
What does a pressure transducer do
It converts physical energy to electric energy
123
Where should a transducer be placed
Level with the tip of the catheter. If transducer is too high, the readings will be lower than actual reading
124
How do you monitor anything in the left heart
PCWP
125
What valves could you monitor with the PCWP
Mitral (bicuspid) valve
126
How can perfusion be defined
The gradient of blood flow through the capillaries
127
How would you monitor anything in the right heart
With the CVP pressure
128
What does the CVP monitor
Fluids and right heart
129
What can be seen in trans illumination
Pneumothorax
130
What does the Silverman score show
Respiratory distress in infants. Scored 1-10, 10 being the worst score
131
What is the normal score for a dubowiz or Ballard method? What does it measure
40 is normal. Measures gestational age. 42 would be post term
132
What is phosphatidylglycerol (PG)? And what does it represent
It is a protein that appears in the baby’s lungs. It represents lung maturity. It shows up at 36 weeks gestation and rises until term. It is the MOST reliable indication of pulmonary maturity. Even in diabetes
133
What is alveolar dead space
Air goes in but there is no blood to transport oxygen.
| Seen in pulmonary embolism
134
If ABG is normal but the capnograph dropped what can you suspect
Pulmonary embolism. Treat with heparin
135
What is transcutaneous monitoring of PO2 and pco2 and what is the normal temp
Measures oxygen content. Done by heating the area around the electrode to 43-45C thus improving capillary blood flow (perfusion) and enhances gas movement through the skin
136
How often should a transcutaneous monitor be changed
Should be changed every four hours. If redness or blistering occurs (erythema) the electrode should be moved to a new site more often
