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Kick Ass Respiratory Exam > Patient Assessment > Flashcards

Patient Assessment Flashcards

1
Q

What is another name for crepitus and what causes it?

A

Subcutaneous emphysema

Trauma, barotrauma, medical procedure, spontaneous pneumothorax

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2
Q

Increased tactile fremitus, or vibrations when talking, are felt in what disease states?

A

Vocal fremitus increases due to inflammation and consolidation like pneumonia and abscess

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3
Q

How is pitting edema classified, what disease states is it indicative of, and what is the recommended therapy

A

Stages 1-3+

CHF and renal failure

Diuretics

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4
Q

When pressed with your finger, Increased venous distention is noted above the clavicle in what disease processes?

A

Right heart failure
Fluid overload
Obstructive lung disease and air trapping

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5
Q

What life functions are tested with a capillary refill test and how quickly should the nailbed color return?

A

circulation and perfusion.

3 seconds

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6
Q

What is paradoxical movement of the chest wall called and what should you suspect

A

Flail chest

Trauma and underlying lung issues (ie pneumothorax)

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7
Q

What are some causes of hyperpnea, or deep breathing?

A

Metabolic disorder, CNS disorder

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8
Q

What is the difference between hypopnea and bradypnea and some reasons for both?

A

Shallow breathing-OSA

Slow breathing-sleep, drugs, alcohol, metabolic disorders

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9
Q

A deep and rapid breathing pattern that approaches 1:1 and that does not have periods of apnea? What is the classic diagnosis?

A

Kussmauls breathing
Diabetic keto acidosis
Metabolic acidosis
Hypoxemia
Renal failure

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10
Q

“The respiratory rate varies from normal to faster and may include short periods of apnea. It is most often seen with head injuries, but also can be seen with drug overdose, increased intracranial pressure, and congestive heart failure,

A

Cheyne stokes breathing

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11
Q

What are two ways to apply a forced expiratory technique to help with mobilizing secretions?

A

Mid inspiratory cough

Huff cough

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12
Q

A change from white or yellow sputum to green is indicative of what

A

 pneumonia

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13
Q

Green and foul smelling sputum is typical of what disease processes?

A

Lung abscess

Bronchiectasis

Cystic fibrosis

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14
Q

Where is the apical pulse normally palpated and what is it known as?

A

Area of the left midclavicular line in the fifth intercostal space

Point of maximum impulse

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15
Q

Intropy, or variable force, with each heartbeat is usually a sign of

A

Heart disease

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16
Q

Vibrations that are felt by the hand on the chest wall are known as?

A

Tactile fremitus

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17
Q

Increased density has what impact on tactile fremitus?

A

More intense vibrations

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18
Q

What are the three subdivisions of tactile fremitus?

A
  1. Vocal fremitus
  2. Pleural rub fremitus-inflamed pleural surfaces
  3. Rhonchial fremitus-secretions
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19
Q

How would he describe vesicular breath sounds?

Where are they heard?

A

Normal

All areas of the lung

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20
Q

Bronchial, aka tracheal breath sounds, are heard over what areas and what would it indicate if they were heard over the lung periphery?

A

Trachea and bronchus

Consolidation

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21
Q

Increased vesicular breath sounds are normal in what patients?

A

Children
Debilitated adults

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22
Q

Late inspiratory, crackles are heard in patients with what conditions

A

pneumonia,
pulmonary edema, or fibrosis

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23
Q

How would you describe a harsh, monophonic? High-pitched inspiratory sound over the larynx?

Treatment?

A

Stridor

Racemic epinephrine

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24
Q

When stridor is heard on inspiration and expiration, is commonly caused by what?

A

Aspirated foreign body, tracheal stenosis, or laryngal tumor

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25
Q

What causes a galloping heart rate and what is the typical pathologic finding?

A

A third (s3) or fourth (s4) heart sound

Congestive heart failure

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26
Q

In a fetus, infection, fetal immaturity, congenital heart malformation, and the effect of maternal drugs can have what impact on the babies heart rate?

A

Tachycardia

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27
Q

Fetal asphyxia and distress can caused their heart rate to become?

A

Bradycardic

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28
Q

What will likely develop an a premature neonate without sufficient surfactant?

A

Respiratory distress syndrome

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29
Q

What is the L: S ratio, indicative of?

A

Lecithin/sphingomyelin ratio is the relative amount of these two surfactant components. In general, the more lecithin compared with sphingomyelin, the more mature, the lungs.

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30
Q

What is the second test involving the presence of surfactant called?

What is the significance?

A

PG or phatidylglycerol in the amniotic fluid

The presence of PG in the amniotic fluid always indicates lung maturity

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31
Q

What does transillumination of the chest in an infant identify?

A

Pneumothorax

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32
Q

What test on babies monitors upper chest movement, lower chest movement, xiphoid, retractions, nasal dilation, and expiratory grunt to determine respiratory distress

A

Silverman- Anderson score

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33
Q

An inflammation of the epiglottis and Superglottic structures is a medical emergency called?

What do you see an x-ray?

A

Epiglottitis

Thumb Sign

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34
Q

Loryngotracheobronchitis is also known as?

What’s seen on chest x-ray

A

Croup

Steepling or pencil sign

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35
Q

Besides chest x-ray, what are clinical indicators of epiglotitis versus Loryngotracheobronchitis?

A

An epiglottitis, the patient presents with a fever, drooling and difficulty swallowing. The white blood cells are elevated and has a rapid onset.

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36
Q

Inspection: hyper inflated chest with use of accessory muscles
Palpation: Decreased expansion/decreased fremitus
Percussion: hyperresonance/low diaphragm
Auscultation: long, expiratory time /wheezes

A

Asthma and COPD

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37
Q

Inspection: inspiratory lag on affected side
Palpation: decreased fremitus and trachea and heart shift toward affected side
Percussion: dullness 
Auscultation: absent breath sounds

A

 atelectasis (lobar)

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38
Q

Inspection: possible, inspiratory lag, splinting on affected side
Palpation: rhonchial fremitus
Percussion: dullness
Auscultation: bronchial breath sounds, bronchophony, pectoriloquy

A

Consolidation (pneumonia)

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39
Q

Inspection: inspiratory lag on affected side
Palpation: absent, crematories, trachea, and heart shifted away from affected side
Percussion: hyperresonance
Auscultation: absent breath sounds

A

Tension pneumothorax

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40
Q

Inspection: inspiratory lag on affected side
Palpatatuon: decreased fremitus
Percussion: dullness
Auscultation: absent breast sounds

A

Pleural effusion

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41
Q

What are the four life functions in order of importance?

A

Ventilation

Oxygenation

Circulation

Perfusion

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42
Q

What is normal urine output

A

40 mL/hr

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43
Q

What is the normal CVP (central venous pressure)

A

2-6 mm Hg

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44
Q

If a persons CVP is less than 2 mm Hg, what is a possible treatment recommendation?

A

Fluid therapy

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45
Q

If a patient’s CVP is greater than 6 mmHg what is the treatment recommendation?

A

Diuretics

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46
Q

What is normal PCO2?

A

35 to 45 torr

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47
Q

What are the four steps to the physical examination of a patient?

A

Inspection
Palpation.
Percussion
Auscultation

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48
Q

What should a respiratory therapist consider when a patient is lethargic somnolent or sleepy?

A

Sleep apnea
Excessive O2 with retainer

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49
Q

When a patient seems anxious or nervous, which should respiratory therapist consider may be the cause?

A

respiratory distress or hypoxemia

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50
Q

General malaise, angry, combative, or irritable patients could potentially be suffering from

A

Electrolyte imbalance

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51
Q

What is the potential emotional state of patients with severe hypoxia or with a tension pneumothorax or status asthmaticus

A

Panic

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52
Q

What is orthopnea and what condition could it demonstrate?

A

Difficulty breathing except in the upright position

CHF

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53
Q

How many stages of dyspnea are there and what stages the worst?

A

Five stages with five being the worst. Stage 5 is dyspnea at rest

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54
Q

Diaphoresis, or extreme sweating, can indicate heart failure, infection, anxiety, or tuberculosis (night sweats). As a respiratory therapist, what would you suggest for each?

A

Heart failure – diuretics and positive inotropic agents infection fever – antibiotics
Nervousness – sedatives
Tuberculosis – anti tubercular drugs

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55
Q

What are a few reason a patient look pale, or pallor, in a patient assessment

A

Anemia

Acute blood loss

Vasoconstriction

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56
Q

What causes cyanosis, or discoloration of skin and mucous membranes, in patient inspection?

A

Caused by hypoxia from an increased amount of reduced hemoglobin (5g )

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57
Q

Normal respiratory rate depth and rhythm is called. What and what is the normal rate?

A

Eupnea
12 to 20 breaths per minute

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58
Q

Over 20 breaths per minute is called tachypnea. What’s could be the cause?

A

Hypoxia
Fever
Pain
CNS problem

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59
Q

Normal sleep, drugs, alcohol, and metabolic disorders can all lead to what type of breathing

A

Bradypnea, less than 12 breaths/minute

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60
Q

An increased respiratory rate with increased depth at a regular rhythm is named what, and what are the potential causes?

A

Hyperpnea
Metabolic disorder
CNS disorders

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61
Q

Gradual increasing the decreasing rate and depth in respiratory cycle lasting from 30 to 180 seconds with periods of apnea lasting up to one minute. Can be caused by cranial pressure increase, brainstem injury, or drug overdose.

A

Cheyne Stokes

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62
Q

Biots breathing is caused by a CNS problem and is different than Cheyne Stokes breathing in which way?

A

Each breath has the same depth

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63
Q

A breathing pattern of over 20 breaths per minute, with increased depth, a regular rhythm, and labored breathing sounds. That is classic in diabetic ketoacidosis, but can also be indicative of hypoxemia, metabolic acidosis and renal failure

A

Kussmauls breathing

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64
Q

An apneustic pattern is marked by prolong, gasping inspiration fall by extremely short, insufficient expiration. What are some causes?

A

Problem with respiratory center, trauma or tumor

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65
Q

Why does hypertrophy happen with COPD patients?

A

Due to increase accessory muscle usage

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66
Q

What makes cachexia different than normal muscle loss.

A

It’s due to a underlying condition, like COPD, CHF or AIDS

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67
Q

When the chest moves inward during inspiratory efforts instead of outward, it’s called retractions and what does it indicate in an adult? How about a newborn?

A

Severe airway instruction in adults

Respiratory distress in newborns

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68
Q

Nasal flaring in newborns indicates what?

A

Respiratory distress

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69
Q

What could a dry or nonproductive cough complaint indicate

A

Tumor in the lungs

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70
Q

What is macroglossia?

A

Enlarged tongue

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71
Q

What classes of Mallampati are considered difficult and what should be utilized?

A

Class three and class four are considered difficult airways and you should use a fiber optic bronchoscope or a video assist device

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72
Q

Tachycardia could indicate hypoxemia anxiety or stress. Which should a respiratory therapist recommend recommen

A

Oxygen therapy

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73
Q

Bradycardia can indicate heart failure, shock or a code emergency. What should respiratory therapist recommend?

A

Atropine

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74
Q

How many beats per minute change indicates an adverse reaction in a patient

A

20

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75
Q

What is paradoxical pulse/pulses paradoxus mean?

A

Pulse/blood pressure varying with respiration. May indicate severe air trapping. (status asthmaticus, tension pneumothorax, or cardiac tamponade.)

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76
Q

What causes a tracheal deviation away from the pathology?

A

Massive pleural fusion
Tension, pneumothorax,
Neck, or thyroid tumor
Large mediastinal mass

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77
Q

What causes a tympanic or hyper resonant sound in diagnostic chest percussion?

A

Air trapping
Emphysema
Pneumothorax

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78
Q

During egophany, if a spoken E or 99 sounds different during auscultation, what does it indicate?

A

Consolidation

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79
Q

Terms that referred to increased intensity or transmission of the spoken voice and indicate consolidation and pneumonia are called?

A

Broncoohony
Whispered pectoriloquy

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80
Q

What are the three types of crackles, where is the fluid, and treatment recommendations

A

Coarse Crackles (rhonchi) large airway secretions/cough or sxn.
Medium crackles-middle airway secretions/bronchial hygiene
Fine crackles-fluid in the alveoli and associated with CHF or pulmonary edema/O2’s, IPPB, positive inotropic, diuretics

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81
Q

What would you suspect and recommend for treatment with a unilateral wheeze?

A

Foreign body obstruction
rigid bronchoscopy

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82
Q

What are the three things that can cause stridor, or crowing Inspiratory sound and how would treat?

A

Supraglottic swelling/epiglotitis/racemic epi/intubation if severe or marked
Subglottic swelling/croup/cool aerosol
Foreign body obstruction-bronchoscopy

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83
Q

A low pitched snoring type of sound, on inhalation, that usually arises from the vibration of fluid or the vibration of tissue that is relaxed or flabby. What is the treatment?

A

Stertor
CPAP

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84
Q

What is the diagnosis and treatment for a coarse grating, rasping, crunching sound heard on oscillation, and what is the cause and treatment?

A

Pleural friction rub
Caused by inflamed visceral or parietal pleura rubbing together. Maybe associated with pleurisy, TB, pneumonia, pulmonary infarction, cancer, etc.
Steroids antibiotics.

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85
Q

What are normal cardiac heart sounds and what do you recommend if they’re not normal?

A

S1-caused by the closure of the mitral and tricuspid valves at the beginning of the ventricular contraction.

S2- sound heard when systole ends when the ventricles relax and the pulmonic and aortic valves close
DX-echocardiogram

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86
Q

How do hypoxemia and cardiac stress affect blood pressure?

A

Increase it

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87
Q

Decrease in blood pressure caused by

A

Hypovolemia

CHF

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88
Q

Narrowed bronchi could indicate what?

A

Bronchogenic carcinoma

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89
Q

An increased cardiac shadow indicates cardiomegaly, and what the two potential causes 

A

Congestive heart failure
pericardial effusion

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90
Q

What can cause the pulmonary artery to enlarge?

A

Pulmonary hypertension
Embolism

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91
Q

A slanted or diagonal chest X-ray, called oblique position, is used to diagnose what

A

The position of pulmonary lesions

92
Q

What is a lateral decubitus x-ray used for?

A

Differentiate pleural effusions from pneumonia

93
Q

What is apical lordotic chest x-ray used for

A

Help confirm tuberculosis

94
Q

What is an end expiratory chest x-ray used for?

A

Detect, small pneumothorax and diaphragmatic excursion

95
Q

Where should the tip of endotracheal tube to be positioned on x-ray?

A

2 to 6 cm above the carina or at the level of the aortic arch/knob

96
Q

On chest x-ray, pacemaker, wires electrode should be normally positioned where

A

Right ventricle

97
Q

On chest x-ray, the pulmonary arctic catheter should appear where

A

Right lower lung field

98
Q

On chest x-ray, where should central venous catheter rest?

A

In the superor vena cava or right atrium

99
Q

Chest tube should be seen where in a chest x-ray

A

Pleural space

100
Q

Where should nasogastric and feeding tubes be positioned?

A

2 to 6 cm below the diaphragm

101
Q

Any ill-defined radiodensity on an x-ray is known as what and what does it indicate

A

Infiltrate

Atelectasis

102
Q

Any solid white area on a chest x-ray is known as what and what is the diagnosis

A

Consolidation

Pneumonia pleural effusion

103
Q

Vascular markings are increased and absent in what conditions?

A

CHF

Pneumothorax

104
Q

Diffuse infiltrates indicate what 2 potential diagnosis

A

Pneumonia or atelectasis

105
Q

Diagnosis and treatment for patchy infiltrates, plate like infiltrates, crowded, pulmonary vessels, crowded air bronchograms

A

Atelectasis
Lung expansion therapy

106
Q

What diseases indicated by ground glass or honeycomb pattern, diffuse bilateral radiopacity. Also called reticulogranular or reticulonodular? Treatment

A

ARDS

Oxygen, low volume therapy, CPAP, peep

107
Q

Dx. And Tx for blunting of the costaphrenic angle, basilar infiltrates with meniscus, concave superior interface. Fluid level on affected side, possible mediastinal shift to unaffected side.

A

Pleural effusion
Thoracentesis
Chest tube
Antibiotics
Steroids

108
Q

Air bronchograms with increased density from consolidation and atelectasis indicates what diagnosis and what is the treatment

A

Pneumonia.

Antibiotics

109
Q

A wedge shaped peripheral infiltrate indicates what and how would you treat

A

Pulmonary embolus
Heparin and clot buster( streptokinase)

110
Q

On a chest x-ray, cavity formation in the upper lobes is indicative of what and what is the suggested treatment

A

Tuberculosis
Antitubercular drugs
Nutritional support
Isolation

111
Q

Fluffy infiltrates, butterfly pattern or batwing pattern with diffuse whiteness indicates what disease and what is the treatment

A

Pulmonary edema
Diuretics and positive inotropic agents, like Digitalis and Digoxin

112
Q

What is the only way to truly diagnose tuberculosis?

A

Acid fast stain

113
Q

What is the safest diagnostic text for a pulmonary embolus?

A

A spiral CT scan with contrast

114
Q

In place of Ferris material during MRI, which should be used

A

Aluminum

115
Q

What is the second best test to determine a pulmonary embolism?

A

Ventilation/oerfusion scan

116
Q

What should a respiratory therapist recommend to evaluate sleep disorders?

A

Electroencephalograph EEG

117
Q

What is the indication for a pulmonary angiography, or arterial pulmogram

A

When you suspect a pulmonary embolus, and you have an inconclusive V/Q scan and or CT scan. It is the most definitive and most risky.

118
Q

What should a respiratory therapist recommend if he hears abnormal heart sounds

A

Echocardiogram-non-invasive method for monitoring cardiac performance

119
Q

What is the cardiac procedure that is done for both diagnostic and therapeutic purposes. It can be used for angioplasty, PCI, balloon, sept, ostomy, and electrophysiology studies.

A

Cardiac catheterization

120
Q

What are normal intracranial pressures?

A

5-10 mm Hg

121
Q

How would you reduce intercranial pressures as a respiratory therapist?

A

Hyperventilate to target a PCO2 of 25 to 30 torr.

Keep the head of bed elevated greater than 30°

Narcotics and benzodiazepines

Osmotic agents to remove fluid from the brain like mannitol and hypertonic saline

122
Q

What are cerebral perfusion pressures and what is the normal value?

A

Pressure gradient to determined cerebral perfusion

Normal value is 70 to 90 mmHg

123
Q

Why would a respiratory therapist recommend exhaled nitric oxide testing?

A

Used to monitor the patient response to anti-inflammatory (corticosteroid)treatment

124
Q

Why would a respiratory therapist recommend exhale, carbon monoxide testing and what does 7-10 ppm indicate

A

Used to monitor abstinence and cigarette smokers.

A light smoker

125
Q

Elevated CO levels can be seen in what two types of patients

A

Smokers
OSA patients

126
Q

What test is the main indication for bronchiectasis

A

Bronchography

127
Q

In a complete blood count, or CBC, the measurement of RBCs, hemoglobin (hb) and hematocrit (Hct) are all evaluating for what?

A

Anemia or polycythemia

128
Q

What is the normal value for RBCs in a complete blood count? What factor does it increase for hemoglobin and hematocrit?

A

4-6 mil/mm3
By a factor of three
Hb: 12-16 g/100 mL blood
Hct: 40-50%

129
Q

What is the normal WBC in a CBC measurement and what the highs and lows indicate

A

5000 10,000

Increased equals bacterial infection recommend an antibiotics

Decrease WC indicates viral infection recommend antiviral agents

130
Q

Why do WBC’s decrease in a viral infection?

A

The Segs component of the white blood cell dies off fighting the viral infection, but the Bands portion aren’t triggered to multiply

131
Q

What do eosinophils in a CBC indicate?

A

Asthma or allergic reaction

132
Q

What do elevated monocytes indicate in a CBC. Greater than what %?

A

Tuberculosis paragraph greater than 3% of WBC

133
Q

What is the most important and common factor in metabolic alkalosis?

A

Hypokalemia, lower than 3.5-4.5 mEq/L

134
Q

How do you easily remember normal potassium and sodium?

A

It’s a relationship to PCO2.
Add a decimal for potassium equals 3.5 to 4.5
add one to sodium for 135 to 145

135
Q

What is a normal range for chloride?

A

90-100 new/L

136
Q

What is another name for total CO2 content and what electrolyte is impacted with high levels?

A

Bicarbonate (HCO3-)
Leads to metabolic alkalosis and low potassium

137
Q

What is the normal range for bicarbonate (HCO3-)

A

22-26 mEq/L

138
Q

What blood chemistry test is the most specific for evaluating kidney failure?
What is the normal range?

A

creatinine
0.6-1.3 mEq/L

139
Q

What is the normal range for blood urea nitrogen (bun)?

A

8 to 25 mg/dL

140
Q

Sputum cultures and sensitivity take 48 to 72 hours. When you are in a hurry, what is the test you recommend to test sputum

A

Ramstein. It takes one hour.

141
Q

What is normal clotting time?

A

Six minutes

142
Q

What is a platelet count done for and what is the normal value?

A

Should be done if a coagulation defect is suspected

Normal value is 150,000 to 400,000/mm3

143
Q

What test is used for monitoring heparin therapy and what is the normal value in length of time required for plasma to form a fibrin clot?

A

APTT-activated partial thromboplastin time: 24-32 seconds

144
Q

What test is used to monitor warfarin, or Coumadin, therapy and what is the normal time to form a clot?

A

PT-Prothrombin time: 12-15 seconds

145
Q

What protein found in a cardiac enzyme test is a specific indicator of damage to the heart muscle

A

Troponin, levels greater than 0.1 ng/mL place a patient at high risk of death from MI

146
Q

What does a respiratory therapist recommend for treatment of high troponin levels and myocardial infarction

A

OMAN
Oxygen, morphine, aspirin, nitroglycerin

147
Q

What is BNP, or brain natriuretic peptide

A

Protein released by the cardiac muscle when heart failure develop or worsen

Normal value is less less than 100 pg/ml

148
Q

What is the measurement of serum BNP, brain natriuretic peptide, helpful in determining?

A

If the patient symptoms are the result of CHF or another condition such as COPD. Elevated levels, >300 pg/mL, indicate CHF.

149
Q

How do hypertrophy and infarction affect the axis of an echocardiogram?

A

Hypertrophy shifts access towards the enlargement. Infarction shifts the access away.

150
Q

What is the best lead in electrocardiogram?

A

Lead 2. Right arm negative to left leg positive

151
Q

what is the only lead that produces an upside down pattern on an EKG?

A

AVR lead. Right arm positive. Everything else negative.

152
Q

What’s the difference between heart flutter and fibrillation?

A

Heart flutter is 200 beats or more minute and fibrillation is too fast to count

153
Q

What do you call a heart rhythm with a p wave

A

Sinus

154
Q

What drug do you prescribe with sinus bradycardia?

A

Atropine

155
Q

How do you treat atrial flutter and fibrillation?
What additional drugs do you prescribe for fibrillation

A

Digoxin, beta blockers, calcium channel blockers,

anticoagulants, and thrombolytics

156
Q

On an EKG, what indicates a PVC and how do you treat it?

A

A wide QRS wave with no P-wave.

Oxygen, lidocaine consider other causes

157
Q

When a patient has ventricular tachycardia with no pulse, would you defibrillate or cardiovert? What drugs would you recommend?

A

Defibrillate

Epinephrine and amiodarone

158
Q

A depressed or inverted T wave indicates what in an EKG

A

Ischemia -reduced blood flow to tissue

159
Q

An elevated ST segment in electrocardiogram indicates what?

A

Myocardial injury

160
Q

What will you see on an EKG with a major heart attack?

A

Inverted T waves
elevated S-T segment
Significant Q waves

161
Q

What is the treatment for serious heart injury or infarction

A

OMAN
Oxygen, morphine, aspirin, and nitroglycerin

162
Q

Normal term is how many weeks

A

38-42

163
Q

AGA, LGA and SGA, stand for what in infant assessment?

A

Appropriate for gestational age

Large for gestational age

Small for gestational age

164
Q

What does Apgar stand for?

A

Appearance

Pulse

Grimace

Activity

Respiratory effort

165
Q

How many points can an infant earn on each letter in the APGAR scale? What are the levels?

A

2
0-3 resuscitation needed
4-6 stimulate, warm, O2
7-10 routine care

166
Q

At what time period Do you evaluate Apgar scores?

A

1 and 5 minutes

167
Q

What is the normal heart rate for an infant?

A

110-160

168
Q

What is the normal respiratory rate for an infant?

A

30-60

169
Q

What is the normal blood pressure for an infant?

A

60/40

170
Q

What is the normal weight for a term infant?

A

3000 grams

171
Q

How do you remember a Silverman score for respiratory distress?

A

It’s exactly opposite of Apgar score. high means bad

172
Q

What is a normal score in a Dubowitz or Baller method for gestational age indicates a post term infant

A

40
Higher than 40

173
Q

A ductus arteriosus causes what type of shunt and how much higher does it need to be?

A

A right to left shunt. The PAO2 level from the right arm, often exceeds that found in the lower extremities.

15 torr higher

174
Q

Term infants, blood glucose level should be greater than?

A

30 mg/dL

175
Q

What is capnography?

A

The monitoring of exhaled carbon dioxide

176
Q

What are the different symbols for exhale carbon dioxide?

A

ECO2, ETCO2, PETCO2

177
Q

Will PETCO normally be lower or higher than arterial CO2

A

Lower. As it dilutes with dead space

178
Q

What is the normal value in percent of ECO2?

A

3-5%

179
Q

What could a decrease in exhaled carbon dioxide indicate

A

An increase in ventilation or decreased perfusion (deadspace disease, pulmonary embolism, hypovolemia)

180
Q

What two CO2 gas percentages is capnography calibrated with and how often?

A

0% and 5%
Every eight hours

181
Q

What is the purpose of a co-oximeter/hemoximeter and what are the normal values?

A

Used to diagnose carbon monoxide poisoning

0-1%

182
Q

What is the treatment for carbon monoxide poisoning?

A

100% O2 via non-rebreather

183
Q

On a transcutaneous monitor, what electrodes provide PO2 and PCO2 measurements

A

 Clark is O2

Severinghouse is CO2

184
Q

For accurate, transcutaneous monitoring, what temperature do you need to heat the skin around the electrode?

A

43 to 45°C improves capillary blood flow and enhances movement through the skin

185
Q

How often should you move the electrotrode in transcutaneous monitoring

A

Change it every four hours to prevent Patient burns 

186
Q

What life functions is hemodynamics measuring

A

Circulation and perfusion

187
Q

What three factors control blood pressure

A

Heart

Blood.

Vessels

188
Q

An increase in the heart rate will increase blood pressure. What drugs will increase heart rate.

A

Chronotropic drugs like atropine. Less systemic side effects

189
Q

A decrease in heart rate will decrease blood pressure. What drugs will decrease heart rate?

A

Beta blockers or Beta antagonists will decrease heart rate such as atenolol, propranolol, labetalol, and other drugs ending in olol.

190
Q

What drugs will increase contractility and therefore increase blood pressure?

And what drugs decrease contraction and therefore BP

A

Positive inotropic drugs, like digitalis, digoxin and dobutamine

Negative inotropic drugs. Also known as calcium channel blockers like Verapamil.

191
Q

How do you treat excessive fluids and increased blood pressures?

A

Diuretics such as furosemide

192
Q

How do you treat decreased pressures due to loss of fluids

A

Treat with fluids or blood products

193
Q

What are the two types of vasodilators, and some representative examples, you could give to lower blood pressure?

A

Direct vasodilators like nitroprussides, nitroglycerin, hydrazine, and milrinone)

Ace inhibitors, like lisinopril, and other pril drugs

194
Q

What are some drugs that would treat vasodilation?

A

Vasoconstrictors
-epinephrine
-phenylprine
-dopamine
-dobutamine

195
Q

What is a pressure transducer used for?

A

Convert pressures, or analog signals, into electrical signals, or digital signals that can display on a monitor

196
Q

What is important about transducer placement?

A

It should be at the same level as the tip of the catheter. If it’s higher, readings are lower than actual.

197
Q

What three pressures does a standard pulmonary artery catheter measure

A

The proximal catheter port measures CVP

The distal port with the balloon deflated measures PAP
The port with balloon inflated measures PCWP

198
Q

The presence of dicrotic notch in a wave form indicates what location

A

 PAP or pulmonary artery

199
Q

What is pressure dampening

A

Occurs in the monitors not showing the normal dichrotic notch and the catheter is obstructed

200
Q

What is normal troubleshooting for pressure dampening or pulmonary artery catheter are not reading correctly

A

Blood clot, bubble in the catheter or transducer or of the tube.

Flush the catheter and rotate the catheter, pull the catheter

201
Q

An increase in CVP indicates what potential issues

A

Right heart failure, cor pulmonale, tricuspid valves stenosis

202
Q

An increase in PAP pressures and potentially CVP pressures indicates what pathologies

A

Lung disorders

Pulmonary hypertension

Air embolism

203
Q

What what pathologies cause an increase in PCWP, or wedge pressure, Decrease cardiac output and could increase pulmonary artery pressure, or PAP?

A

Left heart failure

Mitral valve stenosis

CHF

204
Q

All pressures rise or fall with hyper or hypovolemia, but what hemodynamic measurement is involved impacted

A

CVP increases with hypervolemia and decreases with hypovolemia

205
Q

What is pulse pressure?

A

Systolic minus diastolic pressure. Normal is 40.

206
Q

What is the Fick equation?

A

QT= VO2/C(a-v)O2 x10

207
Q

What is the stroke volume equation and what is the unit of measurement?

A

QT= heart rate times volume. Change to liters.

208
Q

To do a thermal dilution study, determine cardiac output, what is necessary

A

A cold saline injection through a pulmonary artery catheter

209
Q

What is normal cardiac output

A

4 to 8 L per minute, depending on body size

210
Q

What is the formula for cardiac index and how does it relate to cardiac output?

A

Cardiac index equals cardiac output divided by body surface area

CI=QT/BSA

It’s typically half the number, so multiplied by two to get cardiac output

211
Q

What is the formula for systemic vascular resistance and what is it measuring?

A

SVR=(MAP-CVP)/QT

Is the pressure gradient across the systemic circulation divided by the cardiac output

212
Q

What is pulmonary vascular, resistance, measuring and what is the formula?

A

The pressure gradient across the pulmonary circulation divided by the cardiac output

PVR = (MPAP minus PCP)/QT, or cardiac output

213
Q

For systemic, vascular resistance, and coronary vascular resistance how do you convert Hg/L\min to dynes

A

 Multiplied by 80

214
Q

Accumulation of fluid in the abdomen, generally caused by liver failure

A

Ascites

215
Q

What information would help the therapist determine a patient’s circulation is adequate

A

Heart rate and strength

Cardiac output

216
Q

What changes could you monitor that help indicate if the patient has adequate perfusion

A

blood pressure
temperature
urine output
Sensorium
Hemodynamics

217
Q

What are five items that are important to examine when interviewing a patients medical record

A

Chief complaint
Admitting diagnosis.
History of current illness.
Overall medical history.
Medication’s

218
Q

Drugs commonly prescribed to treat anxiety disorders, panic disorders, insomnia, acute stress reactions, muscle spasms, and certain types of seizures. Indicated for increased intercranial pressures

A

Benzodiazepines

219
Q

What is the Katz scoring system used for

A

Evaluating a persons activities of daily living

220
Q

What type of breathing had prolonged gasping inspiration fall by extremely short insufficient expiration?

A

Apneustic

221
Q

What type of drug decreases blood pressure 

A

Calcium channel blockers have a negative inatropic effect. Examples include Verpamil and Norvasc

222
Q

On an EKG, what indicates a multifocal premature ventricular contraction and how do you treat it?

A

When the QRS complexes are different.

Oxygen, lidocaine, consider other causes

223
Q

How would you treat ventricular flutter or fibrillation?

A

Defibrillate

CPR

Epinephrine and amiodarone

224
Q

What patient tests values would determine how well a patient is ventilating?

A

PaCO2
EtCO2

225
Q

What four findings might indicate that the patient’s fluid intake has exceeded urine output

A

Weight gain
electrolyte imbalance
Increased hemodynamic pressures
decreased lung compliance

226
Q

Kerley B lines on a CXR indicate what disease process

A

Cardiogenic pulmonary edema

Kick Ass Respiratory Exam (7 decks)

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