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Patient Assessment Flashcards

(170 cards)

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1
Q

Four Critical Life Functions

A
  • Ventilation
  • Oxygenation
  • Perfusion
  • Circulation
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2
Q

First priority (out of the four life functions)

A

Ventilation!

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3
Q

Most common issue (out of the four life functions)

A

Oxygenation

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4
Q

What are signs? Give examples

A

Objective: can be measured
- Pulse, Color, Blood Pressure

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5
Q

What are symptoms? Give examples

A

Subjective: patient tells you
- Pain, Nausea, Weakness

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6
Q

Pack years equation

A

Pack Years = #packs/day x years smoked

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7
Q

Normal Urine Output

A

40mL/hour (about 1L/day)

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8
Q

Sensible Water Loss

A

Urine, Vomiting

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9
Q

Insensible Water Loss

A

Lungs, Skin

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10
Q

Normal Central Venous Pressure

A

2-6 mmHg

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11
Q

What does decreased CVP lead to?

A

Hypovolemia (recommend fluid therapy)

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12
Q

What does increased CVP lead to?

A

Hypervolemia (recommend diuretics)

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13
Q

What is Orthopnea?

A

Difficulty breathing except when sitting upright
Seen in CHF!

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14
Q

What is General Malaise?

A

Run down feeling, nausea, weakness, fatigue

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15
Q

What is Dysphagia?

A

Difficulty swallowing

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16
Q

What is Peripheral Edema?

A

Excessive fluid, commonly in arms and ankles
Causes: CHF, renal failure

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17
Q

What is Ascites?

A

Excessive fluid in the abdomen (beer belly)
Causes: Liver failure

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18
Q

What is finger clubbing caused by?

A

Chronic Hypoxemia –> pulmonary disease

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19
Q

In how many seconds should color return for capillary refill?

A

3 seconds

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20
Q

What is Diaphoresis?

A

State of profuse sweating and SOB

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21
Q

Barrel Chest

A

Airtrapping for a long period of time; increased A-P diameter

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22
Q

Underlying pathologies for unequal chest movement

A
  • Pneumothorax
  • Post-lung resection
  • Flail chest
  • Atelectasis
  • ET tube inserted in right/left mainstem bronchi
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23
Q

What is Eupnea?

A

Normal respiratory rate, depth, and rhythm

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24
Q

What is Tachypnea?

A

Increased respiratory rate

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25
Causes of tachypnea
- Fever - Pain - Hypoxia
26
What is Bradypnea (Oligopnea)
Decreased respiratory rate
27
Causes of Bradypnea
- Sleep - Drugs - Alchohol
28
What is Hyperapnea?
Increased rate and depth with regular rhythm
29
Causes of Hyperapnea
- Metabolic disorder - CNS disorder
30
What is Cheyne-Stokes?
Gradually increasing then decreasing rate and depth; lasts 30-180 seconds w/ periods of apnea
31
Causes of Cheyne-Stokes
- Increased ICP - Brainstem injury - Drug overdose
32
What is Kussmaul's?
Increased rate and depth, irregular rhythm, breath sounds are labored
33
Causes of Kussmaul's
- DKA - Hypoxemia - Renal Failure
34
Normal muscles of ventilation
- Diaphragm - External intercostals
35
Accessory muscles of ventilation
- Internal intercostal - Scalene - Sternocleidomastoid
36
What is Hypertrophy?
Increased muscle size (occurs with COPD)
37
What is Atrophy?
Muscle wasting; starvation (occurs in paralysis)
38
What classes of Mallampati are considered difficult intubation?
Class III and Class IV (utilize fiberoptic bronch)
39
What change in heart rate is considered an adverse reaction?
20 beats/min
40
Resonant chest percussion
Normal air-filled lung
41
Flat chest percussion
Atelectasis is present
42
Dull chest percussion
Pleural effusion or pneumonia
43
Tympanic chest percussion
Air-filled stomach (extra air)
44
Hyperresonant chest percussion
Pneumothorax or emphysema (or air-trapping)
45
Vesicular breath sounds
Normal
46
What is Egophony?
Consolidation of lung
47
What does hypertension indicate?
Increased cardiac stress --> hypoxemia
48
What does hypotension indicate?
Poor perfusion --> hypovolemia, CHF
49
What is crowding ribs associated with?
Atelectasis
50
What are straight/horizontal ribs associated with?
Air trapping
51
What is important about Lateral Decubitus?
Once patient is moved to side and moves = PLEURAL EFFUSION
52
How many cm should the ET tube be above the carina?
2-6 cm
53
What quickly determines tube position?
Inspection and Ausculation
54
Where should nasogastric and feeding tubes be positioned?
2-6 cm below the diaphragm
55
What is Croup?
Subglottic swelling (steeple sign)
56
What is Epiglottitis?
Supraglottic narrowing (thumb sign)
57
What is Extrapulmonary Air?
Air found outside of the lungs
58
Examples of Extrapulmonary Air
- Pneumothorax - Pneumomediastinum - Subcutaneous Emphysema
59
Radiolucent CXR
Normal for lungs Dark pattern = air
60
Radiodense/Opacity CXR
Normal for organs/bones White pattern = solid + fluid
61
Infiltrate CXR
Any ill-defined ATELECTASIS
62
Consolidation CXR
Solid white air PNEUMONIA / PLEURAL EFFUSION
63
Hyperlucency CXR
Extra pulmonary air PNEUMOTHORAX, COPD, ASTHMA ATTACK
64
Vascular marking CXR
Vessels Increased w/ CHF Decreased w/ PNEUMOTHORAX
65
Diffuse CXR
Spreading throughout ATELECTASIS / PNEUMONIA
66
Opaque CXR
Fluid / Solid CONSOLIDATION
67
Pulmonary Edema on CXR
Fluffy infiltrates, butterfly/batwing pattern
68
Pulmonary Edema treatment
- Diuretics - Digoxin - Digitalis
69
Atelectasis on CXR
Patchy infiltrates, crowded pulmonary vessels
70
Atelectasis treatment
Lung Expansion Therapy (CPAP, PEEP, IS)
71
ARDS or IRDS on CXR
Ground glass appearance, honeycomb
72
ARDS or IRDS treatment
- High oxygen - Low Tidal Volume or PIP - PEEP - CPAP
73
Pleural Effusion on CXR
Blunt costophrenic angle, elevated diaphragm
74
Pleural Effusion treatment
- Thoracentesis - Chest tube - Antibiotics - Steriods
75
Pneumonia on CXR
Air bronchogram
76
Pneumonia treatment
Antibiotics
77
Pulmonary Embolus on CXR
Peripheral wedge-shaped infiltrate
78
Pulmonary Embolus treatment
- Heparin - Streptokinase
79
Tuberculosis on CXR
Cavity formation
80
Tuberculosis treatment
Antitubercular agents
81
What do CT scans help diagnose?
- Masses - Bronchiectasis - Pulmonary embolus (spiral CT)
82
What does a normal ventilation scan with an abnormal perfusion scan indicate?
Pulmonary embolism
83
Pulmonary Angiography
Test used to diagnose pulmonary embolism - USED AS A LAST RESORT; INVASIVE + EXPENSIVE
84
Indication for EEG
Evaluating sleep disorder
85
Indication for Echocardiogram
Abnormal heart sounds
86
Normal Intercranial Pressure (ICP)
5-10 mmHg
87
How high should an ICP be when initiating treatment?
Greater than 20mmHg
88
Therapies to reduce ICP
- Hyperventilation (target PaCO2 of 25-30) - Sedation - Lower jugular venous pressure
89
Normal Cerebral Perfusion Pressure (CPP)
70-90 mmHg
90
Formula for CPP
CPP = MAP - ICP
91
What is FENO testing?
Measures nitric oxide concentration in patients exhalation
92
What is FENO testing useful for?
- Asthma - Cystic Fibrosis - COPD
93
What does a decreased FENO suggest?
decrease in airway inflammation
94
What does an increased FENO suggest?
increase in airway inflammation
95
What patients have elevated FECO levels?
Smokers and OSA
96
Normal RBC
4-6 mil/mm3
97
What do RBC's do?
Contains hemoglobin needed for oxygen transportation
98
Normal Hb
12-16 g/100mL blood
99
What does Hb do?
Carries oxygen
100
Low RBC/Hb/Hct
Anemia - Blood loss; hemorrhage
101
High RBC/Hb/Hct
Polychythemia - Chronic tissue hypoxemia; COPD
102
Normal Hct
40-50%
103
What does Hct do?
Spin the whole blood and measure the % of RBC in the blood volume
104
Normal WBC
5,000-10,000 per mm3
105
What does WBC do?
Changes in response to infection
106
Increased WBC
Leukocytosis - bacterial infection --> recommend antibiotics
107
Decreased WBC
Leukopenia - viral infection --> recommend antiviral agents
108
Types of WBC
Neutrophils: Major WBC; 64% Lymphocytes: 30% Monocytes: associated w/ TB; 3% Eosinophils: associated w/ asthma; 2% Basophils: 1%
109
What are electrolytes closely associated with?
- Fluid levels - Muscle function - Kidney function
110
Normal Potassium (K+)
3.5-4.5 mEq/L
111
Hypokalemia occurs with?...
- Metabolic Alkalosis - Vomiting - Excessive excretion
112
How does hypokalemia look on an ECG?
Flattened T waves
113
Hyperkalemia occurs with?...
- Kidney Failure - Metabolic Acidosis
114
How does hyperkalemia look on an ECG?
Spiked T wave
115
Normal Sodium (Na+)
135-145 mEq/L
116
Hyponatremia occurs with?...
- Fluid loss from diuretics - Vomiting - Diarrhea - Fluid buildup from CHF
117
Hypernatremia occurs with?...
- Dehydration
118
When Na+ is retained, what is it exchanged for?
K+
119
Normal Chloride (Cl-)
90-100 mEq/L
120
Hypochloremia occurs with?...
Metabolic Alkalosis
121
Hyperchloremia occurs with?...
Metabolic Acidosis
122
Normal Bicarbonate (HCO3-)
22-26 mEq/L
123
High CO2 reflects
High HCO3- leading to metabolic alkalosis
124
Low CO2 reflects
Low HCO3- leading to metabolic acidosis
125
High PCO2 leads to
Respiratory Acidosis
126
Low PCO2 leads to
Respiratory Alkalosis
127
Normal Creatinine
0.7-1.3 mg/dL
128
Why is Creatinine and BUN important?
Evaluates kidney function
129
Normal Blood Urea Nitrogen (BUN)
8-25 mg/dL
130
What does increased BUN indicate?
Kidney Failure
131
Clear sputum
Normal
132
Mucoid sputum
Chronic bronchitis
133
Yellow sputum
Presence of WBC (eosinophils); bacterial infection
134
Green sputum
Gram negative bacteria; bronchiectasis, pseudomonas
135
Brown/dark sputum
Old blood; anaerobic lung infection
136
Bright red sputum
Hemoptysis (bleeding tumor, TB)
137
Pink frothy sputum
Pulmonary edema
138
Normal Clotting Time
Up to 6 minutes
139
Normal Platelet Count
150,000-400,000/mm3
140
What does decreased platelet count indicate
- Sepsis - Decreased bone marrow function
141
What does increased tropinin indicate?
Myocardial Infarction (heart attack)
142
What do you recommend for an MI?
- Oxygen - Morphine - Aspirin - Nitroglycerin
143
Normal Brain Natriuretic Peptide (BNP)
<100 pg/mL
144
What is BNP associated with?
CHF
145
>300 pg/mL
mild heart failure
146
>600 pg/mL
moderate heart failure
147
>900 pg/mL
severe heart failure
148
Term Infant
38-42 weeks of gestational age
149
Preterm Infant
Less than 38 weeks of gestational age
150
Post term infant
More than 42 weeks of gestational age
151
APGAR
Appearance Pulse Grimace Activity Respiratory Effort
152
APGAR scoring
0-3 = resuscitate 4-6 = support; stimulate, warm, give oxygen 7-10 = monitor
153
What is Transillumination
Lights chest up - Recommened when pneumothorax is suspected - Light = pneumo
154
Normal Temperature for infant
36.5 Celcius
155
Normal Heart Rate for infant
110-160 beats/min measured using; brachial, femoral, apical pulse
156
Normal Respiratory rate for infant
30-60 breaths/min
157
Normal Blood Pressure for infant
60/40 for Term 50/30 for Pre-term
158
Normal Birth Weight for infant
>3000 g for Term
159
What does nasal flaring and retractions mean for an infant?
Distress!
160
What does grunting indicate for an infant?
RDS from decreased lung volume
161
What is Silverman Score?
Assessment of respiratory distress - 0-10 scoring - The lower the better
162
Normal Lecithin/Sphingomyelin (L/S) Ratio
2:1 or higher
163
Low L/S Ratio needs...
Surfactant
164
Normal ETCO2
3-5% (or 35 torr)
165
Increase PECO2/PETCO2 means
Decrease ventilation/ventilatory failure
166
Decrease PECO2/PETCO2 means
Increase in ventilation or decreased perfusion
167
During CPR the PETCO2 should...
Increase
168
Normal COHb
0-1%
169
COHb for smokers
2-12%
170
Value for Carbon Monoxide poisoning
COHb >20%

TMC (6 decks)

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