Patient Assessment - Respiratory

Question 1

Define:

Adventitious Breath Sounds

Answer 1

Abnormal airway sounds.

Question 2

What position do patients sit in when experiencing respiratory distress?

Answer 2

• Tripod position
• Semi-Fowler position

Question 3

What is the normal respiratory rate in infants?

Answer 3

25-50 breaths/min.

Question 4

What is the normal respiratory rate in children?

Answer 4

15-30 breaths/min.

Question 5

What is the normal respiratory rate in adults?

Answer 5

12-20 breaths/min.

Question 6

Define:

Orthopnea

Answer 6

Shortness of breath when lying flat.

Typical in obese and patients with heart failure.

Question 7

List visual assessment questions for the Respiratory Distress patient.

Answer 7

• Patient position?
• How adequate is the rise and fall of the chest?
• Gasping for air?
• Skin color?
• Flaring of nostrils?
• Pursed Lips?
• Retractions?
• Accessory muscle use?
• Is the chest wall moving symmetrically?
• Rate or rhythm of breathing?

Question 8

Define:

Paradoxical Motion

Answer 8

Chest segment moves:

• IN during inhalation.
• OUT during exhalation.

Question 9

What causes Paradoxical Motion?

Answer 9

flail chest

Question 10

Define:

Pulsus Paradoxus

Answer 10

Systolic BP drops more than 10 mmHg during inhalation.

Question 11

What causes Pulsus Paradoxus?

Answer 11

• Pericardial tamponade
• Severe COPD
• Tension pneumothorax

Increased intrathoracic pressure

Question 12

What commonly exacerbates Asthma?

Answer 12

• cold weather
• stress

Question 13

What is a good assessment tool for indication of an intact gag reflex?

Answer 13

eyelash reflex

Question 14

How do you assess breath sounds?

Answer 14

• Anteriorly
• Posteriorly

Key areas:

1. Apex
2. Base
3. Bilaterally

Question 15

Define:

Cheyne-Stokes respiration

Answer 15

Increasing rate and depth of breathing, followed by a decrease, and a period of apnea.

Question 16

What indicates Cheyne-Stokes respiration?

Answer 16

brainstem insult

Question 17

Define:

Kussmaul respiration

Answer 17

Rapid and deep breathing.

Question 18

What indicates Kussmual respiration ?

Answer 18

Diabetic Ketoacidosis

DKA

Question 19

Define:

Biot respiration

Answer 19

Irregular rate and depth of breathing, with periods of apnea.

Question 20

What indicates Biot respiration?

Answer 20

Increased intracranial pressure.

Question 21

Define:

Agonal respiration

Answer 21

Shallow, slow and irregular breathing.

Question 22

What indicates Agonal respiration?

Answer 22

Near death, caused by cerebral hypoxia.

Question 23

If there is concern for upper airway obstruction, what breath sounds should you also obtain?

Answer 23

Tracheal breath sounds

Question 24

Define:

I/E ratio

Answer 24

The ratio between inhalation and exhalation in terms of time.

Question 25

What is the normal **I/E Ratio**?

Answer 25

1 : 2 ## Footnote 1: inhalation 2: exhalation

Question 26

What **I:E ratio** will be seen in patients who have **difficulty exhaling?**

Answer 26

1:4 or 1:5

Question 27

# Fill in the blank. **Always** auscultate directly on the patient's \_\_\_\_\.

Answer 27

skin

Question 28

# Define: wheezing

Answer 28

**High-pitched** breath sound.

Question 29

What causes **wheezing**?

Answer 29

* COPD * Anaphylaxis * Asthma

Question 30

# Define: Rhonchi

Answer 30

**Perfuse crackles** throughout the larger lower airways. ## Footnote Rhonchi are worse than crackles.

Question 31

What causes **rhonchi**?

Answer 31

* Pulmonary edema * Bronchitis

Question 32

# Define: crackles

Answer 32

**Popping sounds** from the lower airway and often clear from coughing.

Question 33

# Define: stridor

Answer 33

**High pitched and loud** heard during inhalation.

Question 34

What causes **stridor**?

Answer 34

* Foreign body obstruction * Upper zirway obstruction ## Footnote Inflammation of structures,

Question 35

What does a **pulse oximeter** measure? | SpO₂

Answer 35

**Percentage of hemoglobin** that is saturated with oxygen in arterial blood.

Question 36

What is the target **SpO₂**?

Answer 36

\> 94%

Question 37

List **causes** of erroneous **SpO₂** readings?

Answer 37

* bright light * patient movement * poor perfusion * nail polish * abnormal Hgb

Question 38

# Define: carboxyhemoglobin

Answer 38

The amount of **carbon monoxide** loaded onto hemoglobin.

Question 39

What are the **normal ABG values**?

Answer 39

* pH: **7.35-7.45** * PaO₂: **80-100 mmHg** * PaCo₂: **35-45 mmHg** * HCO₃: **22-26 mEq/L**

Question 40

What does the **End-Tidal CO₂** measure? | EtCO₂

Answer 40

It measures **CO₂** in exhaled air.

Question 41

What is the **normal EtCO₂**?

Answer 41

35-45 mmHg

Question 42

# Define: normal waveform capnography

Answer 42

**Sudden increase** during exhalation, with a **gradual plateau** at end exhalation.

Question 43

During **hyperventilation**, the EtCO₂ reading \_\_\_\_\_\.

Answer 43

decreases ## Footnote Pt is blowing off CO₂.

Question 44

During **hypoventilation**, the EtCO₂ reading \_\_\_\_\_\.

Answer 44

increases ## Footnote Pt is retaining excess CO₂.

Question 45

How is the patient placed in the **recovery position**?

Answer 45

Left Lateral Recumbent position

Question 46

What are the procedures for performing the **Head Tilt Chin Lift**?

Answer 46

1. Ensure the pt is in the supine position. 2. One hand is on the forehead, and the other is under the jaw. 3. Lift the chin upward, lifting the entire mandible with it.