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patient assessment
| Question | Answer |
|---|---|
| normal cvp | 2-6 mmhg <2 mmhg indicate hypovolemia >6 mmhg indicate hypervolemia |
| Bradypnea breathing patterns and conditions associated with it | decreased respiratory rate, variable depth and irregular rhythm causes: sleep,drugs,alcohol, metabolic disorders |
| cheyne-stokes breathing patterns and condition associated with it | gradually increasing then decreasing rate and depth in a cycle lasting from 30-180secs, with periods of apnea lasting up to 60 secs. (increase,increase,decrease,decrease,apnea) causes: increased intracranial pressure,drug overdose |
| biot's breathing patterns and condition associated with it | increased resp. rate and depth with irregular periods of apnea causes: CNS problem |
| kussmaul's breathing patterns and condition associated with it | increased respiratory rate,increased depth,irregular rhythm, breathing sounds labored (deeper and deeper, deeper & fast) cause: metabolic acidosis, renal failure,diabetic ketoacidosis |
| What causes hypertrophy of the accesory muscles and what type of patient might this be present in? | accesory muscles are used to increase ventilation during times of stress, increased airway resistance, and decreased compliance. Occurs in COPD. |
| Describe the four neck pathologies that might complicate endotracheal intubation | 1. short receding mandible 2. enlarged tongue(macroglossia) 3. bull neck 4. limited range-of-motion of the neck |
| What is the normal range for a patient's heart rate? | 60-100/min |
| What term would be used to describe a heart rate of 160/min? What would this indicate? | tachycardia, indicates hypoxemia,anxiety,stress |
| What term would be used to describe a pulse of 52/min? What would this indicate? | bradycardia, indicates heart failure,shock,emergency |
| What does paradoxical pulse/pulsus paradoxus indicate? | indicate severe air trapping (pulse/blood pressure goes up and down during breathing) |
| causes of tracheal deviation: PULLED to the abnormal side | 1. pulmonary atelectasis 2. pulmonary fibrosis 3. pneumonectomy 4. diaphragmatic paralysis |
| causes of tracheal deviation: PUSHED to normal side | 1. massive pleural effusion 2. tension pneumothorax 3. neck or thyroid tumors 4. large mediastinal mass |
| What is tactile fremitus? | vibrations that are felt by the hand on the chest wall |
| What is meant by tenderness? | patients skin my be tender around incisions,chest tubes,bruises,fractured bones and burns. |
| What is meant by crepitus and what condition is it associate with? | bubbles of air under the skin that can be palpated and indicates the presence of subcutaneous emphysema |
| What breath sounds would be expected in a patient with pulmonary edema? | fine crackles |
| Describe the following heart sounds and when they would occur in the cardiac cycle SECOND sound (S2) | is normal and occurs when systole ends. The ventricles relax and the pulmonic and aortic valves close |
| Describe the normal appperance of each of the following structures on a chest x-ray HEMIDIAPHRAGMS | Are Rounded (Dome-Shaped) |
| Describe the normal appperance of each of the following structures on a chest x-ray TRACHEA | is Midline, Bilateral Radiolucency, with Sharp Costophrenic Angles |
| Describe the normal appperance of each of the following structures on a chest x-ray CLAVICLES | Head of ClAVICLES Should Be Level |
| What condition cause OBLITERATION of the COSTOPHRENIC ANGLES on a chest xray? | Angle made by the outer curve of the diaphragm and chest wall. These angles are Obliterated by Pleural Effusions |
| In what pathology is the diaphragm flattened on a chest xray? | Flattened with COPD, Left or Right Hemidiaphragms may shift downward with a pneumothorax; appearing Flattened on one side |
| What pathology would cause crowding of the ribs on a chest xray? | atelectasis |
| Describe the following terms in relation to quality of a radiologic images EXPOSURE/PENETRATION | will show the intervertebral disc spaces thru the shadow of the mediastinum |
| Describe the following terms in relation to quality of a radiologic images UNDER PENETRATION | image does not allow visualization of the intervertebral discs thru the heart shadow |
| Describe the following terms in relation to quality of a radiologic images OVER PENETRATION | image will show black lung parenchyma without blood vessels |
| Describe each of the following positions used for chest x-rays and what pathology each can identify: Lateral Decubitus Position | patient lying on the affected side, valuable for detecting small pleural effusions |
| Describe each of the following positions used for chest x-rays and what pathology each can identify:End Expiratory Image | taken when pt is at end-exhalation, valuable for detecting a small pneumothorax |
| Where should the tip of the endotracheal tube be positioned when viewed on a chest roentgenogram? | Should be Positioned below the Vocal Cords and no Closer Than 2cm or 1 in above the Carina. Approximately at the same level of the aortic Knob or Aortic Arch |
| What is the quickest way to determine adequate Ventation following endotracheal intubation? | Observation and Auscultation |
| Describe where each of the following should be located when positioned properly CHEST TUBE | Should be Located in the Pleural Space Surrounding the Lung |
| Describe where each of the following should be located when positioned properly NASOGASTRIC and FEEDING TUBE | Should be Positioned in the Stomach 2-5cm below the Diaphragm |
| Describe where each of the following should be located when positioned properly PULMONARY ARTERY CATHETER | Should Appear in the Right Lower Lung Field |
| Describe where each of the following should be located when positioned properly PACEMAKER | Should be Normally Positioned in the Right Ventricle |
| Describe where each of the following should be located when positioned properly CENTRAL VENOUS CATHETER | Are Placed in the Right or Left Subclavian or Jugular Vein and Should Rest in the Vena Cava or Right Atrium of the Heart |
| What diagnostic test is appropriate for determining an upper airway obstruction in a child? | A Lateral Neck X-Ray (croup and epiglottis) |
| Briefly describe each of the following condition CROUP | A Viral Disorder Common in Infants and Young Children, X-ray will reveal Tracheal Narrowing with Subglottic Swelling in a Classic Pattern called; Steeple Sign, Picket Fence Sign, Pencil Point Sign |
| Briefly describe each of the following condition EPIGLOTTITIS | A Potentially Life-Threating Inflammation of the Supraglottic Airway caused by a Bacterial Infection, Lateral Neck X-ray Shows Supraglottic Narrowing with an Enlarged and Flattened Epiglottis and Swollen Aryepiglottic Folds |
| radiology terminology and interpretation: RADIOLUCENT | dark pattern, air diagnosis: normal for lungs |
| radiology terminology and interpretation: RADIODENSE/OPACITY | white pattern,solid,fluid diagnosis: normal for bones, organs |
| radiology terminology and interpretation: INFILTRATE | any ill-defined radiodensity diagnosis: Atelectasis |
| radiology terminology and interpretation: CONSOLIDATION | solid white area diagnosis: pneumonia/pleural effusion |
| radiology terminology and interpretation: HYPERLUCENCY | extra pulmonary air diagnosis: copd, asthma attack, pneumothorax |
| radiology terminology and interpretation: VASCULAR MARKINGS | lymphatics, vessels,lung tissue diagnosis: increased with CHF absent, absent with pneumothorax |
| radiology terminology and interpretation: DIFFUSE | spread throughout diagnosis: atelectasis/pneumonia |
| radiology terminology and interpretation: OPAQUE | fluid, solid diagnosis: consolidation |
| diagnostic descriptions and interpretation: PULMONARY EDEMA | TERM: fluffy infiltrates, butterfly pattern,batwing pattern DESCRIPTION: diffuse whiteness, infiltrate in shape of butterfly Tx: diuretics, digitalis, digoxin |
| diagnostic descriptions and interpretation: ATELECTASIS | TERM: patchy infiltrates, platelike infiltrates, crowded pulmonary vessels, crowded air bronchograms DESCRIPTION: scattered densities, thin-layered densities |
| diagnostic descriptions and interpretation: ARDS or IRDS | TERM: ground glass appearance, honeycomb pattern, diffuse bilateral radiopacity DESCRIPTION: reticulogranula,reticulonodular |
| diagnostic descriptions and interpretation: PLEURAL EFFUSION | TERM: blunting/obliteration of costrophrenic angel,concave superior interface/border DESCRIPTION: fluid level on affected side, possible mediastinal shift to unaffected side |
| diagnostic descriptions and interpretation: PNEUMONIA | TERM: air bronchogram DESCRIPTION: increased density from consolidation and atelectasis |
| diagnostic descriptions and interpretation: PULMONARY EMBOLUS | TERM: peripheral wedge-shaped infiltrate DESCRIPTION: may be normal |
| diagnostic descriptions and interpretation: TUBERCULOSIS | TERM: cavity formation DESCRIPTION: often in upper lobes |
| Describe a CT Scan | An X-ray through a specific plane of the body part to be examined. Images as narrow slices of the organ or body part |
| With What Pathologies Would a CT be indicated? | Useful in detecting the presence of a Mediastinal Mass, Pleural and Parenchymal Masses and Pulmonary Nodules and Lesions not Visualized on a Chest X-Ray |
| What Special type of CT Scan is indicated to diagnose a Pulmonary Embolus? | A spiral CT scan with contrast dye may be used |
| What is advantage of using MRI over a conventional X-ray? | Magnetic Resonance imaging is used to obtain Two-Dimensional Views of an organ or structure without the use of radiation |
| What type of Ventilators are used with MRI and why? | Fluidic(non-electric, gas powered)Ventilators are used for PT requiring Mechanical Ventilation because the magnetic fields would disrupt electronic devices |
| Describe how this test is performed Pulmonary Ventilation/Perfusion Scans (V/Q Scan) | Radioisotope(xenon gas) is inhaled and the location of the gas is recorded producing a photographic pattern of distribution throughout the lungs |
| What is indicated by normal Ventilation with Abnormal Perfusion | Pulmonary Emboli |
| What are three indications for a barium test? | abnormalities in the Hypopharynx, Esophagus or Stomach |
| A PET scan would be useful to help diagnose what conditions | cancer, brain disorders and heart disease |
| What is the main indication for bronchography? | bronchiectasis |
| List two hazards of bronchograpy | 1. allergic reaction 2. impairment of ventilation |
| A EEG is indicated to assess activity of the __ | brain |
| List 4 indications for an EEG | 1. brain tumors 2. traumatic brain injuries 3. loss of brain function 4. epilepsy |
| A pulmonary angiogram is indicated to diagnose __________ | pulmonary embolism |
| List two indications for a pulmonary angiogram | 1. high clinical suspicion for pulmonary embolism 2. inconclusive V/Q scan and/or CT scan |
| An echocardiogram is a ______ method for monitoring _____ | noninvasive, cardiac performance |
| An echocardiogram is used to assess _____, _____, and ____ | cardiac function, left ventricular volume, ejection fraction |
| List three indications for an echocardiogram | 1. myocardial disease 2. abnormal heart sounds 3. valvular disease or dysfunction |
| describe the procedure for cardiac catherization | catheter is inserted into a chamber or vessel of the heart, once its placed it can be used to perform a number of procedures. |
| List three procedures that utilize cardiac catherization | 1. angioplasty 2. percutaneous coronary intervention (PCI) 3. balloon septostomy |
| What does a CBC(Complete blood count)measure? | Complete blood count measurement of all major ingredients of the blood |
| What are neutrophils? | Major WBC(White Blood Cells) |
| Describe the difference between bands and segs: BANDS | BANDS:Immature cells: normally 4% of WBC; Increased with Bacterial Infections SEGS:mature cells: normally 60% of WBC; Decreased with Bacterial Infections |
| What Pathology would show an increase in eosinophils? | asthma; 2% of WBC; Increased with ALLERGIC Reactions (Produce Yellow Sputum) |
| What are electrolytes and what is their function? | Elements required by the body for normal metabolism, Closely associated with fluid levels and kidney fuction |
| Describe the signs and symptoms of an electrolyte imbalance? | Muscle weakness, soreness, Nausa Mental changes(Lethargy, Dizziness,Drowiness) |
| State the normal value for creatinine and describe what the test evaluates | |
| State the normal value for BUN and describe what the test evaluates | normal value: 0.7-1.3mg/dL evaluates kidney function |
| What would an increase in BUN indicate? | increase in BUN indicate Kidney failure |
| What would each of the following types of sputum be associated with? MUCOID | chronic bronchitis (white/gray) |
| What would each of the following types of sputum be associated with? YELLOW | presence of WBC -baterial infections |
| What would each of the following types of sputum be associated with? GREEN | stagnant sputum - bronchiectasis, pseudomonas |
| What would each of the following types of sputum be associated with? BROWN | aerobic lung infection (old blood) |
| What would each of the following types of sputum be associated with? BRIGHT RED | bleeding tumor, TB - hemoptysis |
| What would each of the following types of sputum be associated with? PINK FROTHY | pulmonary edema |
| What bacteria is identified by an acid fast stain? | mycobaterium tuberculosis |
| What information is obtained from a culture & sensitivity? | culture to identify the bacteria present sensitivity to identify what antibiotics will kill the bacteria, takes 48-72hr |
| What information is obtained from a gram stain? | identifies whether bacteria are gram positive or gram negative, takes 1hr |
| Coagulation studies are a series of tests that evaluate ________________ | the clotting mechanism of the body |
| Elevated level of BNP indicate __________ | CHF |
| A mantoux test is the most reliable test for detecting ______ | TB sensitivity |
| Allergy testing may be indicated in patients with ______ | asthma, to help identify allergen triggers such as dust, pollen, mold and food |
| List the two types of allergy test procedures | 1. skin-prick or scratch test 2. intracutaneous test |
| Describe the clinical use of the following Equipment OSCILLOSCOPE | provides a continuous visual image of the electrical activity of the heart on a screen |
| Describe the clinical use of the following Equipment ELECTROCARDIOGRAPH | instrument used for recording the electrical activity of the heart |
| Describe the clinical use of the following Equipment HOLTER MONITOR | a portable version of electrocardiograph that is worn under the clothes by the pt for 24-48hrs period to detect cardiac arrhythmias. |
| Briefly describe the electrophysiology of the heart. | |
| Label the P,Q,R,S, and T waves on the following tracing: | |
| The axis of an ECG measures | the net direction fo all the electricity through the heart during contraction |
| What is the direction of the normal axis? | down and to the left |
| What two factors will affect the direction of the axis? | hypertrophy and infarction |
| Define an electrode | an object placed on the skin to conduct electric current from the body to a monitoring or measuring device |
| Define a lead | displays movement of electricity from one electrode to another |
| How many electrodes are use for a 12 lead ECG? | 10 |
| Which LIMB LEAD will normally produce a negative or upside down pattern? | AVR |
| Describe two methods used to measure the heart rate on an ECG strip | 1. 300/ # of large boxes between R waves 2. 1500/ # of small boxes between R waves |
| If an ECG tracing has regular and distinct P wave with R waves that are 6 large boxes apart this would be interpreted as ____ | 300/6= 50, <60 bradycardia |
| A patients ECG tracing has 5 large boxes between the R waves. What is the estimated heart rate for this patient. | 300/ # of large boxes between R waves 300/ 5 = 60 |
Created by:
ruthpeligrino
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