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patient assessment

QuestionAnswer
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