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Tuesday Test 1/9/18

Types of Assessment (4) 1) Initial 2) Emergency 3) Focused 4) Ongoing
What is Initial Assessment? 1st encounter with patient
What is Emergency Assessment? Life threatening (immediate) problems
What is Focused Assessment? Detailed examination
What is Ongoing Assessment? Every subsequent visit with pt after the 1st visit
Types of Data ........... (2) 1) Subjective 2) Objective
Assessment is the process of ........ (3) 1) Collecting Data 2)evaluating data 3)developing a treatment plan
What is subjective data? Symptoms the pt tells you
What is Objective data? Signs that you observe or collect
Role of Respiratory Practitioner (3) Collect data to determine: 1) degree of anatomic alterations & clinical manifestations 2) Select optimal treatment/dlvy therapy 3) Document Everything
Optimal Treatment / Therapy To correct anatomic alterations and pathophysiologic mechanisms caused by disease
4 Life Functions in order of importance 1) Ventilation 2) Oxygenation 3) Circulation 4) Perfusion
6 Major Vital Signs 1) Temperature (T) 2) Pulse (P or PR) 3) Respiration (R or RR) 4) Blood Pressure (BP) 5) Pulse Ox (SpO2) 6) Blood Glucose Level
Normal Body Temperature 37 degrees C +/- 0.5 degrees (98.6 degrees F +/- 2 degrees)
Normal Temp Ranges Adult = 97-99 Child 98.6-99.6 Infant 96-99 Geriatrics 95-99
Why does Increased temp causes vasodilation? Allows more warm blood to flow near the surface of the skin, where the heat can be lost to the air.
Decreased temp causes vasoconstriction why? Blood vessels supplying warm blood to the skin become narrow or constrict (vasoconstriction). This reduces the flow of warm blood near the surface of the skin, and reduces heat loss.
Febrile Having or showing symptoms of fever
Afebrile Not feverish
Hyperthermia Having a body temperature greatly above normal. Synonym of Pyrexia.
Pyrexia Raised body temp; fever. Synonym of Hyperthermia.
Hypothermia Abnormally low body temperature, usually dangerously low.
Induced Hypothermia (aka targeted temp mgmt) deliberate reduction of core body temp in pts who don't regain consciousness after cardiac arrest.
Factors that affect temperature 1) age 2) environment 3) Time of day 4) exercise 5) stress 6) hormones
Sites to check temperature 1) oral 2) rectal 3) ear (aural) 4) axillary (armpit or groin)
Nine pulse sites 1) Radial 2) brachial 3) carotid 4) femoral 5) dorsalis pedis 6) apical (apex of heart) 7) posterior tibial (back ankle) 8) popliteal (back knee) 9) temporal (temple)
Normal Ranges of pulses Adult = 60-100 Child = 60-130 Infant >= 100
Rhythm of pulse is described as ...... Regular or irregular
Strength of pulse is described as ....... Strong, Weak, or Bounding (unable to palpate)
Conditions that may alter strenghth of pulse Pulsus alternans, Pulsus paradoxus, Stimulation of SNS, Stimulation of PNS
Pulsus alternans Arterial pulse alternating strong and weak beats.
Pulsus paradoxus Abnormally large decrease in stroke volume, systolic blood pressure and pulse during inspiration.
Tachycardia Heart rate that exceeds the normal resting rate. +100 BPM
Bradycardia Slow heart rate, below 60 BPM, but usually does not cause symptoms until the rate drops below 50 BPM.
Inspiration is ...... active
Expiration is ....... passive
Inspiration and expiration together equal....... one whole respiration
Correct way to count respiration Start counting with first inspiration• Infants and children: count a full minute. • Adults: count for 30 seconds x2 or 15 seconds x4
Normal Ranges for breaths per minute (BPM) Adult = 12-20 Child = 20-40 Infant = 30-60
Tachypnea Abnormally fast breathing
Bradypnea Abnormally slow breathing
Apnea Not breathing
Hypoventilation Breathing at abnormally slow rate, causes increased CO2 in blood
Hyperventilation Breathing at abnormally fast rate, causes decreased CO2 in blood
Cheyne Stokes Abnormal breathing; gradual increase in rate & depth, followed by decrease resulting in apnea
Kussmaul Deep and labored breathing pattern
Biots Abnormal breathing; groups of quick, shallow breaths, followed by regular or irregular periods of apnea
Systolic Blood Pressure definition and Range The maximum arterial pressure during contraction of left ventricle; 100-139
Diastolic Blood Pressure definition and Range The minimum arterial pressure during relaxation and dilation of ventricles when they fill with blood; 70-89
What is pulse pressure and Range? Difference between systolic and diastolic pressures. Represents the force the heart generates when contracting; 30-50
Pulse pressure equation PP = SBP - DBP
Blood pressure is determined by ....... Flow and resistance
Blood flow is equal to ...... Cardiac output
Cardiac Output equation CO = SV x HR
Why would there be decreased SV? 1) poor pumping action 2)decreased blood volume
What decreases both CO and flow? Bradycardia
What increases both CO and flow? Increased HR or blood volume
What happens when heart is compensating to maintain CO and flow? Increased HR develops in response to decreased SV or BV
Resistance increases as....... vessels constrict
Resistance decreases as...... vessels dialate
What regulates and monitors vascular tone? Autonomic nervous system
Hypertension Abnormally high blood pressure; a state of great psychological stress
Factors for hypertension Age, race, family history, overweight, not physically active, smoking, too much salt, too little potassium
Why does chronic hypertension lead to CHF? It can cause ischemic heart disease; means that the heart muscle isn't getting enough blood; is usually the result of atherosclerosis, which impedes blood flow to the heart
Hypotension Abnormally low blood pressure
Hypotension is associated with ...... Causes inadequate flow of blood to the body's organs; can cause strokes, heart attacks, & kidney failure. It's most severe form is shock. Common causes of low blood pressure include a reduced volume of blood, heart disease, and medications.
Causes of Hypotension Reduced volume of blood, heart disease, and medications.
Symptoms of Hypotension fatigue. lightheadedness. dizziness. nausea. clammy skin. depression. loss of consciousness. blurry vision.
Orthostatic Hypertension (aka postural hypertension) Sudden and abrupt increase in BP when person stands; a rise of 20 or more when standing.
Pulse Oximetry (SaO2 or Pox) Normal Range Newborns = 88-90% All others >= 95%
Range of Mild hypoxia Newborns = 86-88% All Others = 90-95%
Range of Moderate hypoxia Newborns = 85-86% All Others = 85-90%
Range of Severe hypoxia Newborns = 83-85% All Others = below 85%
What is sequence of Physical Exam of chest and lungs? 1)Inspection 2)Palpation 3)Percussion 4)Auscultation
Inspection Visual examination of the abdomen; shape of the abdomen, skin abnormalities, abdominal masses, and movement of the abdominal wall with respiration.
Palpation Palpation of pts anterior and posterior chest walls; assesses for tenderness and degree of chest expansion
Percussion Percussion of pts anterior and posterior chest walls; method of tapping on chest to determine the underlying structure
Ausculation Listening to lung sounds, usually with a stethoscope
Types of Sputum Description Color, Smell, Amount, Consistency
Descriptions used for color of sputum Clear, white (opaque), yellow, yellow-green, green, brown, blood-tinged, pink, bloody
Descriptions used for smell of sputum Odorless or Foul
Descriptions used for amount of sputum Copious, moderate, small
Descriptions used for consistency of sputum Thin, thick, tenacious (stick together), viscous (thick), watery, purulent (pus) , mucopurlent (sticky & pus), frothy (bubbly)
Types of patient cough efforts Weak, poor, fair, good, strong, effective (clears or produces sputum), ineffective (nonclearing and no sputum)
Normal ABG's PaO2 = 80 - 100 mmHg, PaCO2 = 35 - 45 mmHg, pH = 7.35 - 7.45, HCO3 =22-26 (28), SaO2 = 95 - 100%
Range of Sodium Na+ 1.35-1.45 mEq/L
Range of Potassium K+ 3.5 - 4.5 mEq/l
Rangle of Chlorine Cl- 85 to 100 mEq/l
Range of Calcium Ca++ 4.5 to 5.5 mEq/l
Glucose levels normal 70 to 110 mg/dl <100 1st am <140 2hrs after meal
BUN (Blood Urea Nitrogen) Test kidney function 7 to 20 mg/dl
Creatinine Test kidney function 0.5 to 1.2 mg/dl
Bilirubin Test liver function 0.1 to 1.2 mg/dL
Blood chemistry studies drawn in ...... Red or Speckled top tube
Hematology Studies drawn in ....... Purple top tube with EDTA
Coagulation Studies drawn in ........ Blue top with heparin
RBC normal range 4-6 mill/mm3
Hgb normal range 12-16 g%
Hct (hematocrit) normal range 40-50%
WBC normal range 5,000 to 10,000 mm3
Neutrophils range WBC 60-70%
Lymphocytes range WBC 20-25%
Monocytes range WBC 3-8%
Eosinophils range WBC 2-4%
Basophils range WBC 0.5 - 1%
Normal platelet count 150,000 to 350,000 mm3
Bronchoscopy procedure where dr looks at your airway through a bronchoscope. Dr will examine your throat, larynx , trachea, & lower airways. Performed for diagnostic & therapeutic purposes
Thoracentesis Procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. Done for diagnostic and therapeutic purposes.
What does SOAP stand for? S=Subjective Information O=Objective information A=Assessment of pt P=Plan for treatment modalities
Common information charted in Respiratory section of pts medical records 1) Dr orders & f 2)Time/date 3)V/S (PR, RR &SpO2) pre & post 4) Chest inspection 5)Meds admin 6)O2 therapy 7)Sputum 8) ABG results 9) Comment section
Hypoxia Ranges in All except newborns Mild = 90 - 95% Moderate = 85-90% Severe < 85%
Normal PaO2 Range 75-100 mm Hg
Normal PaCO2 Range 35-45 mm Hg
Normal pH Range 7.35-7.45
Normal HCO3 Range 22-26 (28)
Created by: Beccaboop