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CA test 2
clinical assessment
| Question | Answer |
|---|---|
| what are tracheal breath sounds? | high pitched, loud intensity sounds heard over the trachea |
| what are bronchovescicular breath sounds? | moderate pitch, moderate sound, heard around upper half of sternum and between the scapulae. |
| what are the vesicular breath sounds? | low pitch, soft intensity and heard in the peripheral lung areas |
| what is stridor? | loud, high pitched sound that can sometimes be heard w/o at stethoscope. it is a sign of obstruction and heard mostly on inspiration. |
| what are discontinuous breath sounds? | breath sounds that are intermittent, crackling, or bubbling on short duration. |
| In a diagram of normal breath sounds, what does the thickness of the stroke represent? | the intensity |
| in a diagram of normal breath sounds, what does the angle represent? | the pitch |
| when one hears crackles, what is going on in the airways? | excessive secretions or fluid in the airways OR collapse airways that are popping open during inspiration |
| in what disease processes can you hear polyphonic wheezing? | anytime multiple airways are obstructed eg asthma, bronchitis and CHF |
| what is pleural friction rub? | creaking or grating sound (sounds leathery) that occurs when the pleural surfaces become inflamed and the roughened edges rub together during breathing. usually localized to a certain site of the chest wall. |
| what is bronchophony? | an increase in the intensity and clarity of vocal resonance produced by enhanced transmission of vocal vibrations. |
| what does bronchophony indicate? | inc lung tissue density (eg consolidation in pneumonia) |
| what is the possible lung mechanism behind fine crackles? | sudden opening of peripheral airways |
| when are fine crackles usually heard? | late inspiratory |
| what disease processes are fine crackles associated with? | atelectasis, fibrosis, pulmo edema |
| what is biot's breathing like and what disease process does it indicate? | irregular with periods of apnea. (increased ICP) |
| what is kussmaul breathing and what disease process does it indicate? | deep and fast, like panting. (metabolic acidosis) |
| what is asthmatic breathing like and what disease process does it indicate? | prolonged expiratory phase. (obstructive pulmonary disease) |
| what is cheyne'stokes breathing and what disease process does it indicate? | shallow breathing increases depth and rate followed by a period of apnea. Regular. (CNS problem, CHF) |
| what is apneustic breathing and what disease process does it indicate? | long inspiration, like a sigh. (brain stem injury) |
| what is paradoxical breathing and what does it indicate? | chest wall collapses or moves in while abdomen moves out. associated with respiratory muscle fatigue. |
| what is apnea and what can cause it? | no breathing. (Arrest, complete airway obstruction) |
| where is the PMI (point of max impulse-of heart)? | mid-clavicular line 5th intercostals space |
| PMI shifts towards/away from lobal collapse? | toward |
| PMI shifts towards/away from pneumothorax? | away |
| what is a quiet SI or S2 sound indicative of? | Hyperinflation, poor CO |
| what is ascites especially associated with? | liver cancer, liver cirrohsis, and other cancers |
| hepatomegaly can be sign of what? | right sided heart failure |
| what is clubbing associated with? | Clubbing-chronic long standing hypoxemia, lung cancers, infiltrative/interstitial lung disease, CHD, liver disease, inflammatory bowel disease |
| what is pedal edema? | swelling of lower extremities due to inc in the hydrostatic pressure of the venous system. |
| what disease process is pedal edema associated with? | left and right heart failure. |
| what is blanching? | skin that is white with spots of red |
| what does blanching of skin indicate? | inadequate perfusion, possible lack of arterial blood flow |
| what is cellulitis? | inflammation of soft tissue in the extremity |
| what disease process is cellulitis associated with? | heart failure or obesity or lung disease |
| what are the four parts of the treatment plan and evaluation? | oxygenation, ventilation, airway management and secretion management |
| what is massive hemoptysis? | more than 300 ml in a 24 hour period |
| how long is a normal PR interval on an ECG? | .12 to .20 seconds or 3-5 small boxes |
| what is going on in the heart during the P wave? | Atrial Conduction |
| what is going on in the heart during the QRS complex? | Ventricular Conduction |
| what is going on in the heart during the ST segment? | Time between left ventricular depolarization and repolarization |
| what is going on in the heart during the T wave? | Repolarization |
| on the ECG grid, what does the vertical axis mean? | mV (volts) |
| on the ECG grid, what does the horizontal axis mean? | seconds |
| on the ECG grid, what does one large vertical box mean? | 5 mm or .5 mV |
| on the ECG grid, what does one large horizontal box mean? | .2 sec (.04 per each small box) |
| what is the normal length of a QRS complex? | less than 0.12 sec (3 small blocks) |
| what is the six second rule in counting heart rate on the ECG? | Measure the number of R waves or beats in a six second period then multiply by 10 |
| what is the block rule in counting heart rate on the ECG? | Count the number of large (0.2 sec) blocks between R waves |
| what is the order of heart rate in counting the heart rate for block rule? | 300 (1 block=.2), 150 (2 blocks), 100,75,60,50 |
| what happens during supraventricular tachy? | ectopic focus above the ventricles,HR around 150, electrical pulses from av node have gone a bit crazy, can deteriorate into v tach or v fib. |
| what would you give lidocaine for during an arrhythmia? | to dec mycocardia irritability |
| what would you give nitroglycerine for during an arrhythmia? | potent vasodilator |
| what are colloids? | consist of large molecules that attract and hold water |
| what does tonicity mean? | describes how much osmotic pressure is exerted by a solution |
| what is the tonicity of average body cell fluid? | .9%, is isotonic to .9% NaCL solution |
| what does hypertonic mean? | solution more than .9% |
| what does a CBC lab test mean? | complete blood count test-provides detailed description of WBCs, RBCs and platelets |
| what is leukocytosis? | elevation of the WBC count |
| what is leukopenia? | WBC count below normal |
| what are common causes of leukopenia? | bone marrow disease, chemo and radiation therapy for cancer |
| What is normal WBC count? | 4500 to 11,500 mm3 |
| what is the percentage of neutrophils in the WBC count? | 40% to 75% |
| what is the absolute count of neutrophils? | 1800 to 7500 |
| what are the causes for an abnormality in neutrophil count? | increases due to bacteria infection and trauma, reduced w bone marrow diseases |
| what is the percentage of eosinophils in the WBC count? | 0 to 6% |
| what is the absolute count of eosinophils? | 0 to 600 |
| what are the causes for an abnormality in eosinophils count? | increased w allergic reactions and parasitic infections |
| what is the percentage of basophils in the WBC count? | 0 to 1% |
| what is the absolute count of basophils? | 0 to 100 |
| what are the causes for an abnormality in basophils count? | increased w allergic reactions |
| what is the percentage of monocytes in the WBC count? | 2% to 10% |
| what is the absolute count of monocytes? | 90-1000 |
| what are the causes for an abnormality in monocytes count? | inc w invasion of foreign material |
| what is the percentage of lymphocytes in the WBC count? | 20 to 45% |
| what is the absolute count of lymphocytes? | 900 to 4500 |
| what are the causes for an abnormality in lymphocytes count? | inc w viral infections, reduced count w immunodeficiency probs |
| what is neutrophilia? | elevation of the absolute value of neutrophils |
| what are immature neutrophils referred to as? | bands (due to banded shape of nucleus) |
| what are mature neutrophils known as? | segs |
| when both bands and segs are elevated in the CBC, what does this mean? | body is fighting a more severe bacterial infection. severe infection causes the bone marrow to release both mature and immature neutrophils |
| what is neutropenia? | reduced number of circulating neutrophils |
| what can anemia mean? | RBC production is inadequate or excessive loss of blood has occured |
| what is thrombocytopenia? | significant reduction in the platelet count |
| what hazards come with thrombocytopenia? | pt will bruise easily and at risk for hemorrhage |
| What is the normal value for sodium? | 137-147 mEq/L |
| what is the normal value for potassium? | 3.5 to 4.8 mEq/L |
| what is the normal value for chloride? | 98 to 105 |
| what is the normal value for co2? | 25-33 |
| what is the normal value for BUN? | 7-20 |
| what is the normal value for cholesterol? | 150-220 mg/l |
| what is the normal value for glucose? | 70-105 |
| What does the total co2 mean in terms of hco3? | co2 reps the level of hco3 in venous blood |
| how does elevated hco3 mean for co2? | means elevated co2 |
| what does decreased hco3 mean for co2? | means abnormally low total co2 |
| what are the chloride levels in CF patients? | they are elevated (more than 60-80) bc of their inability to reaborb it |
| how do you calculate the anion gap? | adding hco3 and cl values together and subtracting them from Na |
| what does anion gap evaluate? | the balance between anions and cations in the serum |
| what is the normal range of anion gap? | 8-16 mEq/l |
| what does elevation of the anion gap suggest? | a metabolic acidosis is present (esp if over 16) |
| what are the two most common tests to evaluate kidney function? | BUN and creatinine |
| what will the BUN look like during renal disease? | can be over 20 mg/dl |
| what are normal levels of creatinine? | .7-1.3 mg/l |
| what is range for mild hypoxemia? | 60-80 mmHg |
| what is range for moderate hypoxemia? | 40- 60 mmHg |
| what is range for severe hypoxemia? | 40 or less mmHg |
| for adequate oxygenation, there are five requirements: | transfer of oxygen across the alveolarcapillary membrane,presence of hemoglobin to carry the O2,cardiac output to deliver O2 to the tissue bed,release of O2 from the hemoglobin molecule,ability of the cells to utilize O2. |
| what is the effect of Acidosis, fever, and increased concentrations of 2,3-diphosphoglycerate (2,3-DPG) on the oxy-hb dissociation curve? | shifts it to the right-making oxygen more readily available for delivery to tissues.dec affinity |
| what is the effect of Alkalosis and decreased 2,3-DPG concentrations on oxy-hb dissociation curve? | shifts to the left- increasing oxygen binding to Hgb and potentially reducing oxygen delivery to tissues. inc affinity |
| what are two examples of chemicals that inhibit the cells from using O2? | Lactic acidosis and cyanide poisoning |
| Case study A 47 year old man is seen in the ED Results are : ph 7.47, PaCO2 33, HCO3 20, PaO2 122mmhg. Can this PaO2 be correct? | Using Dalton’s Law and Alveolar air equation: (Pb-H2O) X FIO2 - (PaCO2 X RQ) (760- 47) X .21 - (33 X 1.25) 149.73 – 41.25= 108.48 Alveolar |
| Case study A 47 year old man is seen in the ED Results are : ph 7.47, PaCO2 33, HCO3 20, PaO2 122mmhg. Can this PaO2 be correct? | 108.48 Alveolar 122 arterial Aging – about 3mm loss AC Membrane thickness- about 10 mm loss 122 – (3+10) = 109 arterial |
| what is a way to treat hyperkalemia? | give albuterol up to 10 mg/hr |
| what is the impact of Primary Respiratory Disturbances-Acidosis on dead space? | Increased dead space- ventilation where no gas exchange takes place. |
| Primary Respiratory Disturbances-Acidosis | bad alveolar ventilation- the lung's inability to excrete CO2,Increased production of CO2-Changes in metabolic rate like fever.,Increased dead space- ventilation where no gas exchange takes place |
| Primary Respiratory Disturbances- Alkalosis | Hyperventilation- excessive alveolar production of CO2-Changes in metabolic rate like fever.,Increased dead space- ventilation where no gas exchange takes ventilation. |
| Hypoventilation is frequently seen with | muscle weakness/ fatigue, CNS malfunction, and mechanical disadvantage. |
| Increased production of carbon dioxide is frequently seen in | burn patients, septic conditions, fever, and malnutrition. |
| Increased dead space ventilation is frequently seen | in rapid shallow breathing, anatomical. Disorders, which are characteristic of wasted ventilation like PE. Or V/Q imbalances. |
| Primary Metabolic Disturbances- Acidosis | Loss of plasma HCO3.,Increase in nonvolitile acids. ,Evident by plasma HCO3 less than 22 Meq/l. Anion gap is useful in determining acidosis due to a or b. |
| Loss of plasma HCO3 is frequently seen in | diarrhea, decreased renal tubular function renal disease, hyperalimentation nutrition. Normal anion gap. |
| Increased production of fixed acids is seen in conditions like | diabetic ketosis, lactic acid, ingestion of acids aspirin, methanol, ethylene glycol. High anion gap. |
| Primary Metabolic Disturbance- Alkalosis | Increased levels of plasma HCO3.,Loss of fixed acids.,Evident by plasma HCO3 greater than 26 Meq/l and pH greater than 7.45.,Be aware of compensatory mechanisms, especially in chronic hypoventilation situations |
| what are examples seen that lead to metabolic alkalosis? | Bicarbonate replacement in cardiac arrest. Excessive gastric suctioning or vomiting. hypochloremia and hypokalemia. These are common side effects in the COPD patient taking meds for cor pulmonale, and CHF |
| what type of acid base imbalance is cardiac arrest? | Combined respiratory and metabolic acidosis. Apnea results in anaerobic metabolism that results in an increase in fixed acids. |
| What happens to pH during a cardiac arrest? | pH drops quickly below 7.35 with elevated PaCO2 and decreased HCO3. |
| How do you correct cardiac arrest? | Correct with artificial ventilation and bicarbonate administration. |
| what is the frequency of Combined respiratory and metabolic alkalosis? | it is very rare. |
| what is the apneic threshold? | between 26 and 30 mmHg |
| Hypoxic hypoxia | refers to the condition in which there is inadequate oxygen at the tissue cells caused by low arterial O2 tension |
| Anemic hypoxia | -the oxygen tension in the arterial blood is normal but the O2 carrying capacity of the blood is inadequate. |
| Circulatory hypoxia (aka stagnant or hypoperfusion) | arterial blood that reaches the tissue cells may have a normal O2 tension and content, but the amt of blood and therefore the amt of O2- is not adequate to meet tissue needs. |
| Histotoxic hypoxia | develops in any condition that impairs the ability of tissue cells to utilize oxygen. |
Created by:
blueseas
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