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TMC REVIEW
Patient Assessment Part One
| Question | Answer |
|---|---|
| List the four critical life functions. | Ventilation, Oxygenation, Circulation, Perfusion |
| Which of these life functions is the first priority? | Ventilation |
| What assessments would determine how well a patient is ventilating? | RR, Tidal Volume, Chest Movement, Breath Sounds, PaC02, EtC02 |
| What assessments would determine if a patient has a problem with oxygenation? | HR, Color, Sensorium, PaO2, Sp02 |
| What information would help the therapist determine if a patient's circulation is adequate? | HR, Cardia Output, Strength |
| What changes would indicate that a patient may not have adequate perfusion? | Urine Output, Blood Pressure, Temperature,, Hemodynamics, Sensorium. |
| Explain the difference between "signs" and "symptoms" and list an example of each. | Signs: Objective: What we can see Example: Provider View Symptoms: Subjective: What patient explains Example: Patient Feels |
| List 5 items that are important to examine when reviewing a patient's medical record. | Admitting Diagnosis, History present illness, Chief Complaint, Past medical history, Current Medications |
| Define Advance Directive | Instructions of treatment for patient unable to make medical decisions. |
| List and describe the four types of advance directives. | DNR (Do Not Resuscitate) DNI (Do Not Intubate) Living Will Power of Attorney |
| A properly written order for respiratory care should include what four factors. | Type Of Treatment, Frequency, Medication Dose And Route, Physician Signature |
| The respiratory therapist has just finished administering an aerosol treatment with albuterol to a child with asthma. What should be included in documentation of the treatment? | Record Date, Time, Reaction |
| What is the normal value for urine output | 40 ml/ hr |
| What findings might indicate that the patient's fluid intake has exceeded his urine output | Weight, Electrolyte Imbalances, Increased Hemodynamic Pressure, Decrease Lung Compliance |
| Changes in what value can indicate hypovolemia. | Decrease CVP less than 2 mm Hg |
| Describe medication reconciliation. | Medication list up to date |
| State the proper time period for medication reconciliation once a patient is admitted to the hospital. | 24 Hours |
| Semi comatose | Painful Stimuli |
| Lethargic/ Somnolent | Sleepy |
| Obtunded | Continuous Stimulant |
| When assessing a patient's orientation to time, place and person, what are some of the factors that could affect the patient's ability to cooperate. | Language barriers, Hearing Loss, Medication, Fear, Apprehension, Depression |
| Define activities of daily living | Basic task of everyday living |
| List the six criteria that activates of daily living are based upon. | Dressing, Bathing, Eating, Bathroom, Ambulating, Urine/Bowel |
| ADL are evaluated using the | Katz Scoring System |
| Orthopnea | Unable to breath lying flat. |
| General malaise | Flu Like Symptoms |
| Dyspnea | Shortness Of Breath |
| Dysphagia | Difficult To Swallow |
| What are four factors to consider when conducting a patient interview | Resp Care Plan, Social Support System, Physical environment, Environmental Exposure |
| Define Patient Learning Needs | Patient Education Process |
| What criteria is a patient's ability to learn based upon | Social, Emotional, Motivation, Physical /Cognitive, Language, Age , Education, Levels |
| When reviewing a patient's nutritional status what criteria is evaluated | Dietary History: Food intake, Likes/ Dislikes, Appetite Recent Weight Gain/ Loss Carbs eliminate C02 (Low Carb Diet) |
| Peripheral Edema | Fluid In Extremities Pathology: CHF, Renal Failure |
| Ascites | Fluid In Abdomen Pathology: Liver Failure |
| Clubbing | Swelling In Fingers Pathology: Long Term Hypoxia, CHF, CF, COPD |
| Venous Distention | Increase Pressure Veins Pathology: CVP greater than 12 mmHg, Hrt Failure, CHF |
| Capillary Refill | How Fast Blood Returns to Capillary Pathology: Hypotension, Hypovolemia |
| Diaphoresis | Excessive Sweating Pathology: Hrt Failure, Fever |
| Ashen / Pallor | Unhealthy pale appereance Indicate: Blood Loss, Anemia |
| Erythema | Reddish Skin Indicate: Inflammation, Fever, Infection |
| Cyanosis | Bluish Indicate: Hypoxia |
| Kyphosis | Hump Back Severe Restrictive Disorder |
| Scoliosis | Lateral Curvature |
| Barrel Chest | Increase A-P Diameter |
| Describe Symmetrical Movement | Even Chest Movement |
| List five underlying pathologies that can contribute to a patient demonstrating asymmetrical chest movement. | Pneumothorax, Pleural Effusion, Flail Chest, Post Lung Resection, Ett Tube |
| Eupnea | Normal Breathing Pattern Condition: Healthy |
| Tachypnea | Fast Breathing Pattern Condition: Hypoxia |
| Bradypnea | Slow Breathing Pattern Condition: Overdose, Alcohol, Sleep |
| Cheyne-Stokes | Neuro Breathing Pattern Condition: Brain Stem Injury, ICP |
| Biot's | Increased Rate / Depth Of Breathing Condition: TBI, CNS |
| Kussmaul's | Tachypneic Condition: Keto Acidosis |
| What causes hypertrophy to the accessory muscles and what type of patient might this be present in | COPD |
| Muscle wasting is also referred to as | Atrophy / Cachexia |
| List four changes to a patient's upper airway that might complicate airway patency | Bull neck, Trachea Shift, Enlarged Thyroid, Macroglossia (Big Tongue) |
| Describe the four different Mallampati Classifications | Class 1: Fauces, Soft Pallet, Pillars, Uvulva Class 2: Soft Pallet, Pillars, Uvulva Class 3: Pillars, Uvulva Class 4: Uvulva |
| Mallampati Class 3 & 4 are considered difficult airways and would require the use of a | Glidescope or Bronchoscope |
| What is the normal range for a patient's heart rate | 60-100 |
| What term would you be used to describe a heart rate of 160/min? What would this indicate? | Tachycardia Indication: Oxygen |
| What term would be used to describe a pulse of 52/min? What would this indicate? | Bradycardia Indication: Atropine |
| What does paradoxical pulse/ pulsus paradoxus indicate | Pulse / Blood Pressure varies with respirations |
| Tracheal Deviation Pulled To Abnormal Side | Pulmonary Atelectasis Pneumonectomy Diaphragmatic Paralysis |
| Tracheal Deviation Pulled To Normal Side | Massive Pleural Effusion Tension Pneumothorax Neck / Thyroid Tumor Large Mediastinal Mass |
| Describe Tactile Fremitus | "Touch" Vibration |
| What is meant by tenderness | Skin Is Tender |
| Describe crepitus and the condition it is associated with. | Bubbles of air under the skin Indicate: Subcutaneous Emphysema |
| Resonant | Normal Air Filled lungs |
| Flat / Dull | Less Air Indication: Atelectasis, Pneumonia |
| Tympanic / Hyper-resonant | More Air Indication: COPD, Barrell Chest, A-P Diameter (Bilateral) Pneumothorax (Unilateral)-Chest Tube |
| What is the difference between vesicular and adventitious breath sounds | Vesicular: Normal Adventitious: Abnormal |
| What is egophony and what would it indicate | Say "E" Sounds like "A" Indicate: Consolidation |
| What breath sounds would be expected in a patient with pulmonary edema | Fine Crackles |
| Course Crackles | Description: Upper Airway Treatment: Cough / Suction |
| Medium Crackles | Description: Middle Airway Treatment: Bronchial Hygiene / Percuss/ Vibra |
| Fine Crackles | Description: Alveoli Fluid, CHF, Pulm Edema Treatment: Oxygen, Positive Pressure, Positive Inotropic , Diuretics |
| Wheeze Unilateral Wheeze | Description: Bronchospasm Treatment: Bronchodilator Treatment: Bronchoscope (Rigid) Aspiration, Foreign Body Obstruction |
| Stridor Marked Stridor | Description: High Pitched Supra-Epiglottis Sub:Croup Treatment: Racemic Epi, Suction, Bronch Treatment: INTUBATION |
| Stertor | Description: Noisy Breathing Inhalation Treatment: Treat for sleep apnea |
| Pleural Friction Rub | Description: Pleural Layers Rubbing "Crunchy Sound" Treatment: Steroids / Antibiotic |
| Describe the following heart sounds and when each would occur in the cardiac cycle | S1-Normal closure of mitral / tricuspid valves (Lub) S2-Normal ventricles relax, pulmonic / aortic valve close (Dub) |
| Describe what the following abnormal heart sounds might indicate. | S3 / S4-Abnormal Murmur: Turbulent Blood Flow Bruit: Artery / Vein Blood Flow Turbulent Diagnostic Test: Echocardiogram |
| What effect would cardiac stress have on blood pressure | Increased blood pressure Hypertension / Hypoxemia |
| What effect would hypoperfusion have on blood pressure | Decreased blood pressure Hypovolemia / CHF |
| Normal Blood Pressure | 120/80 Systolic: 90-140 Diastolic: 60-90 |
| Describe the appearance of the normal chest on an X-ray | Both hemidiaphragm rounded dome shape Right Side Higher Than Left Right At The Level Sixth Rib Trachea Midline Radiolucent of Lungs Sharp Costophrenic Angle |
| Exposure / Penetration | Show Intervertebral Disc Spaces Through Shadow Of Mediastinum |
| Under-Penetration | Image Does Not Allow Visualization Of The Intervertebral Disc Thru Hrt Shadow |
| Over-Penetration | Black Lung Parenchyma With Out Blood Vessels |
| What condition causes obliteration of the costophrenic angels | Pleural Effusions |
| In what pathology is the diaphragm flattened | COPD |
| What pathology would cause crowding of the ribs | Atelectasis |
| Lateral Decubitus Position | Patient Lying On Affected Side Small Pleural Effusion |
| End Expiratory Image | Measure Diaphragmatic Excursion Image At The End Exhalation Small Pneumo Thorax |
| Where should the tip of the endotracheal tube be positioned when viewed on a chest roentgenogram | Below Vocal Cords 2-6 CM above Carina At level Aortic Knob/ Arch |
| What is the quickest way to determine adequate ventilation following endotracheal intubation? | Inspection and Auscultation |
| Chest Tube | Pleural Space Surrounding The Lung |
| Nasogastric & Feeding Tube | In The Stomach 2-6 CM Below Diaphragm |
| Pulmonary Artery Catheter | Right Lower Lung Field |
| Pacemaker | Right Ventricle |
| Central Venous Catheter | Superior Vena Cava, Right Atrium Of The Hrt, 4th Intercostal Space, RT Sternum |
| Croup | Steeple Sign, Picket Fence Sign, Pencil Point Sign, Hourglass Sign |
| Epiglottitis | Thumb Sign (Edema, Secretions, Tumors, Aspirated Foreign Body) |
| What type of radiographs are helpful in locating areas of air trapping? | Inspiratory / Expiratory Radiograph |
| Radiolucent | Description: Dark Pattern Air Diagnosis: Normal |
| Radiodense / Opacity | Description: White Pattern Solid Fluid Diagnosis: Normal For Bones /Organs |
| Infiltrate | Description: Ill Defined Radiodensity Diagnosis: Atelectasis |
| Consolidation | Description: Solid White Area Diagnosis: Pneumonia, Pleural Effusions (Chest Tube) |
| Hyperlucency | Description: Extra Pulm Air Diagnosis: COPD, Asthma, Pneumothorax |
| Vascular Markings | Description: Lymphatics Vessels, Lung Tissue Diagnosis: Increased With CHF, Absent With Pneumothorax, |
| Diffuse | Description: Spread Throughout Diagnosis: Atelectasis / Pneumothorax |
| Opaque | Description: Fluid Solid Diagnosis: Consolidation |
| Pulmonary Edema | Terminology: Fluffy Infiltrate, Butterfly Batwing Description: Diffuse, Whiteness, Butterfly Shape Treatment: Diuretic, Digitalis, Digoxin |
| Atelectasis | Terminology: Patchy Infiltrates, Platelike Infiltrates, Crowded Pulmonary Vessels, Crowded Air Bronchograms Description: Scattered Densities, Thin-Layered Densities Treatment: Lung Expansion Therapy SMI / IS, IPPB, CPAP, PEEP |
| ARDS or IRDS | Terminology: Ground Glass Appearance, Honeycomb Pattern, Diffuse Bilateral Radiopathy Description: Reticulogranular, Reticulonodular Treatment: Oxygen, Low VT or PIP, CPAP, PEEP |
| Pleural Effusion Terminology: Blunting/ Obliteration Of Costophrenic Angle Basilar Infiltrates With Meniscus Concave Superior Interface/ border | Description: Fluid Level on Affected Side, Possible Mediastinal Shift to Unaffected Side Treatment: Thoracentesis, Chest Tube, Antibiotics, Steroids |
| Pneumonia | Terminology: Air Bronchogram Description: Increased Density From Consolidation And Atelectasis Treatment: Antibiotics |
| Plumonary Embolus | Terminology: Peripheral Wedge-Shaped Infiltrate Description: May Be Normal Treatment: Heparin, Streptokinase |
| Tuberculosis | Antitubercular Agents |
| Describe CT Scan | X-Ray Through a specific plane of the body part |
| For what pathologies would a CT be indicated | Mediastinal, Pleural and Parenchyma Masses, Pulm Nodules, Bronchiectasis |
| What is the advantage of using MRI over a conventional X-Ray | Two Dimensional Views Of Organ Or Structure With Out Use If Radiation |
| What type of ventilators are used with MRI and why | Non-Electric Gas Powered Lines Wont Be Dislocated If Table Is Moved |
| Describe how this test is performed | Xenon gas inhaled; location of the gas is recorded producing photographic pattern. |
| What is indicated by normal ventilation with abnormal perfusion | Pulmonary Embolism |
| What are three indications for a barium swallow test | Dysphagia, Gastric Reflux, Esophageal Varices, Tracheal Esophageal Fistula |
| A PET scan procedure is used to detect and diagnose diseases earlier than | MRI & CT Scans |
| PET scans are useful in determining the presence of | Cancer, Brain Disorders, & Heart Disease |
| What is the main indication for bronchography? | Tumors and bronchiectasis |
| List two hazards of bronchography | Allergic Reaction Impairment Of Ventilation |
| An EEG is indicated to assess activity of the | Brain Activity |
| List four indications for an EEG | Brain Tumors, Traumatic Brain Injuries, Loss Brain Function, Epilepsy / Seizures, Sleep Study |
| A pulmonary angiogram is indicated to diagnose | Pulmonary Embolism |
| List two indications for a pulmonary angiogram | Pulmonary Embolism Unconclusive VQ / CT Scan |
| An Echocardiogram is | Non Invasive method for monitoring cardiac performance. |
| An Echocardiogram is used to assess. | Overall Cardiac Function, Left Vent Volume, and Ejection Fraction |
| List three indications for an echocardiogram | Abnormal Hrt Sounds, Cardiac Anomality's in infant, MRI, Abnormal Cardiac Blood Flow, Valvular Disease Dysfunction |
| Describe the procedure for cardiac catheterization | Cath into chambers of vessel of the hrt |
| List three procedures that utilize cardiac catheterization | Angioplasty, Percutaneous Coronary Intervention, Angiography |
| What is the normal range for ICP | 5-10mm Hg |
| Treatment is recommended when ICP increases above what level | Greater Than 20 mm hg Hyperventilation (Stop after 48 hours) |
| Define cerebral perfusion pressure | Pressure Gradient Determines Cerebral Perfusion |
| What is the formula to calculate CPP | MAP-ICP |
| What is the normal value for CPP | 70-90 mmHg |
| What is the minimum value for CPP | @Least70 mm Hg |
| What is exhaled nitric oxide testing used to evaluate | Respond to anti-inflammatory treatment (corticosteroid) |
| What does a decrease in patients FEno level suggest | Decrease In Airway Inflammation |
| What is exhaled carbon monoxide testing used to evaluate | Exhaled CO Abstinence in cigarette smokers |
| Heavy Smokers Moderate Smokers Light Smokers Non-Smokers | >20 (5 Min Later) 11-20 (5 Min Later) 7-10 <7 |
Created by:
ltidwell0010
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