spc
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| Mucoid Sputum | clear, thin= Asthma
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| Frothy Sputum | Pulmonary Edema
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| Purulent sputum | thick, colored (pus)
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| Yellow/Green/Copious Sputum | Cystic Fibrosis w/ pseudomonas infection
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| Rusty Sputum | Streptococcal pneumonia
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| Fetid Sputum | Foul smelling = lung abscess
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| Tachycardia causes | > 100/min - hypoxemia, hypertension, fever, anxiety
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| Bradycardia causes | < 60/min - complete heart block, endurance athletes, beta blockers
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| Tachypnea causes | > 20/min - "J" receptor stimulation, metabolic acidemia, anxiety
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| Bradypnea causes | < 10/min - drug o.d., head trauma, hypothermia
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| Hypertension causes | > 150/90 - high SVR
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| Hypotension causes | < 90/60 - hypovolemia, shock, CHF
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| Pursed lip breathing seen in | COPD, prevents airway closure
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| What is Ptosis? Causes? | Drooping eyelids. Myasthenia Gravis
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| What is JVD? Common cause? | Jugular Venous Distention: method quantifying R heart pressure. Cor Pulmonale(abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels)
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| Suprasternal Notch | Groove at the top of the Manubrium. Palpate to check for tracheal shifts.
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| Barrel Chest occurs? | COPD
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| Obstructive Breathing | 'Pursed Lips', prolonged exhalation, active neck accessories w/ 'clavicular lift'
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| Restrictive breathing | rapid, shallow, decreases WOB
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| Vocal Fremitus | Vibrations from vocal cords
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| Tactile Fremitus | Palpation to assess vocal fremitus, pt repeats '99'
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| Paradoxical Movement | Chest wall goes in w/ inspiration, out w/ expiration
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| Abdominal Paradox | Abdomen sinks in w/ inspiration, seen in COPD pts w/ impending ventilatory failure
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| Acrocyanosis | Peripheral - nailbeds, due to poor perfusion, low CO, often in COPD pts
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| Central Cyanosis | Oral mucosa, due to severe -
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| Increased Tactile Fremitus | Denotes increased density(consolidation)(less air), pneumonia, atelectasis, fibrosis
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| Decreased Tactile Fremitus | Denotes decreased density(more air), pneumothorax, emphysema
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| Thoracic Expansion - Bilateral Decrease causes | COPD, neuromuscular diseases
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| Thoracic Expansion - Unilateral Decrease causes | Lobar consolidation, atelectasis, pneumothorax, pleural effusion
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| Subcutaneous Emphysema | Air w/in subq tissues, noted w/ pneumomediastinum & pneumothorax, feels like bubble wrap & sounds like rice crispies
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| Normal Percussion sound | Easy to hear, low pitch
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| Hyperresonant sound & causes | Pneumothorax. Hyperinflation from asthma, emphysema (more air)
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| Dullness sound & causes | Atelectasis, pleural effusion, consolidation(pneumonia) (less air, dull, dense, fluid)
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| Bronchial causes | Denotes loss of alveoli - consolidation, atelectasis
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| Diminished causes | Hypoventilation, hyperinflation, pneumothorax(absent), pleural effusion
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| Adventitious sound & causes | Heard in the airways - crackles - 'velcro'. Fluid in the airways, CHF, secretions
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| Wheezing sound & causes | bronchospasm, asthma, large airway obstruction, chronic bronchitis
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| Stridor causes | Upper airway obstruction - croup, post-extubation
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| Hepatomegaly | enlarged liver, Assoc w/ Cor Pulmonale
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| Ascites | Serous fluid in the peritoneal cavity. Assoc w/ CHF
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| Clubbing | Enlargement of terminal phalanges. Assoc w/ CHF, COPD
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| Pedal Edema | Fluid in the subq tissues of the ankles/feet. Assoc w/ CHF, Cor Pulmonale
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| Slow Capillary Refill assoc w/ | Hypovolemia, CHF
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| Cold hands, feet assoc w/ | Shock, hypovolemia
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| COPD inspection | JVD, 'pursed lips', active neck accessories w/ 'clavicular lift', barrel chest, hepatomegaly, clubbing, acrocyanosis, pedal edema, Decreased tactile fremitus, thoracic expansion bilateral decrease, Hyperresonant. Diminished, wheeze
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| Consolidation inspection | Increased tactile fremitus, thoracic expansion unilateral decrease, Dullness. Bronchial breath sounds
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| Tension Pneumothorax inspection | Thoracic expansion unilateral decrease, tracheal shift(away), Hyperresonant. Absent breath sounds. Blood pressure drops, peak vent pressure increases
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| Pleural Effusion inspection | thoracic expansion unilateral decrease, tracheal shift(away), Dullness. Absent breath sounds
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| Cor Pulmonale inspection | JVD, hepatomegaly, pedal edema
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| Shock/Hypovolemia | Slow capillary refill, peripheral skin temp decreased
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| What is Radiolucent? | black areas on xray, low density, air (pneumothorax, bullae, pneumatoceles, parenchyma)
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| What is Radiopaque? | White or grey areas on xray, high density, fluid, fat, bone
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| The trachea shifts towards problems within the lungs and? | away from problems outside of the lungs
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| PA engorgement = | Cor pulmonale
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| Cardiac silhouette description | Heart ratio should be< 50% size of chest area, Right diaphragm 2cm higher than Left
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| Atelectasis xray description | Lobar, tracheal shift toward affected area, hemidiaphragm elevation, narrowed posterior rib spaces, volume loss
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| Pneumothorax xray description | Black hemithorax, lung mass toward Hilum, tracheal shift away from affected area
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| Hyperinflation (copd) xray? | Narrow tear/pear shaped heart, prominent PAs, low & flat diaphragms, wide posterior rib spaces, horizontal posterior ribs, radiolucent lung fields, small or narrow heart shadow
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| A miliary pattern in the apicies? | TB
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| If there is white where there should be black on an xray, this is called? | consolidation, Aleolar opacification (white areas)
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| Interstitial Disease xray description | "Cobbwebs", Honeycombing, miliary pattern, diffuse nodules 2-4cm diameter
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| A ground glass appearance? | ARDS
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| Cardiogenic Pulmonary Edema (CHF) xray desription? | Increased heart ratio > 50%, Kerly B lines - prominent in R lung base, lymph vessels full of fluid. Blunted C/P Angles - notably on R side, dense fluffy lung field opacities that project out from the Hilar areas that look like a 'batwing' or 'butterfly'
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| Blunting of the costophrenic angles and a menicus sign are noted with? | pleural effusion
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| What is a stemi? | an elevated or depressed ST segment. ST elevated MI, not getting enough O2 to the heart causing ischemia
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| Frothy white or pink sputum is noted with | Pulmonary edema
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| The two most common causes of hemoptysis are bronchogenic carcinoma and | chronic bronchitis
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| A child with croup will exhibit a cough most commonly referred to as | barking, can have stridor
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| Wheezing is commonly described as | chest tightness
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| An increase in the cardiothoracic (C/T) ratio is most commonly associated with | CHF
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| Hemidiaphragm elevation and loss of lung volume are noted on chest film with | atelectasis
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| A D-Dimer blood test is ordered for a suspected blood clot? | positive results indicates clot
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| A CPK test if? | marker of stress to muscle tissue, could be heart or even exercise, and systemic inflammation
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| A 3rd heart sound is abnormal and indicates? | CHF
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| A 4th heart sound is abnormal and indicates? | cardiomegaly or MI, left cardiomegaly (COPD) Right cardiomegaly( High BP)
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| When an MI is suspected, troponin levels are drawn? | >0.1 indicate an MI
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| An elevated brain natriuretic peptide (BNP) ? | CHF
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| Shock is? | not getting enough 02 to a vital organ
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| When tissues don't get enough 02 they produce lactate, a lactate great than 2 indicates? | shock, improving lactate mean 02 therapy is working
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| A low BP can cause organs to not get enough 02 because of lack of blood circulation, this can cause? | septic shock, when blood pressure drops significantly
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| Systemic vascular resistance is normally 900-1400, a reduced SVR indicates? | sepsis
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| Cardiogenic pulm edema occurs with an elevated PCWP >20, non cardiogenic? | pulm edema with normal wedge= ARDS
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| Fluid overload, hypervolemia, known as flooding will increase? | all hemodynamic values, including BP
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| Dehydration, shock, blood loss, known as drought will decrease? | all hemodynamic values including BP
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| A patient with a lactate greater than 2? | not getting enough 02, shock
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| What is the normal RBC count for males and females? | males 5-6 mill, females 4-5 mill
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| What are the normal HB levels? | males 14-17 g/dl, females 12-15 g/dl
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| What are the normal hematocrit levels? | males 40-50%, females 35-45%
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| What is the normal WBC level? | 5000-10,000/mm
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| Leukocytosis is an icrease in WBC's, this indicates? | bacterial infection or inflammatory response
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| Leukopenia is a decrease in WBC's, this indicates? | chemo, radiation, systemic disease
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| Anemia will? | decrease RBC, HB, Hematocrit
increased RBC breakdown, or decreased RBC production, blood loss
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| Polycythemia is increased RBC, HB, and hematocrit, this is seen in patients with? | chronic hypoxemic lung/heart disease, can cause rt heart failure, treated with 02 therapy
COPD, pulm fibrosis
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| If eosinophilia is found in the sputum this always indicates? | Asthma
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| Thrombocytopenia is a decrease in clotting cells, this poses a risk of bleeding. What symptoms are seen with this? | petechiae(red, purple spots), ecchymosis (blue, black spots)
caused by meds like prednisone, heparin
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| What is SOAP? | Subjective- Pt states, Objective- therapist finds (vitals, ABG), Assessment- therapists conclusion based on S and O, Plan-treatment plan
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| Oxygen therapy protocol is used too? | treat hypoxemia, decrease wob, and decrease myocardial workload
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| Hyperinflation protocol is used to prevent or treat atelectasis and alveolar consolidation, the methods for this are? | cough and deep breathing, IS, IPPB, CPAP, PEEP
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| Bronchial hygiene therpay is used to mobilize secretions, these methods are? | increased bronchial hydration, cough and deep breathing, CPT, PD, percussion, suctioning, mucolytic, bronchoscopy,
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| What is an infiltrate seen on an x-ray? | A pulmonary infiltrate is a substance denser than air, such as pus, blood, or protein, which lingers within the parenchyma of the lungs. Pulmonary infiltrates are associated with pneumonia, tuberculosis
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| What is an air bronchogram seen on an xray? | filling of alveoli by fluid or inflammatory exudates.
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| What vent parameter is most commonly seen in a patient with sepsis? | high ve
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| What are symptoms of DKA? | fruity breath, kussmauls, possible coma
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| What are the clinical indications to provide oxygen therapy? | Sp02 <90%, Pa02 <80
Acute Hypoxemia; tachypnea, tachycardia, cyanosis, confusion
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| What are clinical indications for hyperinflation therapy? | atelectasis, consolidation, fibrosis, opacity (white area) seen on xray, bronchial breath sounds, dull percussion note, restrictive pft's
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| What are clinical indications for bronchial hygiene therapy? | excess sputum with a weak or strong cough, consider color of sputum, sputum viscosity, and ronchi breath sounds
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| What are clinical indications for aerosolized therapy? | bronchospasm, airway secretions, relax bronchial smooth muscle, wheezing,
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| What is transudate sputum? | thin and watery, few cells, less protein, CHF, Pulm emboli
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| What is exudate sputum? | thick and opaque, many WBC's, more protein, pneumonia, TB, lung cancer, fungal disease
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