Patient Evaluation

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Author:
Anonymous
ID:
198604
Filename:
Patient Evaluation
Updated:
2013-02-07 01:48:23
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Respiratory Therapy
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Respiratory Therapy
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  1. 4 Life Functions
    • Ventilation: RR,TV, Chest Movement, BS, PaCO2
    • Oxygenation: HR, Color,Sensorium, PaO2
    • Circulation: pulse/HR & strength, cardiac output
    • Perfusion: BP, Sensorium, Temp, Urine output, Hemodynamics
  2. Smoking History equation 
    • Pack yrs=#packs/day X #yrs smoked
    • EX: 4 packs/day X 10 yrs=40yrs
  3. What is Lethargic, somnolent, sleepy ?
    COPD O2 overdose, sleep apnea
  4. What is stuporous, confused?
    responds inappropriately, drug overdose, intoxication.
  5. What is obtunded?
    drowsy state, decreased cough or gag reflex (possible aspiration) 
  6. What is anxiety, nervousness?
    Watch every movement asthmatic, respiratory distress, hypoxemia 
  7. What is euphoria?
    Drug overdose
  8. When a patient has anger, combative, irritalbe?
    electrolyte imbalance 
  9. What disease is associated with orthopena? 
    • Heart Problem
    • CHF
  10. What to look for in patient/family history?
    • HX Present Illness
    • Past medical history 
    • Family history
    • Social history
  11. Peripheral Edema?
    • Excessive fluid in tissues
    • In arms & ankles
    • CHF/Renal Failure 
  12. Venous Distention
    • CHF
    • Obstructive lung disease, during exhalation
  13. Erythema
    • Redness skin b/c capillary congestion, inflammation or infection 
    • Transcutaneous monitor 
  14. What is Eupnea?
    Normal RR, depth, rhythm
  15. What is tachypnea?
    increased RR
  16. What is bradypnea?
    decreased RR
  17. What is hyperpnea?
    • increased RR
    • increased depth, regular rhythm
  18. What is Biots?
    Increased RR, depth w/irregular periods of apnea each breath same depth. 
  19. What is Kussmauls?
    • Increased RR, depth irregular rhythm, BS labored
    • Need insulin for tx. 
    • Metabolic Acidosis, Renal Failure, Diabetic Ketoacidios
  20. Normal Pulse: 
    Tachycarida:
    Bradycardia: 
    • Normal Pulse:    60-100 
    • Tachycarida:      >100 
    • Bradycardia:      <60
  21. Trachea Pulled Abnormal Side
    • Pulmonary Atelectasis
    • Pulmonary Fibrosis
    • Pneumonectomy
    • Diaphragmatic Paralysis
  22. Trachea Pushed Normal Side 
    • Massive Pleural Effusion 
    • Tension pneumothorax
    • Neck/thyroid tumors
    • Large mediastinal mass 
  23. Resonant
    • Normal air filled lung
    • Hollow sound
  24. Flat
    Over sternum, muscle, areas atelectasis
  25. Dull
    • Fluid filled organs heart or liver
    • Pleural effusion or PNA
  26. Tympanic
    • Over air filled stomach
    • drum like & over lungs increased
  27. Hyperresonant
    • Pneumothorax/ emphysema 
    • Booming sound
  28. Normal BS
    Vesicular 
  29. Bilateral Vesicular Sounds
    Normal Lungs
  30. Bronchial BS
    Normal over trachea or bronchi heard over lung periphery=lung consolidation 
  31. Rales (crackles)
    Secretion/Fluid
  32. Coarse rales (rhonchi)
    large airway secretions, suctioning needed 
  33. Medium Rales
    Middle airway secretions, chest therapy 
  34. Fine Rales
    Alveoli, fluid, CHF, Pulmonary edema, IPPB, heart drugs, diuretics, oxygen
  35. Wheeze
    • Due to bronchospasm
    • Need bronchodilator 
  36. Stridor
    upper airway obstruction 
  37. Normal Blood Pressure 
    • Adult 120/80
    • Acceptable 90/60 to 140/90 
  38. Pulmonary Artery Catheter Location
    Right lower lung field
  39. Central Venous Catheters location
    Right or left subclavin or jugular vein and rest on vena cava or right atrium of heart 
  40. Nasogastric tubes/Feeding tubes
    Positions in stomach 2-5 cm below diaphragm 
  41. Croup
    • Subglottic Swelling
    • Steeple sign, picket fence,pencil point
    • lateral neck xray
  42. Epiglottis 
    • inflammation supraglottic bacterial infection
    • Supraglottic narrowing Flattened epiglottis swollen aryepiglottic folds 
    • Thumb Signs 
    • Lateral Neck xray
  43. Infiltrate
    Atelectasis
  44. Consolidation
    • PNA 
    • Pleural Effusion
  45. Hyperlucency
    • COPD
    • Asthma attack
    • Pneumothorax
  46. Vascular Marking
    • Increased w/ CHF
    • Absent w/ pneumothorax
  47. Diffuse 
    • Atelectaiss 
    • PNA
  48. Opaque
    Consolidation
  49. Fluffy Infiltrates
    Pulmonary Edema (diuretic) 
  50. Butterfly/Batwing
    Pulmonary edema
  51. Patchy/Plate like infiltrates
    Atelectasis
  52. Ground glass or reticulogranular
    ARDS/ IRDS
  53. Honeycomb Pattern or Reticulondular
    ARDS/IRDS
  54. Air Bronchogram
    PNA
  55. RBC
    4-6
  56. HB
    Low HB____
    High HB____
    • 12-16
    • Anemia
    • Polycythemia
  57. HCT
    Low
    High
    • 40-50%
    • Anemia
    • Polycythemia
  58. WBC
    Increase WBC
    Decrease WBC
    • 5,000-10,000
    • Leukocytosis=bacterial infection 
    • Leukopenia=viral infection 
  59. Potassium (K)
    Low
    High
    • 3.5-4.5
    • Hypokalemia
    • Hyperkalemia
  60. Sodium (Na)
    Low
    High
    • 135-145
    • Hyponatremia
    • Hypernatremia
  61. Chloride
    80-100
  62. Bicarbonate 
    22-26
  63. Creatinine
    0.7-1.3
  64. BUN
    8-25
  65. Mucoid
    white,gray, chronic bronchitis
  66. Yellow
    • WBC
    • Bacterial Infection
  67. Green
    • Stagnant sputum
    • Gram neg bronchiectasis
    • Pseudomonas 
  68. Brown/Dark
    old blood
  69. Bright Red
    hemotysis (bleeding tumor, TB)
  70. Pink frothy
    pulmonary edema
  71.           What is this? Treatment? Rate?         
    • Sinus Tachycarida 
    • Treatment: oxygen
    • Rate >100 
  72.         What is this? Treatment? Rate? 
    • Sinus Bradycardia
    • Treatment: Oxygen, Atropine
    • Rate <60 
  73.           What is this? Treatment?  
    • Premature Ventricular Contraction
    • Treatment: oxygen, Lidocaine 
  74.        
    • Ventricular Tach-V tach
    • >100
    • Defib (no pulse) 
    • Lidocaine
    • Cardiovert (pulse present) 
  75.        
    Defilbrilate 
  76.       
    • Confirm 2 leads first
    • Epinephrine, atropine, CPR
  77. Term Infants:
    Preterm:
    • 38 to 42 weeks
    • Less 38 weeks
  78. 0-3
    4-6
    7-10
    • Resuscitate 100% O2
    • Support Stimulate, warm, administer O2
    • Monitor-Routine care 
  79. Neonate
    Pulse
    RR
    BP
    • Pulse  110-160
    • RR      30-60
    • BP      60/40
  80. Lecithin/Spingomylein (L/S) Ratio
    Normal Rate 2:1 or higher good
  81. 3 Factors control BP
    • Heart
    • Blood
    • Vessels
  82. Normal Pressures
    Systolic
    Diastolic
    Mean
    • Systolic      120
    • Diastolic     80
    • Mean          93
  83. Mean Arterial Pressure (MAP) Equation 
    • 2X diastolic + systolic
    •               3
  84. PAP
    • 25/8
    • Pulmonary Hypertension, Chronic hypoxemia, COPD
  85. PCWP
    • 4/12
    • Left heart, CHF
  86. MAP
    120/80
  87. CVP
    • 2-6 or 4-12 cm/H2O
    • R. Heart, cor pulmonale
  88. Increase PAP, CVP, PCWP
    Fluid problem=hypervolemia
  89. Decrease PAP, CVP, PCWP
    Hypovolemia
  90. Pulse Pressure Equation
    • Systolic-Diasolic
    • Normal: 40mmHg
  91. Cardiac Output
    4-8
  92. Cardiac Index
    2.5-4.0
  93. Where is capnograhpy placed?
    Proximal to patient airway connection at ET tube. 
  94. Transcutaneous PO2 & PCO2
    Clark & Severinghaus Continuous, non-invasive PO2 & PCO2 placed on skin instead blood sample.
  95. Troubleshooting Transcutaneous PO2 & PCO2
    unable to calibrate check membrane, poor connections, air leak, increase TcPo2 to read higher than PaO2. 

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