Resp 110: Chapter 15

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Resp 110: Chapter 15
2013-07-18 01:26:27
Bedside Assessment

Bedside Assessment
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  1. Open-Ended
    Encourage patient to talk. help establish rapport. "what brings you to the hospital?" "what happened next?"
  2. Close-ended
    Gather specific information - "when did your cough start?" "How long did it last?"
  3. Direct Questions
    "Why?" can be open or closed
  4. Indirect Questions
    "I gather that you feel worse today than yesterday" sounds like a statement
  5. Neutral
    "Tell me more about..." "What happened next?" not leading!
  6. Dyspnea
    • difficult or labored breathing
    • occurs when the work of breathing is too high and/or when the drive to breathe is elevated
  7. Orthopnea
    dyspnea in the reclining position; associated with CHF (patient likely sleeps in recliner - blood pools in alveoli and makes it difficult to breathe)
  8. Plataypnea
    dyspnea when moved to the upright position (classic of liver failure)
  9. Chronic Bronchitis
    a cough for three consecutive months for two consecutive years
  10. Inspiratory Stridor
    Heard when problem in upper airway
  11. Purulent Sputum
    sputum that has pus in it, yellow or green
  12. Fetid Sputum
    foul smelling
  13. Bronchiectasis
    purulent sputum separates into layers
  14. Apple Green Sputum is indicative of what?
    pseudomonas infection
  15. Red currant jelly looking sputum is indicative of what?
    Klebsiella ppneumonia
  16. Frothy white or pink sputum is indicative of what?
    pulmonary edema
  17. Hemoptosis
    coughing up blood or bloody sputum from the airways - most often occurs in patients with history of lung disease - common causes include bronchitis, lung cancer, tuberculosis, trauma, and pulmonary embolism
  18. Hematemasis
    vomiting blood from the gastrointestinal tract
  19. Pleuritic Chest Pain
    chest pain located laterally or posteriorly, is sharp in nature, and increases with deep breathing (pulmonary problems)
  20. Nonpleuritic Chest Pain
    chest pain located in the center of the chest and may radiate to the shoulder or arm; it is often caused by coronary artery disease (heart problems)
  21. Pedal Edema
    swelling of the ankles most often due to heart failure - may indicate need for O2 therapy
  22. Patients with chronic hypoxemic lung disease usually develop...
    right heart failure (cor pulmonale) due to pulmonary hypertension
  23. Orient x3
    level of consciousness and orientation to time, place, and person
  24. Cyanosis
    indicates respiratory failure
  25. Pursed-lip breathing
    seen in patients with COPD (air trappers, overly-compliant lungs) who have obstruction of airways
  26. Jugular veinous distension
    seen in patients with CHF and cor pulmonale
  27. Kyphoscoliosis
    abnormal curvature of the spine - often causes restrictive lung disease
  28. Kussmaul breathing
    deep and fast breathing often caused by metabolic acidosis (ketoacidosis)
  29. tactile fremitus
    vibrations felt through palpating - increased with pneumonia and atelectasis, reduced with emphysema, pneumothorax (collection of gas in pleural space), and pleural effusion (fluid between pleural layers
  30. Resonance
    • evaluated by tapping - percussion
    • decreased - pneumonia or pleural effusion (bc of mucous and fluid in lungs)
    • increased - emphysema or pneumothorax
  31. Breath Sounds
    normal sounds of breathing
  32. Adventitious Lung Sounds
    the abnormal sounds imposed on the breath sounds (crackles and wheezes)
  33. Tracheal Breath sounds
    heard directly over the trachea and created by turbulent flow; loud and high-pitched
  34. Bronchovesicular breath sounds
    heard around the sternum; softer and slightly lower in pitch than tracheal breath sounds
  35. Vesicular Breath Sounds
    heard over lung parenchyma; represent attenuated turbulent flow sounds from the larger airways; very soft and low-pitched
  36. Egophany
    voice takes on "bleating" quality, useful for locating areas of consolidation in lungs. Letter "A" turns into "E" when listening to chest
  37. Whispering Pectoriloquy
    Patient whispers 1,2,3 during auscultation - normally would sound muffled but over consolidation it will sound clear
  38. Stridor
    continuous ALS heard over the upper airway
  39. Wheezes
    continuous ALS
  40. Crackles
    Discontinuous ALS
  41. Monophonic Wheezing
    wheezing that indicates one airway is affected
  42. Fine Crackles
    wheezing that indicates many airways are involved - heard with pulmonary fibrosis and atelectasis
  43. Digital Clubbing
    seen in congenital heart disease. bronchiectasis, various cancers, and interstitial lung disease
  44. Digital Cyanosis
    often a sign of poor perfusion; the hands and feet are typically cool to the touch (5-6 OF UNSATURATED HEMOGLOBIN
  45. Eupnea
    normal breathing
  46. Apnea
    no breathing (cessation of breathing for at least 10 seconds)
  47. Tachypnea
    fast breathing (normal RR is 12-20 BPM)
  48. Bradypnea
    slow breathing
  49. Hypopnea
    shallow breathing
  50. Hyperpnea
    big breathing
  51. Orthopnea
    difficulty breathing lying down
  52. Platypnea
    shortness of breath when standing upright
  53. Hyperventilation
    big, deep, fast breaths
  54. Hypoventilation
    small, shallow, slow breaths
  55. Dyspnea
    difficult or labored breathing as perceived by patient
  56. Cheyne-Stoke's breathing
    irregular type of breathing; breaths increase and decrease in depth and rate with periods of apnea.  often associaed with disease of CNS and CHF
  57. Palpation
    the art of touching the chest wall to evaluate underlying structure and function
  58. Percussion
    tapping on a surface to determine the underlying surface
  59. Auscultation
    the process of listening for bodily sounds
  60. Paryoxysmal Nocturnal Dyspnea (PND)
    at night COPD (coughing and expectoration usually in the morning) (how many pillows, orthopnea! usually associated with left heart failure
  61. Tachycardia
    pulse greater than 100 bpm
  62. Bradychardia
    less than 60 bpm
  63. Normal Sinus Rhythm
    same time interval between every beat
  64. Pulsus alternans
    strong beats alternating with weak beats (can occur with heart failure)
  65. Pulsus Paradoxus
    • The force of the pulse weakens during inspiration and regains force during expiration (found in hyperventilation associated with emphysema, asthma, pneumothorax (ptx) or a massive pleural effusion)
    • inhale, floods right ventricle and stays out of left = reduced pulse on inspiration (greater than 10 mmHg drop in blood pressure on inspiration)
  66. Normal BP
    120/80 mmHg
  67. Hypertension
    greater than 140/90 mmHg
  68. Hypotension
    less than 90/60 mmHg
  69. Facors affecting BP
    • volume of blood in the arteries
    • increased blood volume
    • increases with age
  70. Orthostatic Hypotension
    hypotension upon standing
  71. PEEP (Positive End Expiratory Pressure)
    causes a continuous pressure in the intrapleural space and therefore impedes venous return