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Look at interviews, space, questions, we should be asking.
- 1. To Establish a relationship between clinician and patient.
- 2. To obtain essential diagnostic information.
- 3. To help monitor changes in the patients symptoms and response to therapy.
Introduce yourself in what spaces?
- Social space: 4-12 feet
- Personal space: 2-4 Feet
Common questions to ask for each symptom?
- WHen did it start?
- How severe is it?
- Where on the body is it?
- What seems to make it better or worse?
- Has it occured before?
Vitals. Normal Rates.
- Temperature: 98.6
- Heart Rate: 60-100
- Respiratory Rate: 12-20
- Systolic Blood pressure: 120 mmhg
- Diastolic Blood pressure: 80 mmhg
Vitals. Lowest normal
- Temperature: 97F (Hypothermia)
- Heart Rate: <60 Bradycardia
- Respiratory Rate: <10 Bradypnea
- Systolic Blood Pressure: 90 mmhg <Hypotension
- Diastolic Blood Pressure: 80 mmhg <Hypotension
Vitals. Highest Normal
- Temperature: 99.6 Hyperthermia
- Heart Rate: >100 Tachycardia
- Respiratory Rate: >20 Tachypnea
- Systolic Blood Pressure: 140 mmhg >Hypertension
- Diastolic Blood Pressure: 90 mmhg > Hypertension
Where to palpate pulse?
The radial artery is the most common site used to palpate the pulse. Also can palpate teh carotid, brachial, femorl, temporal, popiteal, posterier tibal, and dorsal pedis pulses.
Is the art of tapping on surface to evaluate what's underneath
Percussion (Decreased resonance)
Causes: Pneumonia, or pleural effusion
Percussion (Increased resonance)
Causes: Eymphysema, Pneumothorax
Different breathing patterns.
- Biots Respiration: Irregulatr breathing w/ long period of apnea. Causes Intercranial pressure (head injuries)
- Cheyne Stokes respiration: Irregular; breath increased and decreased in depth and rate w/ period of apnea. Diseases of Central Nervous System; C.H.F.
- Kussmaul's Respiration: Deep and Fast Respirations. Causes Metabolic acidosis
Sputum samples, what should you be evaulating?
Colors, Consistency, Amount.
Level of Conciousness
If Patient appears concious, assess the patient to time, place, and person (sensorium) an alert patient who is well oriented to time, place, and person is said to be "oriented x3" and sensorium is considered normal.
Common cause of fever?
Fever: an elevated body temp due to disease. May occur as something as viral infection of the upper airway or as serious as bacteria pneumonia or TB.
Patient w/ fever will have an increased metabolic rate and thus increase O2 consumption, CO2 production. May cause tachypnea if increase O2 consumpion and Co2 removal occurs.
A signifiicant decrease in pulse strength during spontaneous inhalation. They are associated with acute obstructive pulmonary disease, who experience asthma attack.
Alternating succession of strong and weak pulses. As sociated with left sided heart failture, not related to respiratory disease.
Dyspnea in the reclining position. Associated with CHF. Appears to be caused by sudden increase in Venous return that occurs in reclining.
Dyspnea moved to upright position
Different terms for Sputum
- Phlegm: Mucus from tracheo broncial tree that has not been comtaminated by oral secretions.
- Sputum: Mucus that comes from the lungs but passes through teh mouth and exits.
- Purulent: Puss cells suggesting bacteira infection. Appears thick, colored and sticky. Yellow - Active. Green - Old.
- Fetid: Foul smelling sputum.
- Mucoid: Clear and thick, common in airway disease (Asthma.)
- Hemoptysis: Blood streaked sputum.(Massive or non massive)
- Hematemisis: Vomitting blodo from GI tract.
Pleuretic chest pain
Located laterally or posteriouly. Is sharp in nature, and increases deep breathing.
Nonpleuritic chest pain
Located in the center of the chest and may radiate to shoulder or arm; caused by coronary artery disease, known as angina.
Sitting upright while bracing his or her elbows on a table. Helps the accessory muscles gain a mechanical advantage for breathing. Patient w/ severe pulmonary hyperinflation.
Results of poor blood flow, in the extremedies or fingers.
Occurs b/c blood changes color in the presence or absence of oxygen. Refers to the present of Cyanosis on "central parts of the body" - including lips, mouth, head, and torso.
Common signs of Cor Pulmonale patients
Pedal Adema: swelling of the lower extremedies. Occurs w/ herat failture which causes an increase in teh hydrostatic pressure of the blood veseels in teh lower extremedies. Causes fluid to leak into the interstital spaces, lead to pedal edema.
Jugular Venous Distention: Present when jugular vein is enlarged.
Tactile Fremitus (Feeling Vibrations through fingers), what will cause an increase?
Is increased w/ pneumonia and atelectasis.
Wheezes and Stridor
Rapid airflow through obstructed airways. High pitched, usually expiratory. (Causes: Asthma, CHF)
Rapid airflow through obstructed upperairway, high pitched, monophonic (Causes CROUP, epiglottitis)
Excess airway secretions moving through airway. Inspiratory and expiratory. (Causes severe pneumonia, bronchitis)
Sudden opening of peripheral aiways, late inspiratory. Sudden opening of small airway w/ deep breathing. (Causes atelectasis, fibrosis, pulmonary edema.)
Point of maximal impulse. Where you see teh heart beat. Usually in COPD, cor polmonal, seen right side.
S1 and S2
- S1 - Created by closure of AV valves.
- S2 - Created by closure of semilunar valves.
What causes mumurs for adults?
What is cap refil? What will cause it? indicative?
when cardiac output is reduced and digital perfusion is poor, capillary refill is slow, taking several seconds to complete. In healthy people, takes 3 sec. Abnormal refill may also indicate poor vasuclar supply.