Dealing with the Patient

  1. What are the two types of chest pain?
    • Pleuritic
    • Nonpleurtic
  2. Pleurtic
    • Type if chest pain
    • Made worse by breathing
    • Sharp in nature
    • Located laterally and posteriorly on chest wall
    • Associated with diseases that affect lining of the lung ( pheumothorax, pulmonary embolism, pneumonia)
  3. Nonpleuratic
    • Type of chest pain
    • Not affected by respiratory efforts
    • Radiates
    • Dull pressure sensation
    • Located centrally in chest
    • Assiciated with ischemic heart disease
  4. Sputum
    • Noticible production is a sign of disease of airway
    • Most common cause is smoking (also caused by asthma and pheumonia)
  5. How is sputum described?
    • Mucoid- clear/thick (airway diseases without infection
    • Fetid- foul smell
    • Purulent- pus (bacterial infection)
    • Copious- large amounts (most often seen in bronchiectasis)
    • Color
  6. Cough
    • Most frequent symptom (caused by stimulation of cough receptors from mechanical, chemical, inflammatory and thermal sources)
    • Usually associated with airway disease (found in acute upper respiratory infection, asthma, bronchitis)
  7. What should you ask about a cough?
    • When and how often
    • Productive
    • How severe
  8. What are the most common symptoms of patients with cardiopulmonary disease?
    • Dyspnea
    • Cough
    • Sputum production
    • Chest pain
    • Hemoptysis
    • Fever
    • Wheeze
  9. What to ask about dyspnea?
    • When, where and why?
    • Rate 1 to 10
    • History of disease
    • Stable or worsening
  10. What to ask about sputum?
    Recent changes in color and amount
  11. Hemoptysis
    • Caused by infections disease
    • 20-30% of the time cause is undetermined
    • Chronic hemoptysis can be caused by chronic disease
    • When associated with bronchitis- harmeless
    • When associated with carcinoma-life threatening
  12. Fever
    • Abnormal rise in body temperature due to disease (usually due to an infection)
    • Common respiratory problem associated with fever (viral infection, bacterial bronchitis, bacterial pneumonia, fungal infections, tuberculosis)
  13. Wheeze
    • Caused by narrow airways due to constriction or obstruction
    • Associated with SOB, cough, sputum
    • Commonly found in asthmatics, congestive heart failure, bronchitis
  14. What are the four basic vital signs?
    • Heart rate
    • Respiratory rate
    • Blood pressure
    • Body temperature
  15. What is considered the fifth vital sign?
    Pulse oximetry
  16. What are different breathing patterns?
    • Abdominal paradox due to diaphragm fatigue
    • Biot's respiration due to increased intracranial pressure
    • Cheyne-Stokes due to CHF or CNS disorder
    • Kussmal's due to metabolic acidosis
    • Apneustic due to brain damage
    • Paradoxical respirations due to chest trauma, diaphragm paralysis, muscle fatigue
    • Asthmatic due to obstruction of airflow out of lungs
  17. Chest inspection
    Degree of symmetrical expansion
  18. Chest percussion
    • Resonant
    • Hyperresonance
    • Dull
    • Flat
  19. Other things to look for when assessing the patient
    • jugular venous distention
    • digital clubbing
    • cyanosis
    • abdomen
    • pursed lip breathing
  20. CBC
    • Complete blood count:
    • leukocytosis (increased WBC)
    • leukopenia (decreases WBC)
    • anemia
    • polycythmia
  21. Serum electorlytes
    • sodium
    • potassium
    • cholide
    • total bicarb
  22. Data collected via a lab
    • Sputum
    • cardiac enzymes
    • ABG (arteriole blood gas)
    • pulmonary function testing
  23. types of patient records
    • traditional chart
    • problem oriented medical record (POMR)
    • computer documentation
  24. what do traditional chars include?
    • admission sheet
    • physician's order sheet
    • progress notes
    • history and physical examination data
    • medication sheet
    • respiratory care sheet
    • nurses' admission info
    • nursing care plans
  25. Most common POMR
    SOAP note
  26. What does SOAP mean?
    • Subjective (feeling by the patient/nonmeasurable)
    • Objective (measureable tests like bp, rr, temp etc.)
    • Assessment
    • Plan
  27. What does IER mean in SOAPIER note?
    • Implementation
    • Evaluation
    • Revision
  28. Health care associated infections
    • HAIs
    • infection that patients aquire during a course of recieving medical treatment
  29. PPE for Concact
    Gloves and gown
  30. PPE for Droplet
    Gloves, gown, mask
  31. PPE for airborne
    Gloves, gown, goggles, n95
Card Set
Dealing with the Patient
Patient assessment, Patient Interview, Infection control