RT ACCS - Patient Assessment

  1. What are the four life funcations?
    Ventilation, Oxygenation, Circulation, Perfusion.
  2. How is ventilation measured?
    Respiratory Rate, Tidal Volume, Chest movement, Breath Sounds, PaO2, ETCO2
  3. Oxygenation is measured how?
    Heart rate, Color, Sensorium, SaO2, PaO2
  4. How is circulation measured?
    Heart/Pulse rate and strength, Cardiac Output
  5. How is perfusion measured?
    Blood Pressure, Sensorium, Temperature, Urine Output, Hemodynamics
  6. Define Ventilation
    Movement of air in and out of the lungs
  7. Define Oxygenation
    Getting oxygen into the blood
  8. Define Circulation
    Movement of blood through the body
  9. Define Perfusion
    Getting blood and oxygen into the tissues
  10. What are the types of Advance Directives?
    DNR, DNI, Living Will, POA
  11. Define DNR
    No CPR
  12. Define DNI
    No invasive ventilation. May Do Non invasive ventilation
  13. Define Living Will
    States what the patient would like to be done if patient become terminally ill (less than 6 months to live). Does not state a health care proxy
  14. Define POA.
    Gives a specific person the authority to make medical decisions about a patient.
  15. What is the difference between Signs and Symptoms?
    Signs: Something that can be measured, i.e. HR, RR, B/P

    Symptom: Something that is felt, i.e. nausea, weakness, dyspnea
  16. Define Orthopnea and give possible diseases that could cause
    Difficulty breathing expect when upright

    CHF, Cardiac issues
  17. Define General Malaise and give examples of causes
    Run down feeling, nausea, weakness, fatigue, and headache

    Caused from an electrolyte imbalance
  18. Define Dyspnea
    • Difficulty breathing
    • Measured from grade I to grade V
  19. Define Syncope & list different types
    Temporary loss of consciuosness

    Vasovagal, Orthostatic, Carotid Sinus, Tussive
  20. Define Vasovagal Syncope
    Common dizziness and fainting caused by a loss of peripheral venous tone
  21. Define Orthostatic Hypotension
    Excessive drop in blood pressure when standing
  22. Define Carotid Sinus Syncope
    Associated with hypersensitive carotid sinus, More common in elderly adults
  23. Define Dyshagia
    Difficulty swallowing
  24. Define Fever of Unknown Origin (UFO)
    Cause of the fever that is never identified
  25. Respiratory Care plans should include...
    Case management plans, Therapy Protocols, Disease management, Patient/Family education needs.
  26. Define PERRLA
    Pupils that are: Equal, Round, and Reactive to light and accomidation
  27. Define Miosis
    Pinpoint pupils
  28. Define Oiplopia
    Blurred/Double Vision
  29. Define Ptosis
    Drooping of upper eye lids
  30. Define Nystagmus
    Cyclic movement of the eyeball
  31. Causes of Peripheral Edema
    CHF, Pulmonary HTN, Venous Insufficiency, and Renal Failure
  32. Define Ascites
    Fluid in the abdomen, caused by liver failure
  33. Define Clubbing and list causes
    Present when nail bed and angle of skin increases.

    Chronic Hypoxemia
  34. What is venous distention?
    • Observed in jugular veins (JVD)
    • May be seen in CHF and obstructive lung disease
  35. Define Diaphoresis
    Profuse sweating
  36. Define Jaundice
    Increase in bulirubin in blood and tissue. Most commonly seen in face and trunk
  37. Define Erythema
    Redness of the skin. May be caused by capillary congestion, inflammation or infection
  38. Define Cyanosis
    • Blue or blue - gray color of the skin (dusky)
    • Caused by hypoxia from increased amount of hemoglobin
  39. Define Ecchymosis
    Hematoma or bruising
  40. What is an increase in A-P Diameter and what is it associated with?
    Caused by air trapping for a long period of time, also known as barrel chest. Associated with COPD
  41. Define Hypernea
    Increased Respiratory Rate. Caused by metabolic and CNS disorders
  42. Define Cheye Stokes Breathing
    Gradually increasing then decreasing rate and depth in a cycle lasting 30 - 180 seconds, with periods of apena lasting up to 60 seonds. Caused by OD, Increased ICP, and Meningitis
  43. Define Biots Breathing
    Increased respiratory rate and depth with irregular periods of apnea. Caused by CNS problems
  44. Define Kussmauls Breathing
    Increaed respiratory rate, over 20, increased depth, irregular rhythm, breathing sounds labored. Caused by Metabolic Acidosis, Renal Failure, and Diabetic Ketoacidosis
  45. Define Apneustic
    Prolonged gasping inspiration followed by extremely short, insufficient expiration. Caused by problems with Respiratory Center, trauma, or tumor
  46. Define Paradoxial Pulse/Pulsus Paradoxus and what it indicates
    • Pulse and BP varies with respiration. 
    • Indicates: Severe Air Trapping i.e. status asthmaticus, or cardiac tamponade
  47. Define Resonant Percussion
    Normal Air filled lungs, Sounds Hollow
  48. Define flat percussion
    Heard over sternum, Muscle or atelectasis
  49. Define Dull percussion
    Heard over fluid filled organs (Heart/Liver), Indicates pleural effusions, or pneumonia. Will give a thudding sound
  50. Define Tympanic percussion
    Heard over air filled stomach. Drum like sounds. When heard over lungs indicates increased volume
  51. Define Hyperresonant
    Booming sound, Heard over a pneumothorax or emphysema
  52. Anatomic Deadspace
    Approx. 1mL per lb of IDEAL BODY WEIGHT
  53. Define hemodynamics
    Movement of blood. Deals with circulation and perfusion
  54. Swan Ganz Catheter Transducers
    • Must be level with the tip of the catheter
    • Transducer lower than tip of the catheter, readings will be higher
    • Transducer higher than tip of catheter, readings will be lower
  55. Length (cm) used for proper insertion of swan ganz
  56. What is the difference between culture and sensitivity and how long do the results take
    • Culture is allowing the specific sample to grow any bacteria
    • Sensitivity is the process identifying the antibiotics that kill the bacteria 
    • Results take 48 to 72 hours
  57. What is gram staining and how long do the results take
    • Identifies if any bacteria is gram positive or gram negative
    • Results take 10 minutes
  58. What does acid fast staining detect
  59. What are good indicators of Renal Function
    Creatinine, and Blood Urea Nitrogen
  60. Describe lateral decubitus position and what is diagnosis
    • Patient lays on affected side
    • Diagnosis: Small pleural effusion
  61. Where should the NG tube located on a XRAY
    2 - 5 cm below the diaphragm
  62. Describe the XRAY for pulmonary edema
    Fluffly infiltrates, butterfly/batwing pattern, Kerly B Lines (lateral decubitus)
  63. Describe the XRAY for atelectasis
    Patchy infiltrates, Plate like infiltrates
  64. Describe the XRAY for ARDS
    Ground Glass, Honeycomb, Diffuse Bilateral Radiopacity
  65. Describe the XRAY for pulmonary embouls
    Peripheral wedge shaped infiltrate
  66. Describe the XRAY for Pneumonia
    Air Bronchogram
  67. Describe XRAY for plerual effusion
    Concave superior interface/border, Basilar infiltrates with meniscus, blunted costrophrenic angle
  68. Describe XRAY for TB
    Cavity formation in upper lobes
  69. Describe XRAY for pneumothorax
    Deep Sulcus sign
  70. What does an Echocardiography detect?
    Heart wall motion, Vavular disease, Mitral Valve stenosis, reguritation, and prolapse
  71. What does a bubble Echocardiogram detect and how is it preformed?
    CO2 or agitated saline is injected into a vein. Can be used to detect atrial & Ventricular Septal Defects
  72. What does a V/Q Scan Detect
    • Blood flow defects 
    • i.e. PE, Pneumonia, Pleural fluid, Bullae
  73. pH Normal, Acidic, Alkalotic Values
    • Normal 7.4 
    • Normal Range 7.35 - 7.45
    • Acidic lower than 7.4
    • Alkalotic higher than 7.4
  74. PaCO2 Normal, Acidic, Alkalotic Values
    • Normal Range 35 - 45 
    • Acidic Higher than 45
    • Alkalotic Lower than 35
  75. HCO3 Normal, Acidic, Alkalotic Values
    • Normal Range 22 - 26
    • Patient is Acidotic if lower than 22
    • Patient is Alkalotic is higher than 26
  76. Noncompensated (Acute)
    Is when the pH is outside the acceptable range
  77. Compensated (Chronic)
    pH is inside the acceptable range
  78. Metabolic Alkalosis
    When the pH and HCO3 are both high. You may give K+ IF hypokalemic
  79. Metabolic Acidosis
    When the pH and HCO3 and both low.
  80. Respiratory Alkalosis
    When the pH is high and the CO2 is low
  81. Respiratory Acidosis
    When the pH is low and the CO2 is high.
  82. Describe the patient that has a Type 1 ABG
    Patient Looks bad even when the Blood gas looks good
  83. Diseases that are type 1 ABG
    CO Posioning, Anemia, Pulmonary Embolus
  84. Describe the patient that has a Type 2 ABG
    ABG looks bad even when the patient looks good
  85. Diseases that are type 2 ABG
  86. EKG Rates
    • Normal 60-100
    • Bradycardia - <60
    • Tachycardia - >100
    • Fibrillation - >200 - too fast to count
  87. How do you count the rate on an EKG strip
    • 300/number of big boxes
    • Shortcut: 3 Big boxes is 100
    • 5 Big boxes is 60
  88. Sinus Arrhythmia
    • Sinus Rhythm with irregular rate. 
    • Treat other symptoms
  89. Define Sinus Rhythm
    An EKG strip having a positive 'P' wave
  90. Sinus Bradycardia
    • Sinus rhythm less than 60 
    • Treat: O2
  91. Sinus Tachycardia
    • Sinus rhythm higher than 100
    • Treat: Atropine
  92. Premature Ventricular Contractions
    Give O2 and Amiodarone
  93. Multifocal Premature Ventricular Contractions
    Give O2 & Amiodarone
  94. Ventricular Tachycardia
    • Ventricular rhythm rate higher than 100
    • Treat (Pulseless): CPR, Shock, EPI, Amiodarone
    • Treat (Pulse): Cardiovert
  95. Ventricular Fibrillation
    • Completely irregular rhythm
    • Treat: CPR, Shock, EPI, Amiodarone
  96. Asystole
    Treat: Confirm in 2 leads, CPR, EPI
  97. 1st Degree Heart Block
    • PR Interval >0.20
    • Treat: Atropine
  98. 2nd Degree Heart Block - Mobitz 1 (Wenckebach)
    • Skips a beat, PR interval present no QRS
    • Treat: Usually begning, no treatment necessary
  99. 2nd Degree Heart Block - Mobtiz 2
    • Skips a beat, No PR Interval and No QRS
    • Treat: Atropine, Transvenous Pacing
  100. 3rd Degree Heart Block
    • Atrial Rate >60
    • Ventricular Rate >40
    • PR interval cannot be determined
    • QRS widened
    • Treat: Pace maker
  101. What is the Axis of the heart
    Down and to the left
  102. What are the three 'I's' of MI
    • Ischemia
    • Injury
    • Infarction
  103. Dfine Ischemia
    • Reduction of blood flow to tissue
    • Usually no symptoms, inverted t wave
  104. Define Injury
    • Acute damage to the tissue, often from ischemia
    • Has severe symptoms, elevated ST segment
  105. Define Infarction
    • Necrosis of the tissure, resulting from ischemia/injury. May be recent or old
    • Full Blown MI, Significant Q waves
  106. How to reduce Work of breathing by diet
    Low carbs, High protein
Card Set
RT ACCS - Patient Assessment
Patient Assessment