Patient Interview Techniques Overview
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Questions and Answers

What physiological process generates the pulse that is measured when taking vital signs?

  • Elastic recoil of veins
  • Arterial recoil during diastole
  • Atrial contraction during diastole
  • Ventricular contraction during systole (correct)
  • Which of the following is most accurately described by the term 'diastolic blood pressure'?

  • The pressure in the veins during arterial contraction
  • The peak pressure generated by the heart muscle
  • The pressure in the arteries during cardiac relaxation (correct)
  • The pressure in the arteries during ventricular contraction
  • Why is body temperature routinely monitored during patient assessments?

  • To assess for signs of inflammation or infection (correct)
  • To accurately calculate hydration levels
  • To monitor for changes in cardiac output
  • To establish a baseline for respiratory system efficiency
  • A patient is exhibiting a body temperature of 36 degrees Celsius. How would this condition be classified?

    <p>Hypothermia (B)</p> Signup and view all the answers

    Why is oxygen saturation (SpO2) sometimes referred to as the 'fifth vital sign'?

    <p>Due to its importance in assessing respiratory efficiency. (D)</p> Signup and view all the answers

    What is the primary purpose of establishing an initial baseline SpO2 value during a patient assessment?

    <p>To have a reference point for evaluation of respiratory interventions. (C)</p> Signup and view all the answers

    What is the nature of the 'inspection' process, as described in patient assessment?

    <p>An ongoing monitoring process from initial interaction to examination. (B)</p> Signup and view all the answers

    If a patient is disoriented regarding person, place, and time, which condition is MOST likely indicated?

    <p>Decreased perfusion state and cerebral hypoxia (A)</p> Signup and view all the answers

    During the insertion of a Swan-Ganz catheter into a patient, what does the respiratory therapist primarily observe to guide the catheter's progression?

    <p>The pressure waveform as it moves through the chambers (D)</p> Signup and view all the answers

    Which measurement is NOT directly obtained using a pulmonary artery catheter?

    <p>Left atrial pressure (C)</p> Signup and view all the answers

    In the production of x-rays within an x-ray tube, what is the essential physical process that causes the emission of x-ray photons?

    <p>The collision of high-speed electrons with matter inside the tube (C)</p> Signup and view all the answers

    How does the density of an object affect its appearance on an x-ray film?

    <p>Dense objects appear white because they absorb more x-rays. (B)</p> Signup and view all the answers

    Which of the following is the MOST accurate description of how an artery is assessed during an inspection?

    <p>By palpating the artery against bone or muscle, where the artery lies close to the skin surface. (A)</p> Signup and view all the answers

    A patient has a respiratory rate of 28 breaths per minute. Based on the provided information, in which age group would this be considered a normal respiratory rate?

    <p>Toddler (D)</p> Signup and view all the answers

    According to the provided content, which of the following scenarios would MOST likely result in tachypnea?

    <p>Metabolic acidosis (A)</p> Signup and view all the answers

    When performing chest palpation, which parameter is NOT evaluated directly?

    <p>The size of the underlying lung (D)</p> Signup and view all the answers

    A patient presents with a respiratory rate significantly below the normal range. Which term BEST describes this condition?

    <p>Bradypnea (B)</p> Signup and view all the answers

    What is the PRIMARY objective of percussion when assessing the respiratory system?

    <p>To evaluate the size, borders and consistency of underlying lung tissue (D)</p> Signup and view all the answers

    A nurse is about to assess a patient's respiratory rate. What action should they take to obtain the MOST accurate reading?

    <p>Record the breathing rate without patient awareness (A)</p> Signup and view all the answers

    Which finding would indicate the necessity for further respiratory assessment using palpation?

    <p>Presence of an area of tenderness upon touch (C)</p> Signup and view all the answers

    What is the significance, in the context of this content, of observing and assessing tactile fremitus?

    <p>To evaluate vibrations felt on the patients chest (C)</p> Signup and view all the answers

    Which of the following is NOT typically associated with increased airway resistance?

    <p>Medium crackles (B), Fine crackles (D)</p> Signup and view all the answers

    What is the primary function of the accessory muscles during a cough?

    <p>To forcefully expel air from the lungs (A)</p> Signup and view all the answers

    What physiological change is directly responsible for the pursed-lip breathing technique offsetting airway resistance?

    <p>Elevated intrapleural pressure (D)</p> Signup and view all the answers

    Which muscle is primarily responsible for the nasal flaring observed in infants during respiratory distress?

    <p>Dilator naris (C)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the series of events during a typical cough?

    <p>Shallow inspiratory effort (A)</p> Signup and view all the answers

    In infants, what primary purpose does nasal flaring serve during respiratory distress?

    <p>To enhance movement of gas into the tracheobronchial tree (C)</p> Signup and view all the answers

    Which of these describes a typical characteristic of a cough?

    <p>A sudden, audible expulsion of air from the lungs (A)</p> Signup and view all the answers

    What is the immediate physiological effect and purpose of the elevated intrapleural pressure during pursed-lip breathing?

    <p>To offset the increased airway resistance (B)</p> Signup and view all the answers

    Which of the following physical findings is not associated with acute respiratory distress?

    <p>Pleural friction rub (B)</p> Signup and view all the answers

    What is the primary purpose of an arterial catheter in the context of respiratory care described?

    <p>To facilitate frequent or repeated arterial blood gas sampling. (D)</p> Signup and view all the answers

    During a cough, after the initial deep inspiration and partial closure of the glottis, what is the primary process that facilitates the forceful expulsion of air?

    <p>Forceful contraction of the expiratory accessory muscles (D)</p> Signup and view all the answers

    An elevated heart rate, pulse, and blood pressure during acute pulmonary disease are MOST directly stimulated by?

    <p>Peripheral chemoreceptors stimulated by hypoxia. (D)</p> Signup and view all the answers

    In cases of respiratory distress, increased cardiac output functions as what kind of mechanism?

    <p>A compensatory mechanism to address hypoxemia. (C)</p> Signup and view all the answers

    Which factor is NOT stated as a direct trigger for increased cardiac output and blood pressure mentioned?

    <p>Fluid Overload. (B)</p> Signup and view all the answers

    What does a cyanotic or mottled appearance of the skin typically suggest about a patient’s condition?

    <p>The patient has poor perfusion and likely hypoxia. (D)</p> Signup and view all the answers

    When evaluating a patient's perfusion status, which of the following is indicative of inadequate local perfusion?

    <p>Skin that is diaphoretic (wet), cool, or clammy. (D)</p> Signup and view all the answers

    For which patient condition is the central venous pressure (CVP) catheter MOST directly useful for monitoring?

    <p>Patients with right ventricular function issues. (D)</p> Signup and view all the answers

    Which condition is NOT stated as a reason for an increased CVP reading?

    <p>Hypovolemic shock. (D)</p> Signup and view all the answers

    What does the term 'sensorium' refer to in the context of assessing a patient’s perfusion state?

    <p>The patient’s level of consciousness and awareness. (D)</p> Signup and view all the answers

    What does an increased CVP reading directly reflect, relating to ventricular pressure?

    <p>Right ventricular filling pressure. (A)</p> Signup and view all the answers

    Flashcards

    Diastolic Blood Pressure

    The pressure in the arteries when the heart is relaxed between beats.

    Systolic Blood Pressure

    The pressure in the arteries when the heart is contracting.

    Pulse

    A rhythmic throb created by the pumping of the heart's ventricles.

    Pyrexia

    A measure of body temperature above the normal range.

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    Hypothermia

    A measure of body temperature below the normal range.

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    Oxygen Saturation (SpO2)

    The level of oxygen saturation in the blood.

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    Inspection

    A continuous process of observation during patient care.

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    Normal Respiratory Rate

    The normal number of breaths per minute, which varies based on age.

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    Tachypnea

    An increased breathing rate, often associated with fever, metabolic acidosis, low oxygen levels, pain, or anxiety.

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    Bradypnea

    A decreased breathing rate, which can occur due to hypothermia, head injuries, or drug overdose.

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    Inspection of Respiration

    The process of observing a patient's respiratory status by looking at how they breathe.

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    Palpation of Respiration

    The process of touching the patient's chest to evaluate chest expansion, trachea position, skin temperature, muscle tone, and tenderness.

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    Chest Excursion

    The distance between the patient's ribs during inhalation, indicating proper lung expansion.

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    Tactile and Vocal Fremitus

    Vibrations felt on the chest during speech or coughing, indicating the air's movement through the lungs.

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    Crepitus

    A crackling or popping sound heard when listening to the lungs, indicating air trapped in the lung tissue.

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    Percussion

    The process of tapping on the patient's chest to assess the consistency of the underlying lung tissue.

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    Disorientation in Person, Place, and Time

    When a patient is disoriented about their identity, location, and the current time, it may indicate reduced blood flow and oxygen deprivation to the brain.

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    Pulmonary Artery Catheter (Swan-Ganz Catheter)

    A specialized catheter inserted into a vein that allows for measurement of pressures in the heart and lungs.

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    How X-rays Work

    X-rays are created when energized electrons collide with matter, and dense objects absorb more x-rays than less dense objects.

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    X-ray Tube

    A vacuum-sealed glass tube containing a cathode and rotating anode that produces X-rays.

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    Radiopaque

    The inability of an object to allow X-rays to pass through it.

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    Cough

    A sudden, forceful expulsion of air from the lungs, usually caused by irritation or inflammation in the airways. It's a common symptom in respiratory diseases.

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    Wheezing

    A high-pitched whistling sound during breathing, usually caused by narrowing of the airways. It can be heard without a stethoscope.

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    Stridor

    A harsh, high-pitched sound during breathing, often heard during inhalation, usually caused by obstruction of the upper airway.

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    Crackles (Rales)

    A coarse, rattling sound, often heard during inhalation, caused by air passing through fluid or mucus in the small airways.

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    Pleural Friction Rub

    A grating, rubbing sound, often heard during both inhalation and exhalation, caused by inflamed or irritated pleura surrounding the lungs.

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    Accessory Muscle Use

    A breathing pattern where a patient uses accessory muscles (like those in the neck and chest) to help pull air into the lungs due to increased airway resistance.

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    Pursed-Lip Breathing

    A breathing pattern where a patient breathes deeply and holds their breath for a moment before exhaling slowly through pursed lips, helping to keep airways open and reduce air trapping.

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    Substernal Retractions

    A breathing pattern where the area between the ribs and the breastbone retracts during inhalation, indicating difficulty in breathing.

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    Intercostal Retractions

    A breathing pattern where the spaces between the ribs sink inward during inhalation, often seen in infants and children with difficulty breathing.

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    Nasal Flaring

    A flaring of the nostrils during inhalation, often seen in infants experiencing respiratory distress, a reflex to widen the airway and enhance airflow.

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    Arterial Catheter

    A catheter inserted into an artery, primarily used for frequent arterial blood gas sampling. This helps monitor blood oxygen levels, carbon dioxide levels, and pH.

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    Central Venous Pressure (CVP) Catheter

    Measures central venous pressure (CVP) and right ventricular filling pressure, which are vital indicators of right ventricle function.

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    Increased Heart Rate, Pulse, and Blood Pressure in Pulmonary Disease

    An increase in heart rate, pulse, and blood pressure that commonly arises during the acute stages of pulmonary disease. It's the body's response to low blood oxygen.

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    Increased Cardiac Output in Pulmonary Disease

    A compensatory mechanism triggered by low blood oxygen levels, where the heart pumps harder to circulate oxygenated blood.

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    Perfusion State Assessment

    Can be evaluated by observing skin color, capillary refill, and the level of consciousness. These signs can help identify poor perfusion and tissue hypoxia.

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    Cyanosis

    Blue or mottled skin color, indicating poor perfusion and tissue hypoxia.

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    Diaphoretic, Cool, or Clammy Skin

    A condition where the skin is wet, cool, or clammy, often associated with inadequate local perfusion.

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    Increased CVP in Left Ventricular Heart Failure

    Occurs when left ventricular heart failure causes fluid buildup in the lungs (pulmonary edema), leading to elevated CVP.

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    Increased CVP due to High Mechanical Ventilation Pressures

    Excessively high mechanical ventilation pressures can cause an increase in CVP.

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    Increased CVP in Cor Pulmonale

    A condition affecting the right ventricle of the heart, often caused by lung disease, resulting in increased CVP.

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    Study Notes

    Patient Interview Overview

    • Communication techniques during an interview involve using a patient's surname, introducing oneself, and stating the purpose.
    • Open-ended questions encourage narrative responses, used to begin interviews, introduce new topics, or gather further information.
    • Closed/direct questions elicit specific answers (yes/no, one-two words), used to clarify details and expedite the interview, especially in emergencies.
    • Interview techniques include facilitation ('say more'), silence (patient time), reflection (repeating parts of what the patient says), empathy, and clarification (ambiguous words).

    Patient History

    • Biographic data (age, gender, occupation)
    • Chief complaint (reason for seeking care, onset, duration, characteristics)
    • Present health (current illness specifics)
    • Past health (childhood illnesses, accidents, chronic illnesses, hospitalizations, operations, obstetric history, immunizations, last exam date, allergies, current medications, smoking/other habits)
    • Family history
    • Review of body systems (skin, head, eyes, ears, nose, mouth/throat, respiratory, cardiovascular, gastrointestinal, urinary, genital, endocrine systems)
    • Functional assessment (daily living activities, work, sleep, rest, nutrition, relationships, stress management)

    Vital Signs

    • Blood pressure (force exerted on artery walls; systolic during contraction, diastolic during relaxation)
    • Body temperature (assessed for inflammation/infection, varies with conditions and activity, core temp ~37°C/98.6°F)
    • Oxygen saturation (fifth vital sign, immediate baseline, monitors response to care)
    • Pulse (rhythmic pressure throb, generated by ventricular contraction, assessed where artery is close to skin)
    • Respiration (rate dependent on age, newborn 30-60/minute, adult 12-20/minute, ideally measured when patient unaware; tachypnea increased rate, bradypnea decreased rate)

    Systematic Examination of Chest and Lungs

    • Inspection (ongoing process from history to exam, observing signs/symptoms)
    • Palpation (touching chest to assess symmetry, trachea position, skin temp, muscle tone, tenderness, lumps/depressions, tactile/vocal fremitus, chest excursion)
    • Percussion (determine size/consistency of air, liquid, or solid in lungs, dull note from pleural thickening/effusion/atelectasis/consolidation, hyperresonant in COPD/pneumothorax)
    • Auscultation (assess heart, blood vessels, & airflow; abnormal lung sounds include crackles, wheezing, stridor, and pleural rubs)

    Cardiopulmonary Assessment Findings

    • Abnormal sputum production (color/characteristics indicate specific conditions)
    • Cough and its characteristics (productive -amount, consistency, color, odor; nonproductive - frequency, pitch, loudness)
    • Nasal flaring (common in infants with respiratory distress)
    • Chest pain (pleuritic -sudden, sharp, stabbing, worsens with breaths, localized centrally; nonpleuritic -consistent, not worsened by breaths)
    • Abnormal extremity findings (altered skin color-ashen, yellow, red; cyanosis, digital clubbing, peripheral edema, distended neck veins)

    Radiologic Examination of the Chest

    • Standard Positions (PA - patient upright, AP - patient supine, lateral - patient on side, decubitus -patient lying on side)
    • Techniques (radiographs, CT, MRI, Bronchography, Pulmonary angiography, PET)
    • Radiologic Terminology (air cyst, bleb, bronchogram, cavity, consolidation, homogeneous density, infiltrate,lesion, opacity, pleural density, pulmonary mass, nodule, radiodensity,radiolucency)

    Other Important Tests and Procedures

    • Pulmonary function assessment (evaluates respiratory function, differentiates obstructive/restrictive disorders)
    • Ventilation-perfusion scan (identifies PE)
    • Skin tests (evaluates allergic reactions or TB)
    • Thoracentesis/pleurodesis (for fluid accumulation/pneumothorax)
    • Endoscopic examinations (bronchoscopy, mediastinoscopy for detailed airway/mediastinal evaluation)
    • Lung biopsy
    • Hematology, Blood Chemistry, and Electrolyte Findings (RBC count, Hb, Hct, WBC count, and platelet count; detailed blood chemistry panels include Glucose, LDH, SGOT, AST, ALT, Bilirubin, BUN, and Serum creatinine).
    • Thoracentesis (fluid removal from pleural space)
    • Pleurodesis (involves injecting agents to prevent the recurrence of a pneumothorax or pleural effusion.)

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    Description

    This quiz explores effective communication techniques used during patient interviews, including the use of open-ended and closed questions. It also covers the essential components of a patient history, such as biographic data and current health status. Test your knowledge on these fundamental concepts in patient care.

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