CH 16 Workbook Study Guide PDF

**Definitions** Orthopnea -- difficulty breathing when lying on spine (back) Barrel chest -- shape of thorax associated with emphysema Angina -- chest pain typical of acute coronary syndromes Cachexia -- physical wasting associated with chronic lung disease Shock -- blood pressure too low Trip...

**Definitions** Orthopnea -- difficulty breathing when lying on spine (back) Barrel chest -- shape of thorax associated with emphysema Angina -- chest pain typical of acute coronary syndromes Cachexia -- physical wasting associated with chronic lung disease Shock -- blood pressure too low Tripoding -- the sitting position emphysema patient use they are in trouble Pulsus paradoxus -- drop in blood pressure on inhalation (associated with asthma and hyperinflation) Retractions -- soft tissue sucking in around ribs and neck when a patient has severe distress Syncope -- dizziness associated with drop of blood pressure Tachycardia -- a rapid heart rate may indicate a low blood O2 level Febrile -- presence of a fever Pulse pressure -- difference between systolic and diastolic blood pressure Bradycardia -- a slow heart rate that may result in poor profusion of tissues Cyanosis -- bluish discoloration of skin often associated with hypoxemia Pulse deficit -- heart rate auscultated in chest is different than pulse rate felt in the arm Dyspnea -- difficulty breathing Breathlessness -- sensation of suffocation **Lung sound definitions** Wheeze -- musical inspiratory or expiratory sounds Crackles -- inspiratory sounds associated with atelectasis, pneumonia, and fibrosis Stridor -- upper airway sound that may indicate a life-threating obstruction **Patient interview Q/A** What information would you gather before entering the patient's room? - Read the patient\'s medical record to determine history of present illness - chief complaint - past medical history - family/environmental history - systems review (review of systems, ROS) Describe how to start the ideal interview - Space: Personal and try to get at eye level. - Privacy: Use the curtain if it is not a private room. - Introductions: Identify yourself and your purpose; identify the patient. Best approach to interview - \"Good morning Mr. Johnson.\" - Sit in a chair at the bedside. - Keep your clipboard on your lap. - \"Do you need anything right now?\" - \"I\'ll be back to see you in one hour.\" - \"What are you coughing up?\" - \"I understand you don\'t like your treatments.\" - \"How is your breathing today?\" When are "closed" questions most useful? Give examples - Useful when you want specific information or want to clarify - Examples: "how long did the pain last?" or "How much did you cough up?" **Signs and symptoms of CP disease** Describe the Borg scale - [The Borg scale is useful because it quantifies the level of dyspnea. ] - The scale asks the patient to rate his or her dyspnea from 1, least, to 10, worst. Because this is a subjective symptom, the scale allows us to get valuable information and compare how a person responds to therapists. - Research indicates patient perception of difficulty breathing is valid and clinically useful. **Signs and symptoms of CP disease Q/A -- continued** How else can you identify the degree of dyspnea a patient feels? Explain the difference between dyspnea and breathlessness. - Identify the level of exertion (activity) associated with dyspnea. - Dyspnea - the sensation of difficulty breathing. - Breathlessness - means you feel like you are not getting enough air. What are the possible causes of cough? COUGH CUASES DRY Restrictive: congestive heart failure (CHF), fibrosis LOOSE, PRODUCTIVE Inflammation: asthma, chronic obstructive pulmonary disease ACUTE, SELF-LIMITING Viral respiratory infection CRONIC Gastroesophageal reflux disease, nasal drip, asthma, medication (ACE inhibitors) What is the difference between mucus and sputum? - Mucus is normally produced by healthy airways. - Sputum -- when the amount of mucus is increased and expectorated. What are 3 characteristics of sputum that should be documented and reported to members of the heath care team? 1. Color 2. Viscosity (thick, thin, sticky, etc.) 3. Quantity (small, copius, or by volme) What is the most serious kind of nonpneuitic chest pain? - Angina Difference between Pleuritic and Nonpneuitic chest pain - Pleuritic pain is usually located laterally or posterior. - It is a sharp, stabbing pain - associated with pneumonia, pulmonary embolism, and pleural disease that worsens on inspiration. **Signs and symptoms of CP disease Q/A -- continued** Difference between Pleuritic and Nonpneuitic chest pain -- continued - Nonpleuritic (angina) chest pain is usually located in the center of the chest and may radiate. - Chest wall pain, gallbladder disease, reflux, and esophageal spasm are causes other than cardiac disease. - Angina does not vary with inspiration. A significant elevation in temperature (fever) will have what result in metabolic rate, O2 consumption, carbon dioxide production, and breathing pattern. - Significant temperature elevations will elevate all of the factors. Along with fever, what are 2 signs that are highly suggestive of respiratory infections? - Cough - Purulent sputum **Medical History** What do the initials "CC" and "HPI" stand for? - CC = chief complaint -- reason for seeking treatment - HPI = history of present illness List important aeras described in HPI - Onset, frequency and duration of symptoms - Location of pain - Quality of pain - Aggravating and alleviating factors - Associated manifestations What do the initials PMH stand for? - PMH = Past medical history List important areas described in PMH - Childhood diseases - Hospitalizations (injuries, major illness) **Medical History -- continued** List important areas described in PMH -- continued - Medication allergies - Surgeries - Drugs/medications Describe the significant findings for the general appearance below? FINDING SIGNIFICANCE Weak, emaciated, and diaphoretic General ill health and malnutrition; fever, stress, acute anxiety Appears anxious Severity of problem; level of cooperation Sitting up, leaning with arms on table (tripoding) Typical position for patients with obstructive lung diseases who are having trouble breathing What does the phrase "oriented x 4" mean? - Normal sensorium is typically documented as "oriented × 4." - The sensorium is evaluated by asking patients whether they are aware of their current circumstances---namely whether they are oriented to time, place, person (i.e., self), and situation - A normal sensorium is present when the patient can correctly tell the interviewer their name, the current date, their location, and their situation (e.g., "I\'m in the hospital because I fell and broke my hip"). What is the first thing an RT should evaluate in cases of a decreased level of consciousness - The RT should assess oxygenation. **Medical History -- continued** Compare the terms \"Lethargic\" and "Obtunded." - Lethargic - refers to a sleepy patient who is easily aroused and responds appropriately when aroused. - Obtunded patients are difficult to arouse but still respond appropriately once aroused. What is the difference between a "Stuporous" and "Comatose" patient - Stuporous patients do not wake up completely. They do respond to pain and may respond slowly to verbal stimulus. - Comatose patients are unconscious and have loss of reflexes and other response to stimuli. They usually do not move voluntarily. **Vital information** Definitions How can you prevent patients from becoming aware that you are taking their respiratory rate (RR)? - Count their respiratory rate immediately after the pulse, while keeping your fingers on the wrist. What does it mean when patients show a larger (\>10 mm Hg) decrease in pulse strength during spontaneous inspiration? - Pulse pressure normally decreases slightly with inspiration (\10 mm Hg) during spontaneous inspiration that can be quantified with a blood pressure cuff (see later section). - It is a common finding in acute obstructive pulmonary disease, especially in patients experiencing an asthma attack. **Examining the chest and lungs inspection** Description of abnormal chest shapes NOTE: *Barrel* chest is considered obstructive while the *rest* are considered restrictive Explain the difference between vocal and tactile fremitus? - Vocal -- vibration produced by speech - Tactile -- vibration that can be felt Describe the difference between fremitus in emphysema and in pneumonia? - Emphysema causes decreased fremitus because of hyperinflation. - Pneumonia usually increases the intensity of fremitus because of consolidation. **Examining the chest and lungs inspection -- continued** How does subcutaneous emphysema form? What is the feeling of air under the skin called? - Subcutaneous air forms when air leaks from the lung and gets under the tissue layers of the skin. - The crackling sensation is called crepitus. Identify the percussion notes for conditions What are the limitations of percussion? What can't you palpitate? - Abnormalities that are small or deep cannot be easily detected. Compare the mechanisms and causes of course, low pitched crackles and fine, end inspiratory crackles? - Coarse, low-pitched crackles are often caused by secretions being moved by air in the airways. - Fine, end-inspiratory crackles are probably caused by sudden opening of peripheral airways and are associated with restrictive disorders like fibrosis, atelectasis, and pulmonary edema. Contrast monophonic and polyphonic wheezes - Monophonic wheezes indicate a single obstructed airway. The wheezing may be heard on inspiration or expiration. Mucus or a foreign object might be the cause. - Polyphonic wheezes suggest multiple obstructed airways and are first heard on exhalation. As the patient worsens they may be on inspiration and expiration, or in severe cases only on inspiration. They are most likely to be caused by bronchospasm or CHF. How do you test for capillary refill? What is the normal refill time? - Assessed by pressing briefly on the fingernail. - Normal refill time is less than 3 seconds. Where should you check for edema caused by heart failure? Why? - Usually, the feet and legs are checked. - Fluid settles there due to gravity. What is the specific cause of cyanosis? - Deoxygenation of hemoglobin What is peripheral cyanosis? - Peripheral cyanosis presents with bluish color on the extremities. What is the main cause of peripheral cyanosis? - Peripheral cyanosis is most often caused by poor circulation.