Details Title: 000 Kettering A Description: Kettering Patient Evaluation Section A Total Flash Cards: 301 Created: 09/14/2009 11:11:54		New Users: To study from this flashcard set, or to create your own your own study flash cards, REGISTER HERE. Existing Users: CLICK HERE. Additional Health Care Flashcards
Cards in this set: Term What is the main component to the term life functions Definition getting OXYGEN from the air to the BODY TISSUE CELLS Term What are the four critical Life Functions? Definition 1. Ventilation (air in and out of lungs) 2. Oxygen (getting oxygen to the blood) 3.Circulation (moving blood through the body) 4. Perfusion (getting blood and oxygen into the tissue) Term Which of these life functions is the 1st priority? Definition Ventilation Term what vital signs are important in measuring Ventilation Definition respiratory rate, tidal volume, chest movement, breath sounds, PACO2 Term How would the therapist determine if the patient has a problem with oxygenation? Definition HEART RATE - very important and first sign of hypoxemia. Color (cyanosis is a late sign), sensorium, PaO2 Term What information would help the therapist determine if a patient’s circulation is adequate? Definition pulse/heart rate - strength (strong and bouding, hypoxic vs weak and thready heart) Term What changes would indicate that a patient may not have adequate perfusion? Definition blood pressure, pulse, sensorium, temperature changes (cold and clammy, etc) Term When reviewing a patient’s chart list 10 things that are important to examine... Define an advance Directive…. Definition admission notes, signs and symptoms, occupation, allergies, prior surgery or illness history, vital signs, physical examination of the chest, smoking history, advance directives, DNR status, respiratory care orders, patient progress notes, patient laboratory reports, intakes and outputs Term What is the equation for smoke history in pack years? Definition # packs/day x # of years smoked Term What is normal urine output Definition 40mL/hour - approximately 1L per day - MINIMUM Term Define Semicomatose? Definition responds only to painful stimuli Term lethargy/somnolence Definition consider COPD, O2 overdose or sleep apnea Term Define Obtunded Definition drowsy state, may have decreased cough or gag Term Orthopnea Definition breathing only when sleeping upright - associated with heart problems Term Coma Definition does not respond to painful stimuli Term General Malaise. Definition electrolyte problems - weak tired aches and pains Term Dyspnea. Definition shortness of breath, difficulty breathing Term What is peripheral edema associated with Definition CHF Term clubbing Definition related to chronic hypoxemia - years of hypoxemia Term venous distention Definition neck vein, CHF Term capilary refill Definition peripheral circulation Term diaphoresis Definition heart attack, bad infection, fever, anxiety, nervousness, TB (night sweats) Term skin color - Normal Definition pink, tan, brown, black Term skin color - Abnormal Definition decrease in color due to anemia or acute blood loss (vasoconstriction will cause color change by reducing blood flow) Term skin color - juandice Definition increase in bilirubin in blood and tissues, appears mostly in face and trunk Term skin color - erythema Definition redness of the skin, due to capillary congestion, inflammation or infection Term skin color - cyanosis Definition blue or blue-gray discoloration caused by hypoxia from increased amount of reduced hemoglobin Term Kyphoscoliosis- Definition combination of kyphosis and scoliosis and causes severe restrictive impairment Term kyphosis Definition hunchback or convex spinal curve Term Scoliosis- Definition lateral curvature of spine Term pectus excavatum Definition depression of part or all of the sternum Term Barrel Chest- Definition hyper-inflated, increased AP diameter, increased air trapping - COPD Term pectus carinatum Definition anterior protrusion of the sternum Term Describe symmetrical chest movement. Definition normal Term asymmetrical chest movement Definition abnormal Term List 5 underlying pathologies that can contribute to a patient displaying asymmetrical movement. Briefly describe each of the following breathing patterns and identify a patient condition that would be associated with it. Definition chronic lung disease, atelectasis, pneumothorax, flail chest, intubated pt with et tube in one lung Term Eupnea Definition normal Term Tachypnea Definition increased rate of breathing - due to fever, hypoxia pain, CNS problem Term Kussmauls Definition increased rate , increased depth, irregular rhythm, labored, metabolic acidosis, renal failure, diabetic ketoacidosis Term Apnea Definition cessation of breathing Term bradypnea Definition decreased rate (less than 8 per minute) - sleep (Normal), drugs, alcohol, metabolic disorders Term apneustic Definition prolonged gasping inspriation followed by extremely short, insufficient expiration. Problem with respiratory center, trauma or tumor Term hyperpnea Definition increased rate and depth, regular rhythm. Metabolic disorder/CNS disorder Term cheyne-stokes Definition gradually increasing then decreasing in a cycle with periods of apnea lasting up to 60 seconds. Increased intracranial prssure, meningitis, drug overdose Term Biots Definition increased rate and depth with irregular periods of apnea. CNS problem Term Palpating a pulse, what three life functions Definition hypoxic, tachycardia. Failing heart, bradycardia, can't feel pulse…perfusion Term Normal pulse range Definition 60-100 Term tachycardia pulse range Definition greater than 100 Term bradycardia Definition less than 60 Term what pulse rate indicates an adverse reaction* Definition more than 20 beats per minute - stop therapy notify nurse Term tracheal deviation palpation important information Definition pulled toward abnormal side, problem inside lung (atelectasis, fibrosis); pushed away from the problem, outside the lung..pushing everything away from problem ie tension pneumothorax or pleural effusion - would insert chest tube to relieve Term Rales (crackles) indicate what Definition course - large airway secretions and pt needs suction; medium means middle airway, pt needs chest PT; fine (moist crepitant) patient has CHF/pulmonary edema and needs IPPB, heart drugs, diuretics and oxygen Term wheezes indicate what Definition bronchospasm, needs bronchodilator, unilateral wheeze indicates foreign body obstruction and it would need bronchoscope not bronchodilator Term stridor indicates what Definition upper airway obstruction, epiglottitis, croup, foreign body aspiration - topical decongestant (racemic epinephrine) for swelling and edema, suctioning or bronchoscopy, intubation for severe swelling Term pleural friction rub indicates what Definition course grating or crunching, caused by inflamed surface of the visceral and parietal pleura, associated with pleurisy or TB or pneumonia or pulmonary infarction or cancer and drugs such as steroids (for inflammation) or antibiotics (for infection)are indicated Term abnormal heart sound - presence of S3 Definition CHF Term abnormal heart sound - presence of S4 Definition cardiac abnormality such as myocardial infarction or cardiomegaly Term abnormal heart sound - murmur Definition turbulent blood flow, caused by heart valve defects or congential abnormalities Term abnormal heart sound - bruit Definition sounds made in an artery or vein when blood flow becomes turbulent or flows at an abnormal speed. Heard through stethoscope over identified vessel such as carotid artery Term increased blood pressure indicates what Definition cardiac stress - hypoxemia Term decreased blood pressure indicates what Definition poor perfusion - shock Term what is normal percussion Definition resonnant Term flat or dull percussion Definition atelectasis or pneumonia Term tympanic hyper resonnant percussion Definition extra air - pneumothorax or if bi-lateral could be air trapping or emphysema vs unilateral Term what are normal breath sounds call Definition vesicular - any other term would be a change Term Normal heart sounds Definition S1 (lub) S2 (dub) Term what is an obscure word for radiograph, radiogram, chest x-ray Definition roentgenogram (pronounced "rankenogram") Term X-ray (aka radiogram, roentgenogram) where should ET tube be positioned Definition et tube which should be below vocal cords, no closer than 2 cm (2.5 cm) be careful of unit of meausure such as 1 inch above the carina; same level as aortic knob or aortic arch, assure bilateral ventilation and clavicle is too high! Term what will quickly determine adequate ventilation before chest x-ray is done with regard to ET tube Definition observation and auscultation Term trachea normal position Definition midline; if shifted to one side, pathological problem. Should be same size as vertebral column. Major bronchi should not be narrowed at the carina or distal end. If narrowing is present, this may indicate brochogenic carcinoma Term mediastinum Definition area between the lungs where heart, lymphatics, blood vessels and major bronchi are found. May shift with pleural effusions - could take place of trachea to indicate a problem or hilum is shifted, heart shadow could be shifted…indicates same thing Term A-P diameter - when is it increased (anterior posterior diameter) Definition increased with COPD, barrel chest, hyperinflation Term Chest X-ray; costophrenic angle and when obliterated Definition made by outer curve of diaphragm and chest wall. Obliterated by pleural effusions - fluid in the chest Term Chest X-ray; Diaphragm Definition normally dome shaped. Flattened with COPD. Left or right hemidiaphragms may shift downward with a pneumothorax, appearing flattened on one side Term Chest X-ray; vascular markings Definition blood vessels, lymphatics, lung tissue - should see these throughout….in normal. If increased, could indicate fluid problem too much would mke them more prominent Term Chest X-ray; heart shadow Definition left ventricle normally seen, cadiomegaly (enlarged heart) is seen with COPD Term Chest X-ray; soft tissue Definition tissue surrounding the chest and above in the neck area. Subcutaneous emphysems is when air (hyperlucency) is seen in the surrounding soft tissue. Air leaking into soft tissue, air leak or subcutaneous emphysema Term What can you see on an x-ray Definition anything in the body, chest tube, device. Any question assessing position of something, choose x-ray Term AP projection, anterior, posterior Definition film behind back, bedridden patients Term PA projection, posterior, anerior Definition film touching the chest with back to x-ray Term X-ray; Lateral position Definition projection from either right or left side; adds a third dimension to structures viewed on AP or PA films Term X-ray; Oblique position Definition slanting or diagonal view, aid in localizing lesions Term X-ray; Lateral decubitus position Definition patient lying on the affected side, valuable for detecting small pleural effusions Term X-ray; apical lordotic Definition projection of lung apices Term X-ray; end expiratory film Definition taken when the patient is at end exhalation, valuable for detecting a small pneumothorax Term increased blood pressure indicates what Definition both hemidiphragms are rounded or dome-shaped; right hemidiaphragm is slightly higher than the left; right hemidiaphragm is at level of sixth anterior rib; trachea is midline; bilateral radiolucency with sharp costophrenic angles; head of clavicles should be level Term X-ray - position of tubes and catheters Definition chest tubes should be located in pleural space surrounding lung, nasogastric tubes and feeding tubes should be positioned in stomach and small bowels below diaphragm, pulmonary artery catheters should appear in right lower lung field, pacemaker should be normally positioned in right ventricle; central venous catheters are plcd in right or left subclavian or jugular vein and shuld rest in vena cava or right atrium of the heart Term What is a valuable diagnostic tool for upper airway obstruction in children (croup, epiglottitis) Definition a lateral neck x-ray. Both conditions cause a localized swelling of tissues that may cause a partial to complete obstruction of the airway and require prompt and effective therapy Term Croup Definition viral disorder common in infants and young children the x-ray of the neck will reveal trachal narrowing in a classic pattern called a "steeple sign" Term epiglottitis Definition potentially life-threatening inflammation of the supraglottic airway caused by a bacterial infection. A lateral neck x-ray that shows supraglottic narrowing with an enlarged and flattened epiglottis and swollen aryepiglottic folds. This presentation is known as "thumb" sign Term What can the airway be narrowed by Definition edema, secretions, tumors, or aspirated foreign bodies. Most can be identifiable on chest or neck x-ray Term subcutaneous emphysema Definition presence of air in subcutaneous tissue. Patient who presents with subcutaneous emphysema should be assessed for a pneumothorax, tracheal or bronchial injury. The bubbles of air under the skin can be palpated and are referred as crepitus Term extrapulmonary air Definition air found outside the lungs, pneumothorax, pneumoperitoneum, pneumomediastinum, subcutaneous emphysema Term Radiolucent Definition dark pattern, air, normal for lungs - increased radiolucensy..extra air, normal lungs but not anywhere else Term Radiodense Definition white pattern, solid, fluid - normal for bones and organs, fluids, heart shadow. In lungs means, fluid Term Infiltrate Definition any ill-defined radiodensity, atelectasis (something funny, I don't know what it is) doesn't mean atelectasis…could mean atelectasis Term consolidation Definition solid white area, pneumonia/pleural effusion - "I still don't know, worse than infiltrate" probably fluid, inside lung pneumonia, outside pleural effusion - lateral decubitus x-ray could tell you..if it moves when on the side, fluid. Doesn't move probably pneumonia Term hyperlucency Definition extra pulmonary air - COPD, asthma attack, pneumothorax (pneumo would be on one side only (unilateral hyperlucensy)..hyperlucency could be emphysema Term vascular markings Definition lymphatics, vessels, lung tissue - increased with CHF - due to fluid overload, absent with pneumothorax. If none, means lungs pushed away but still have radiolucency..pneumothorax would be increased radiolucency with absent vascular markings Term diffuse Definition spread throughout, atelectasis/pneumonia Term opaque Definition fluid, solid - consolidation Term bilateral Definition on both sides Term unilateral Definition on one side Term fluffy infiltrates Definition diffuse whiteness - pulmonary edema Term butterfly/batwing pattern Definition infiltrate in shape of butterfly - pulmonary edema Term ground glass, honeycomb, granular, nodular (grind up glass, get a bunch of granules) Definition reticulogranular - ARDS/IRDS Term patchy, scattered, thin layered, platelike infiltrates Definition patchy is irregular - atelectasis Term air bronchogram Definition pneumonia - pneumonia fills up small airways with fluid, air in small bronchus stick out Term peripheral wedge-shaped infiltrate Definition pulmonary embolus (tissue around it starts to die, therefore it moves out in wedge shaped appearance) Term concave superior interface/border or basilar infiltrates with meniscus Definition pleural effusion - concave and meniscus (like in a test tube) both mean "curving".. Curving up the side, curling up chest wall is fluid aka pleural effusion (fluid on the outside) Term bronchogram Definition injecting radiopaque dye for bronchiectasis Term V/Q scan Definition associated with embolism - Pulmonary angiography scan can be an alternate test if V/Q is inconclusive Term MRI Definition magnet is key word, nothing magnetic… Term EEG Definition sleep studies Term ICP Definition normal value is 5 - 10 mm Hg start tx if gets above 20 mm Hg - drugs, hyperventilation can treat. ONLY treat if 18, 19, close to 20 Term ultrasonography of the heart Definition Echocardiogram to check heart, valves, etc. murmur, funny heart sounds, EKG doesn't show Term RBC Definition red blood cells, normal value 4-6 - (mid of 5 )high RBC (polycythemia) increased with chronic tissue hypoxemia like COPD, low RBC (anemia) blood loss or hemorhage Term CBC Definition complete blood count Term hematocrit Definition percentage of total blood is RBC Term normal hemoglobin Definition normal RBC of 5 x 3 = 15 which is normal hemoglobin Term normal hematocrit Definition 15 hemoglobin x 3 = 45 Term what are the three ways to count RBC, and what are norms Definition normal RBC is 5 x5 = 15 which is hemoglobin x 3 = 45 which is hematocrit Term If RBC numbers are rising, polycythemic Definition seen in COPD Term if RBC is falling, anemic Definition blood loss, short of breath, hypoxic but blood gas is normal, maybe anemic - run CBC Term WBC Definition normal is 5-10 thousand Term WBC is up Definition bacterial infection - stimulates production Term WBC is down Definition viral infection - does not stimulate production, die in battle, numbers drop Term neutrophils Definition WBC Term eosinophils Definition wbc associated with ashthma, allergic reaction "yellow" sputum Term monocytes Definition TB Term K+ Definition Electrolyte - potassium - check first, most important electrolyte inside the cell - not enough, palpitations, muscle issues. NORMAL Is 4 (3.5 - 4.5) Term electrolyte imbalance Definition feels "bad" headaches, nausea, malaise, complaining of misc maladies, electrolyte imbalance, check electrolytes Term hypokalemia Definition low potassium, ABG changes to metabolic alkalosis. "don't feel good with metabolic alkalosis" low potassium problem. Excessive excretions, vomiting, fluid loss, loses potassium. Or EKG pattern, normal but with no T wave could indicate hypokalemia Term hyperkalemia Definition spiked T-wave, metabolic acidosis, kidney failure (retaining) high potassium Term Na+ Definition sodium. 140 is normal Term Cl- Definition chloride - potassium and sodium follow. Normal is 90. if low, alkalosis (follows K+..goes where it goes) Term Bicarb Definition call it total CO2, CO2 content (reminds us of PCO2 but it is just CO2, quickly converted to carbonic acid breaks down to bicarb acids) most of CO2 is being carried in form of bicarb. Alkalotic, metabolic alkalosis = potassium Term normals for electrolytes Definition CO2 = 35 - 45; 3.5 - 4.5 potassium, 135-145 is sodium - CO2 is the hint. Cloride is PO2, normal is 80-100 for cloride, bicarb 24, - think of blood gases Term Creatinine/BUN Definition monitor kidney function - rises if kidney failure, both are excreted by kidneys they are products of metabolism. If both to choose from, CREATININE is better Term oscilloscope Definition continuous visual image of the heart Term holter monitor Definition portable version of eclectrocardiogram Term what generates the electric impulse of the heart (pacemaker) Definition SA node Term where is SA node located Definition upper right hand corner of heart near superior vena cava - moves to center of heart to AV node, down to ventricles, predomantly left (biggest) . Upper right, moving to center, moving to left ventricle, general direction, atria down toward ventricle, right side moving to left side - direction of electrical activity. down and to the left Term EKG graph paper Definition one milivolt = 10 mm on standard settings Term Basic 12 lead EKG is how many electrodes Definition 10 - electrodes Term what is most important/best of EKG leads Definition lead II - best view of the heart - angled down and to the left (same as electricity of the heart) Term what is best lead for chest leads Definition V5 - directly over left ventricle Term normal rate (EKG) Definition 60 - 100 Term Bradycardia (EKG) Definition less than 60 Term Tachycardia (EKG) Definition greater than 100 Term flutter (EKG) Definition greater than 200 Term fibrillation (EKG) Definition too fast to count Term how to estimate heart rate from EKG strip Definition measure distance between two R waves - look at big boxes - example 4 boxes would be 300/blocks in this example would be 300/4 = 75 which is a normal rate. SO - 3-5 boxes is normal. Closer than 3, greater than 100 farther than 5 less than 60 Term What does a positive P wave mean Definition normal sinus rhythm - if asked normal sinus rhythm, yes if P wave is positive Term normal rate positive p wave on EKG would be what as an interpretation Definition normal sinus rhythm - normal is rate is normal, sinus is p wave is positive Term Normal sinus rhythm Definition normal rate, no skips, no extra beats, no tx Term sinus tachycardia Definition sinus rhythm with rate greater than 100 (less than 3 boxes between R waves) - tx is O2 (first sign of hypoxemia is tachycardia) Term sinus bradycardia Definition sinus rhythm with rate less than 60 - wider than 5 boxes - tx is atropine or O2- atropine is good Term PVC Definition premature ventricular contraction- WIDE is ventricular (not how tall, but how wide) instead of skinny QRS, wide with no P wave (didn’t' start in SA node- not normal travel of electricity takes a long time) lidocaine which reduces irritability of the heart or oxygen. abnormal contraction, not a rhythm. the rhythm is normal sinus rhythm with PVC Term V-tach Definition ventricular tachycardia - tx is defribillation (palpate for pulse, if no pulse defib if pulse than cardioversion) or lidocaine. Rhythm with rate greater than 100 (less than 3 boxes) Term v-fib Definition fibrillation, completely irregular, defibrilate Term miltifocal PVC Definition premature ventricuar contraction - tx is oxygen or lidocaine. Multifocal means many locations, wide ventricular complexes that don't look same b/c came from different places, all PVC's look different and wide which are ventricular. Irritation, oxygen or lidocaine Term Asystole Definition flat line, epinephrine or atropine - confirm in two leads!!!!!! (one angle could make look like flat line) Term Changes in CVP can indicate changes in fluid balance. What does decreased CVP and increased CVP indicate Definition decreased CVP (<2 mmHg) can indicate hypovolemia; increased CVP (>6) can indicate hypervolemia Term During the patient interview, what should you review with regard to the patient's nutritional status Definition usual food intake, food likes and dislikes, appetite, note any weight gain or loss Term With regard to assessment by inspection, what should you pay attention to with regard to evidence of difficult airway Definition existence of clinical factors that complicate either ventilation administered by face mask or intubation performed by experienced and skilled clinicians. Term With regard to assessment by inspection, what should you pay attention to with regard to evidence of difficult airway; look extenernally for evidence of face or neck pathology such as: Definition short receding mandible, enlarged tongue (macroglossia), bull neck, limited range-of-motion of the neck Term What is NIOX testing Definition exhaled nitric oxide testing; measurement of nitric oxide concentration (Feno) in patient's exhaled breath Term What is nitric oxide testing (NIOX) used to monitor Definition the asthma patient's response to anti-inflammatory (corticosteroid) treatment Term What does a decrease in Feno suggest with regard to NIOX testing Definition suggests a decrease in airway inflammation Term How is NIOX testing measured Definition By using a handheld device that provides accurate, reproducible and immediate measurement of fractional exhaled nitric oxide (Feno) Term What is the normal ECG characteristic of the aVR and V1 leads Definition a predominately negative QRS complex Term What is the normal ECG characteristic of the T wave in leads I and II Definition The T wave will normally be upright (positive) Term What is the normal ECG characteristic of the R wave in V1 and what does it do as you approach V5 Definition R wave in V1 will be small and increase in size as you approach V5 Term With catheter position and waveforms what does the pressure and waveform pattern reveal Definition the position of the Swan-Ganz Catheter Term With catheter position and waveforms, what happens when the balloon is inflated Definition when the balloon is inflated, the catheter will "wedge" and the back-pressure from the pulmonary capillary will be measured Term With catheter position and waveforms, if while monitoring the PAP you are unable to get a distinct high and low value (systolic and diastolic pressures) what do you check to see Definition if the balloon is inflated Term With catheter position and waveforms, what does the presence of a double spike (dicrotic notch) normal for and when does it occur Definition the pulmonary artery pressure (PAP) waveform and occurs when the pulmonic valve closes Term With catheter position and waveforms, what is "pressure dampening" Definition when the monitor does not show the normal dicrotic notch and the catheter is somehow "obstructed" Term With catheter position and waveforms, what can cause an obstruction Definition blood clot, bubble in the catheter or transducer dome or kinking of the tube (movement of the catheter does not cause damping) Term What to do if a blood clot occurs Definition aspirate, flush the catheter, rotate the catheter Term AV Block Definition football analogy, 1st degree slows you down with pause (delay) between p wave and QRS. Beginning of p wave to qrs is PR interval, short less than bold square wider than that, delay called 1st degree AV block. If an answer offers 1st degree block but looks normal, double check the spacing. 2nd degree block skips a beat..when you see a p with no qrs comples, 2nd degree block. 3rd is complete block of the AV node, so you are getting p waves with no QRS to follow ventricles will wait for impulse, but if nothing happens will depolarize, slow and uncoordinated, total mess 3rd degree, complete dissociation Term 1st degree AV block Definition PR interval >.20 (measured from beginning of P wave to the beginning of the QRS); may be due ot ischemia or digitalis; TX is atropine Term 2nd degree AV block Definition irregular rhythm; normal P waves, but QRS complex is missing; tx is atropine or electrical pacemaker Term 3rd degree AV block Definition atrial rate >60, ventricular rate <40/min; PR interval cannot be determined: QRS complex is widened, tx is electrical pacemaker Term Axis of ECG Definition The axis (direction of heart) of an ECG measures the net direction of all electricity through the heart during contraction; normally the electrical impulse begins in the upper right hand corner of the heart (SA node, right atria) and moves in waves down and across the heart to the left. Normal axis of the heart is down and to the left Term What two factors affect the axis of the ECG Definition Hypertrophy - increases electrical activity, axis will shift toward hypertrophy(more muscle); Infarction -(less muscle) dead tissue, no electrical activity, axis will shift away from infarction (heart attack, left ventricle) Term MI Definition could be myocardial ischemia, myocardial injury, myocardial infarction - stages of a heart attack Term ischemia Definition reduced blood flow to tissues Term injury (Heart) Definition acute damage to tissue (often from ischemia) Term infarction Definition necrosis or death of tissue (end result of ischemia and injury; may be acute (new) or old Term What will reveal the conditions as they occur in sequence from ischemia to injury to acute myocardial infarction Definition ECG Term How is ischemia indicated on the ECG Definition by a depressed or inverted T wave Term Beside ischemia, what is also indicated by a depressed or inverted T wave Definition digitalis toxicity and hypokalemia Term How is injury (heart) indicated on the ECG Definition elevated S-T segment Term How is infarction diagnosed on the ECG Definition significant Q waves - Q waves 1/2 the height of the R wave are significant, or Q waves 1 small square wide are significant Term What kind of wave will hyperkalemia cause Definition elevated or "spiked" T waves Term During assessment of the infant, what to check in the perinatal history Definition mother's history: history of pregnancy, age, smoking and substance abuse, nutrition, infection, previous pregnancies/outcomes, hypertension/toxemia, mothers with diabetes are prone to premature infants. Also check family history, delivery and postnatal history Term gestational age Definition time since the estimated date of conception Term term infant Definition born between 38-42 weeks gestational age Term preterm infant (premature) Definition less than 38 weeks gestational age Term post term infant Definition more than 42 weeks gestational age Term What is the APGAR score Definition provides a clinical method for evaluating the infant immediately after birth. Allows for a rapid appraisal of an infant in determining the need for resusitation Term When is the APGAR score routinely done and what do the times signify Definition 1 and 5 minutes. 1 minute predicts neonatal survival; 5 minutes predicts future neurological damage Term What are the five factors evaluated during the APGAR scoring of an infant Definition color, heart rate, reflex irritability, muscle tone and respiratory effort Term A in Apgar (first A) Definition appearance (color) - 2 is good and completely pink; bad is 1 body pink extremeties blue - 0 is real bad blue all over and/or pale Term P in APGAR Definition pulse. 2 is good and > 100; 1 is bad and <100; 0 is real bad and absent, no pulse Term G in APGAR Definition grimace (reflex irritability) 2 is good and cough or sneeze; 1 is bad and grimace; 0 is real bad and no response Term A in APAR (second A) Definition Activity; 2 is good and active motion; 1 is bad some flexion of extremeties; 0 is real bad and is limp no movement Term R in APGAR Definition respiratory effort. 2 is good and regular, strong cry - 1 is bad and slow, irregular weak cry - 0 is real bad and absent, no cry Term Action based on APGAR score Definition 0-3 resusitate; 4-6 support by stimulation, warm, administer o2; 7-10 monitor by routine care Term Transillumination Definition recommended for infants, when pneumothorax is suspected; a bright fiberoptic light is placed against the infant's chest in a darkened room, normally a lighted "halo" is seen around the point of contact, a pnemo or pneumomediastinum will cause entire hemithorax to light up Term vital signs for infants, half or double adult Definition respirations approximately double - (120) - blood pressure is half, (60/40) Term Temperature in infants Definition infants lose body heat very quickly and may need to be placed in a warm environment to maintain adequate body temperature; normal temp is 36.5 celcius, servo controlled incubator and radiant warmers provide automatic adjustment of temp; sensor is placed on the infant and feeds back info to the heating/cooling agent; if temp probe comes off skin the unit may overheat causing high air temp and low skin temp alarms to sound Term Pulse in infants Definition normal for term infant is 110-160; tachy is 170 or greater, brady is less than 100; measured using brachial, femoral, or apical pulse; infant can only increase their cardiac output by increasing heart rate Term respirations in infants Definition normal is 30-60; respiratory pause is apnea for 5-10 secs and is normal; short apnea of 10-20 seconds may be normal; long apnea of more than 20 seconds is always abnormal Term Blood pressure in infants Definition normal term infant is 60/40; preterm is 50/30 Term Birth weight in infants Definition normal term infant is > 3000 gm; 28 week gestational age is 1000 gm; low birth weight infants are at higher risk for respiratory problems Term cyanosis in infants Definition acrocyanosis is bluish extremeties and is not true cyanosis; check ucous membranes of mouth, tongue and nail beds Term retractions in infants Definition intercostal, subcostal, substernal or supraclavicular retractions re signs of respiratory distress Term nasal flaring in infants Definition dilation of nasal opening also indicates respiratory distress for infants who must breathe through their nose Term grunting in infants Definition a sound heard at the end of exhalation that indicates respiratory distress (RDS) from decreased lung volumes Term capillary refill in infants Definition blanching the infant's skin to see how long it takes for normal color to return. Longer than 3 seconds may indicate a decreased cardiac output Term Determining gestational age - Dubowitz method Definition assessment of the gestational age is important to differentiate between premature and just small for gestational age. The higher the score the higher the gestational age in weeks. Normal score is 40 correspondening with 40 weeks, a score higher than 40 is a post-term infant; lower than 40 indicates pre-term infant Term new ballard score for determining gestational age Definition modificatin of dubowitz scale, estimates gestational age in very low birth weight infants, normal score of 40 corresponds to 40 weeks - keep in mind over 40 is post term, under 40 is pre-term Term pre-and post-ductal blood gas studies Definition if right-to-left shunting occurs across the ductus arteriosus, the PaO2 level obtained from a pre-ductal site (right arm) often exceeds the PaO2 level obtained from a post-ductal site (umbilical artery or a lower extremety vessel); if the pre-ductal (right radial artery) PaO2 is 15 mmHg higher than the post-ductal (umbilical artery) PaO2, then the patient has a patent ductus arteriosus with a right to left shunt Term Blood glucose in infants Definition important to monitor in infants, term infants should have values greater than 30, premature infnats should have values greater than 20 - if they don't have glucose, their brain will die Term L/S ratio (infant assessment - lung maturity assesment) Definition lecithin/sphingomyelin - a ratio of 2:1 or higher is good. Incidence of hyaline membrane disease (HMD) or infant respiratory distress syndrome (IRDS) approaches zero. Ratio less than 2:1 indicates high risk of HMD/IRDS; as ratio drops below 2, incidence of HMD/IRDS ranges from 40-80%. lower ratios' indicaing higher risk; incidence of false-negative L/S ratio is from 20-25% and occurs when a low L/S ratio is measured with no signs of distress. if 1:1 then premature, poor maturity of lung, surfactant therapy is an option Term PG (infant assessment - lung maturity information) Definition phosphatidylglycerol. Phosphlipid appearing at about 36 weeks gestation and rising until term; most reliable indicator of pulmonary maturity even with diabetes Term PC (infant assessment - lung maturity information) Definition phosphlipid - lecithin makes up the majority weight of surfactant; indicator for lung maturity and will rise as lungs mature Term What does capnography measure Definition EtCO2 (end tidal) or ECO2 (exhaled)- measures exhaled carbon dioxide content using infrared absorption - good way to monitor ventilation. Infrared monitor Term Once a capnograph is set-up, what is drawn to correlate the values Definition blood gas - does not replace a blood gas, but noninvasive way to see how things are changing and signifies when is a good time to draw a blood gas to see what is happening Term What is normal PaCo2 vs normal PetCO2 Definition PaCO2 40; PetCO2 30 - keep in mind that exhaled CO2 drops to 30 because of anatomical deadspace with no CO2, but alveolar gas does and when mixes then it drops..both values drop and rise together, but exhaled is slightly less Term EtCO2 can also be measured as a percent, what is normal Definition 3-5% Term where is capnograph sensor placed Definition proximal(very close to capture as soon as comes out) to the patient's airway connection (at ET tube) - may pull a side stream sample to avoid moisture screwing with values Term What would an increase in capnograph indicate Definition decrease in ventilation (ventilatory failure) Term What would a decrease in capnograph indicate Definition an increase in ventilation or decreased perfusion. Reading of zero or low, reconnect patient to ventilator (could be deadspace from pulmonary embolism which is why blood gas would confirm the exact situation - if blood gas is normal but patient appears to be hyperventilating, could be compensating for deadspace) Term What would low PetCO2 readings immediately following intubation indicate Definition ET tube is in the esophagus Term What should happen to the PetCO2 during CPR Definition it should increase Term Exhaled CO2 detection devices are available to detect esophageal intubation. What are non-electric portable disposable devises designed to produce with the presence of exhaled CO2 Definition designed to produce a color change and have the abilit to produce appropriate color changes for a wide range of PCO2s and respitatory patterns Term What are example color changes with exhaled CO2 detection devices Definition purple - poor; yellow - normal; falso readings can occure in patients who have been without CPR for a period of time and may be used to confirm tracheal intubation. Moisture and secretions can cause false readings and obstruct the sample tube (will read zero) Term What is the most appropriate noninvasive technique for continuous monitoring of oxygen saturation Definition pulse oximetry Term where is the pulse ox probe placed Definition attaches to finger and transmits light pulses through the capillary beds Term What could be the problem if there is a sudden fall in readings without a change in the patient's condition Definition probe needs to be changed or reattached Term SaO2 results in pulse ox are accurate in patinets with good perfusion and sats higher than Definition 70% Term What is pulse ox recommended for Definition monitoring in sleep apnea, and for resting and exercise desaturation Term What is pulse ox accuracy affected by Definition perfusion (shock and hypotension), conditions that interfere with the light transmission (nail polish, erythema, bright ambient lights) Term when will higher than normal sats on a pulse ox result from Definition carbon monoxide poisoning Term what is overnight pulse ox Definition assessment of oxygen fluctuations during an overnight period through the use of pulse oximetry Term when is overnight pulse ox indicated Definition as a screening tool for identifying patients with sleep related breathing disorders and to assess response to treatment for obstructive sleep apnea Term equipment characteristics of pulse ox Definition high quality and portable, able to record oxyhemoglobin saturation and pulse, set to the shortest tiem interval for measurement Term what is an invasive oximetry method Definition co-oximetry/hemioximeter Term what is a co-oximetry/hemioximeter used to diagnose Definition carbon monoxide poisoning Term what is normal COHb Definition 1-3% Term what is COHb for smokers Definition 5-10% Term what is COHb for heavy smokers Definition 10-15% Term what is the best way to evaluate oxygenation in a CO poisoning patient Definition co-oximetry/hemioximeter Term a co-oximeter/hemioximeter works the same way as pulse ox except what Definition blood sample and more wavelengths of light are used instead of the probe attached to the skina and more accurately measures COHb, O2Hb and other non-functional hemoglobin Term Transcutaneous PO2 and PCO2 meausurement Definition electrodes that allow continuous, non-invasive PO2 and PCO2 measurement by electrodes placed on the skin instead of a single measurement with a blood sample Term Transcutaneous PO2 and PCO2 - how is it meausured Definition heating skin and bringing oxygen and CO2 to the surface, heated to 42 - 45 celcius, if patient is getting burned, move around every few hours Term Best placement for transcutaneous PO2 and PCO2 Definition flat areas with good perfusion such as chest beneath center of right or left clavicle Term How is calibration of PO2 and PCO2 done Definition on room air with a zeroing solution. If cannot calibrate, check for torn membrane, poor connections, air leaks will increse the TcPO2 to read hgher than PO2 Term Impedence apnea monitor/pneumogram Definition apnea monitor and associate with infants concerned with infant apnea. Electrodes attached to chest sense changes Term Problems with impedence apnea monitor Definition false alarms, poor electrode contact, monitor may not sense obstructive apnea if patient has hiccups, must be used during naps, rides in car, stroller, etc, may be disconnected during breast-feeding, set low heart rate alarm to 60-80 for infants Term How many chambers in the heart Definition four - two atria two ventricle Term how many valves in the heart Definition four - one for each chamber Term How many branches in circulatory system Definition four- pulmonary and systemic arteries; pulmonary and systemic veins Term How many blood pressures are there Definition four - one for each chamber, valve and branch Term What does hemodynamics comes down to Definition four blood pressures Term What does it mean that the patient has "two" hearts Definition right heart - failure would be cor pulmonale. Left heart - congestive heart failure. Anatomically next to each other, two separate systems. Right heart pumps blood to lungs, left heart to everything else. Term which heart is bigger Definition left heart, responsible for pumping blood to EVERYTHING….HUGE generates a lot of pressure, right heart just sends blood right next door. Pressures will be different Term artery vs vein Definition artery - away from heart; vein goes back to heart Term pulmonary Definition lungs so pulmonary artery means going away from heart to lungs. Term what is pulmonary artery pressure (PAP) Definition 25/8 approximately. Higher than that would be pulmonary hypertension - mean pressure about 14 Term With regard to monitoring of wedge pressure Definition LEFT goes with WEDGE; WEDGE goes with LEFT - monitor left heart, monitor wedge pressure. Term monitoring left heart Definition left goes with wedge, wedge goes with left Term separate left heart problems with lung problems, what if everything is normal but wedge pressure is rising Definition left heart trouble Term everything is normal but PAP is rising Definition pulmonary (lung) problems i.e. embolism, emphysems, etc - causing a backup into pulmonary arteries Term which valve has two cusps Definition bicuspid, mitral, left AV valve - separating valve between atria and ventricle Term what do you do with mitral valve stenosis Definition problem in left heart, wedge pressure will rise Term mitral equals left Definition wedge pressure Term wedge pressure Definition left and refers to mitral valve Term what is important with hemodynamics Definition right heart pumps to lungs, with pulmonry artery system - PAP. Lung disease will back up to PAP. If wedge pressure is changing, left heart. Regular blood pressure monitors perfusion to capilaries, CVP is fluid return to right heart Term losing fluids Definition all pressures falling, especialy CVP. Associated with right heart Term adding fluids Definition pressures rise, especially CVP - associated with right heart Term PVR Definition pulmonary vascular resistance. Take two pulmonary pressures, take smaller from bigger to get gradient and divide by C.O. Trick is in dynes, so multiply answer by 80 Term {image:104905|center} Definition 2nd Degree AV block irregular rhythm normal P waves, but QRS complex is missing   Treatment: Atropine, electric pacemaker (just in case) Term {image:104904|center} Definition 1st Degree AV block PR interval >.2 (measured from the beginning of P wave to the beginning of QRS); may be due to ischemia or digitalix   Treatment: Atropine Term {image:104906|center} Definition 3rd Degree AV block atrial rate >60, ventricular rate <40/minute; PR interval cannot be determined; QRS complex will be widened   Treatment: Electrical pacemaker Term {image:104907|center} Definition Asystole confirm in 2 leads first   Treatment: Epinephrine or Atropine Term {image:104908|center} Definition Infarction Diagnosed by significant Q waves   Q waves 1/2 the height of the R wave are significant, or Q waves 1 small square wide are significant Term {image:104909|center} Definition Injury indicated b elevated S-T segment Term {image:104910|center} Definition Ischemia depressed or inverted T waves   note:  inverted T waves can also be caused by digitalis toxicity and hypokalemia   Also note that elevated or "spiked" T waves could indicate hyPERkalemia Term {image:104911|center} Definition multifocal PVC premature ventricular contractions   Treatment: oxygen, lidocaine Term {image:104912|center} Definition Normal Sinus Rhythm noraml rate, no skips, extra beats, etc.   no treatment Term {image:104913|center} Definition PVC premature ventricular contraction   Treatment: oxygen, lidocaine Term {image:104914|center} Definition sinus bradycardia sinus rhythm with rate <60   Treatment: Atropine, oxygen Term {image:104915|center} Definition Sinus Tachycardia sinus rhythm with rate >100   Treatment: oxygen Term {image:104916|center} Definition V-fib (ventricular fibrillation) completely irregular ventricular rhythm   Treatment: fibrillation Term {image:104917|center} Definition V-tach Ventricular tachycardia ventricular rhythm with rate >100   Treatment: defibrillate (if no pulse) lidocaine cardiovert (if pulse)   Term {image:104918|center} Definition Capnograph