Shared Flashcard Set

Details

BIO 150
Patient Assessment
431
Anatomy
Undergraduate 1
07/03/2008

Additional Anatomy Flashcards

 


 

Cards

Term
Question
Definition
Answer
Term
What are the stages of patient-clinician interaction?
Definition
"Preinteraction stage, Introductory, Initial Assessment, Treatment, Follow-up"
Term
Preinteraction stage
Definition
Review chart to identify important facts stated in the medical history
Term
Introductory stage
Definition
"Introduce yourself, verify ID bracelet"
Term
Initial Assessment
Definition
"Identify health status, brief interview and physical examination"
Term
Treatment and monitoring stage
Definition
Provide treatment and monitor patient's response
Term
Follow-up Stage
Definition
"Ask patient how he/she is feeling, ask if there's anything you can do and let patient know when you will return"
Term
Social Space
Definition
"4-12 feet and is useful for intial intro, first step toward establishing a rapport"
Term
Personal Space
Definition
18 in - 4 ft and is most useful for interview
Term
Intimate Space
Definition
"0-18 inches and is typically only invaded once a rapport, no eye contact, useful for physical exam"
Term
Confidentiality
Definition
"All records are confidential ""need to know"" basis and nothing discussed outside patient rooms"
Term
Open-Ended Question
Definition
encourages patients to describe events as they seem them and promote better understanding of the problem
Term
Closed-Ended Question
Definition
Focuses on specific information and provides clarification
Term
What is the most common symptom of lung disease
Definition
cough
Term
What is a powerful protective mechanism for the lung and airways
Definition
cough
Term
What is a cough caused by?
Definition
"mechanical, chemical, inflammatory or thermal stimulatio of the cough receptors"
Term
What are the commonly accepted cough adjectives?
Definition
"Productive, Effective, Weak, Dry, Chronic productive"
Term
Productive cough
Definition
mucus is produced with the cough
Term
Effective cough
Definition
strong cough
Term
Weak cough
Definition
ineffective
Term
Dry cough
Definition
no secretions
Term
chronic productive
Definition
patient produces phlegm most days for at least 3 weeks
Term
What are the causes of hemoptysis
Definition
"persistent strong coughing, acute infections, brochogenic carcinoma, cardiovascular disease, Trauma, Anticoagulant therapy"
Term
What is streaky hemoptysis
Definition
streaky refers to blood-tinged sputum
Term
What is massive hemoptysis
Definition
More than 400 mL in 3 hours or more than 600 mL in 24 hours
Term
What is the significance of hemoptysis vs hematemesis
Definition
Determining if the blood is from the lung vs the stomach is important
Term
What is blood from the lung associated with
Definition
pulmonary symptoms
Term
What is blood from the stomach associated with
Definition
GI symptoms
Term
What is dependent edema
Definition
swelling of the ankles
Term
What patients often develop right heart failure
Definition
patients with chronic hypoxemia
Term
What does right heart failure often lead to
Definition
reduced venous return and increased hydrostatic pressure in the peripheral venous blood vessels especially in the dependent tissues like the ankles
Term
What can ankle edema or dependent edema be a sign of
Definition
chronic lung disease
Term
What is ankle edema a sign of if not pulmonary
Definition
heart disease
Term
What is a sustained fever
Definition
continuously elevated that varies little during a 24-hour period
Term
What is a remittent fever
Definition
continuously elevated but has larger variations and spikes in a 24-hour period
Term
What is an intermittent fever
Definition
spikes in body temperature cycling with periods of normal or subnormal temperature
Term
What is fever a concern
Definition
may signal infection and increases oxygen consumption
Term
What pulmonary disorders are typically accompanied by fever
Definition
"pneumonia, lung abscess, tuberculosis, empyema which is infection within pleural space"
Term
Clinical presentation is part of which assessment?
Definition
vital sign assessment
Term
How is general clinical presentation accomplished
Definition
by observation of the patient's breathing pattern facial expression level of consciousness nutritional status etc.
Term
How is clinical presentation documented
Definition
a single statement about general presentation is included with the vital sign measurement for the initial evaluation of the patient
Term
How is level of consicousness or sensorium documented
Definition
"patients alert and oriented to time, place and person are said to be ""oriented x 3"""
Term
What is an abnormal sensorium indicative of?
Definition
inadequate cerebral oxygenation
Term
What is normal body temperature
Definition
37 celcius or 99.5 F
Term
How is body temperature maintained
Definition
the hypothalamus maintains body temperature
Term
How does the respiratory system play a role in temperature regulation
Definition
by providing another mechanism of heat release
Term
What is a fever
Definition
abnormal elevation of body temperature due to disease
Term
What is the most common cause of fever
Definition
infection
Term
What kind of patients may not exhibit a fever in the presence of infection
Definition
patients with poor immune systems
Term
What does elevated temperature due to oxygen consumption?
Definition
Increases
Term
Why is a fever a problem for those with lung disease
Definition
increases oxygen consumption and increases the demand for CO2 removal
Term
When is hypothermia present
Definition
When body temperature drops below normal
Term
What type of patients present with hypothermia
Definition
those with head injuries and those exposed to cold environment
Term
How is pulse measured
Definition
palpating radial or brachial impulse
Term
How long should pulse be measured
Definition
measured for 30 sec and multiplied by two
Term
How long should a pulse be measured if it is irregular
Definition
60 seconds
Term
How fast is rapid heart beat and what is it called
Definition
greater than 100 beats/min tachycardia
Term
what is bradycardia
Definition
less than 60 beats/min
Term
What could irregular pulse be a sign of?
Definition
serious heart disease and should be investigated
Term
What is weak peripheral pulse a sign of?
Definition
heart failure
Term
What is extreme drops in the strength of the pulse with inspiration
Definition
pulsus paradoxus
Term
How is respiratory rate measured
Definition
without the patient being aware of measurement
Term
What is a good approach to meausuring respiratory rate without the patient knowing
Definition
watching chest rise while continuing to palpate radial pulse
Term
what is tachypnea
Definition
rapid respiratory rate
Term
what is bradypnea
Definition
slow respiratory rate
Term
What are the two components of arterial blood pressure
Definition
peak pressure that results during ventricular systole and the baseline pressure tha toccurs during ventricular diastole
Term
What is the peak pressure known as
Definition
systolic pressure
Term
What is resting pressure known as
Definition
diastolic pressure
Term
What is the difference between systolic and diastolic pressure
Definition
pulse pressure
Term
When is hypotension present
Definition
BP below 90/60
Term
When is hypertension present
Definition
BP above 140/90
Term
How Is blood pressure most commonly measured
Definition
blood pressure cuff
Term
How is BP measured with a blood pressure cuff
Definition
"cuff is wrapped around patient arm and inflated to a pressure believed to be higher than the patient's systolic pressure, pressure is released slowly while monitoring a pressure monometer and the initial korotkoff sounds disapper which is when the diastolic pressure is noted"
Term
How does respiratory cycle affect blood pressure
Definition
"changes in blood pressure are very slight with breathing, systolic pressure drops slightly with normal inspiration and if drops significantly with inspiration, pulsus paradoxus is presnet which may be a sign of cardiac or respiratory problems like asthma"
Term
Where should trachea be
Definition
midline
Term
What does it mean if trachea is deviated
Definition
unilateral lung problem such as atelactasis or pneumothorax that involves the upper lobe of one lung
Term
What is important in the the examination of neck beside trachea
Definition
status of jugular veins because patients with cor pulmonale jave jvd and use of accessory muscles suggest obstructive lung disease
Term
How is thoracic configuration determined
Definition
inspection
Term
What is a barrel chest
Definition
enlarged A-P diameter which is consistent with COPD
Term
What is kyphoscoliosis
Definition
spine is bent laterally and from front to back which causes restrictive lung problem
Term
what is pectus carinatum
Definition
abnormal sternal protrusion
Term
what is pectus excavatum
Definition
depression of the sternum
Term
What portion of the stethoscope is used for lung sounds
Definition
diaphragm
Term
Describe lung auscultation technique
Definition
beginning at the lung bases and comparing side to side. At least one full respiratory cycle should be evaluated at each location
Term
What are normal sounds of breathing called
Definition
tracheal breath sounds
Term
Where are tracheal breath sounds heard
Definition
"directly over trachea and are loud, high-pitched and have equal inspiratory and expiratory components"
Term
Where are bronchovesicular breath sounds heard
Definition
around the sternum and between the scapulae and are softer and lower pitched than tracheal sounds
Term
What is the most common breath sound evaluated
Definition
normal breath sounds or vesicular breath sounds and are heard over lung parenchyma and are primarily an inspiratory sound
Term
What is a breath sound that is barely heard
Definition
diminished
Term
what is a breath sound that is louder than normal
Definition
harsh or bronchial
Term
What are adventitious breath sounds
Definition
abnormal lung sounds superimposed on the breath sound
Term
how are adventitious breath sounds classified
Definition
classified as continuous or discontinuous
Term
What is another name for continuous ALS (adventitious lung sounds)
Definition
wheezes
Term
What is another name for discontinuous ALS
Definition
crackles
Term
What is stridor
Definition
continuous ALS heard over neck
Term
How are normal breath sounds created
Definition
turbulent flow in main airways
Term
How are bronchial breath sounds heard
Definition
when lung attenuation is reduced as with consolidation
Term
When are diminished or absent breath sounds noted
Definition
when lung attenuation is increased as with emphysema
Term
What are crackles created by
Definition
sudden opening of collapsed peripheral airways
Term
How are wheezes produced
Definition
vibration of airway walls as air passes through at high velocity. Polyphonic wheezes suggest that many airways are obstructed
Term
what is stridor caused by
Definition
upper airway narrowing and is life threatening
Term
What is precordium
Definition
surface of chest wall overlying the heart
Term
what is the precordium examined to assess
Definition
condition of the heart
Term
Where does the base of the heart lie
Definition
directly beneath the middle portion of the sternum
Term
Where does the apex of the heart point
Definition
downward and to the left extending to midclavicular line near fifth rib
Term
why is the precordium palpated
Definition
to determine PMI point of maximal impulse which is created by left ventricular contraction
Term
What does right ventricular hypertrophy often cause with regard to inspection and palpation of precordium
Definition
a heave near the lower left sternal border
Term
What is the first heart sound S1 created by
Definition
closure of A-V valves during systole
Term
what is the second heart sound created by
Definition
closure of semilunar valves during diastole
Term
When does a split S1 or S2 occur
Definition
when the two sides of the heart are not in sync
Term
When can S3 or S4 sounds occur
Definition
when left ventricle is istended and as blood rapidly fills the ventricle during diastole.
Term
what is S3 sound from
Definition
early filling
Term
what is S4 sound from
Definition
filling to due atrial contraction and is called gallop rhythm
Term
When is loud P2 heard
Definition
When pulmonic valve closes with force
Term
When is loud P2 common
Definition
in patients with pulmonary hypertension
Term
When are murmurs heard
Definition
with incompetent or stenotic valves and are produced by rapid blood flow through the narrow valve
Term
When are systolic murmurs heard
Definition
when the semilunar valves are stenotic or when the AV valves are incompetent
Term
When are diastolic murmurs heard
Definition
when the AV valves are stenotic or when the semilunar valves are incompetent
Term
What is the primary role of WBC
Definition
fight infection
Term
What are the five types of WBC
Definition
"neutrophil, basophil, eosinophil, lymphocyte, and monocyte"
Term
How much blood volume does the neutrophils take up
Definition
40% - 75%
Term
Where are neutrophils produced
Definition
in bone marrow and have a life span of about 10 days
Term
When are neutrophils released into circulating blood stream
Definition
when acute infection is present
Term
What do neutrophils contain that destroy bacteria
Definition
enzymes
Term
What percent of WBC is eosinophils
Definition
0% - 6%
Term
When are eosinophils present
Definition
"with allergic reaction, present in sputum of asthmatics"
Term
What percent of WBC are basophils
Definition
0% - 1%
Term
What is the purpose and percentage of lymphocytes
Definition
"fight against viral, fungal, and TB infections and make up 20% - 45% of circulating WBC"
Term
What are the two types of lymphocytes
Definition
T Cells and B Cells
Term
Why are T Cells important
Definition
antibody production and immunity
Term
What percentage of WBC are monocytes
Definition
2% - 10 %
Term
what does the monocyte become when in the tissue
Definition
macrophage
Term
what is the primary role of a monocyte turned macrophage
Definition
phagocytosis of foreign material
Term
What is leukocytosis
Definition
total white cell count is elevated
Term
What is leukocytosis that is caused by neutrophils called
Definition
neutrophilia
Term
When is neutrophilia common
Definition
with bacterial pneumonia and other infections
Term
What is acute neutrophilia caused by
Definition
infection typically resulting in an increasein the immature netrophils known as bands and this is called a left shift
Term
What is pseudoneutrophilia
Definition
occurs when marginated cells are released into the circulation and is common with acute trauma and stress
Term
what is leukopenia
Definition
present whe total white cell count is reduced
Term
When is neutropenia common
Definition
lack of neutrophils and is common when bone marrow fails or when a severe infection is present and neutrophils are destroyed faster than they are produced and is an onimous sign
Term
when is lymphocytosis present
Definition
when the circulating lymphocytes are elevated in count
Term
What is lymphocytosis caused by
Definition
viral infections and infectious mononucleosis
Term
When is lymphocytopenia seen with
Definition
trauma and acute infection
Term
What is common with HIV patients
Definition
lymphocytopenia
Term
What is monocytosis characteristic of
Definition
"chronic infections including TB, syphilis, typhoid fever, and subacute bacterial endocarditis. It is a sign of active disease in TB patients"
Term
Where are RBC produced
Definition
bone marrow
Term
What is the life span of an RBC
Definition
120 days
Term
What is the shape and why
Definition
bioconcave disc to facilitate carrying oxygen
Term
What is RBC made up of mostly
Definition
hemoglobin
Term
What is the portion of total blood volume mde up by the formed elements known as
Definition
hematocrit
Term
What is the hemoglobin count
Definition
amount of hemoglobin on the red cells
Term
What is anemia
Definition
abnormal decrease in RBC count
Term
what is microcytic anemia
Definition
cells are too small
Term
what is hypochromic anemia
Definition
when the cells have too little hemoglobin
Term
what is anemia with normal red cells
Definition
"normochromic, normocytic anemia and is common with acute blood loss"
Term
what is the most common cause of anemia
Definition
iron deficiency
Term
what is polycythemia
Definition
abnormal increase in the red cell count
Term
What is primary polycythemia
Definition
uncommon and due to bone marrow disease
Term
What is secondary polycythemia
Definition
common and is a result of chronic hypoxemia i.e. in heavy smoking and COPD
Term
What are platelets
Definition
smalled formed elements that serve an important role in coagulation and should be checked before ABG puncture
Term
What is used to measure patient's ability to clot the blood
Definition
"platelet count, bleed time, APTT and PT/INR"
Term
"What are platelet count, bleed time, APTT and PT/INR useful for"
Definition
monitoring heparin therapy in the patient being treated for pulmonary embolism
Term
What are the four electrolytes commonly measured
Definition
"sodium, potassium, chloride and CO2"
Term
What is hypernatremia
Definition
elevated sodium concentration
Term
What does hypernatremia often reflect
Definition
inadequate water intake and causes dry mouth and thirst
Term
What is hyponatremia
Definition
decreased measured sodium concentration
Term
What is hyponatremia associated with
Definition
sodium loss as seen with diuretics and in extreme cases cause abnormal sensorium
Term
what is hypokalemia
Definition
abnormal decrease in potassium concentration
Term
What is hypokalemia caused by
Definition
"vomiting, nasogastric suction, and diarrhea and is also seen with potassium shifts from extracellular to intracellular as in metabolic alkalosis"
Term
What does hypokalemia cuse
Definition
"muscle weakness, nausea, muscle cramps, confusion and arrhythmias"
Term
What is hyperkalemia most often associated with
Definition
increased potassium intake but is also seen in metabolic acidosis when hydrogen ions are exchanged for intracellular potassium ions to buffer acidosis
Term
When is hypochloremia seen with
Definition
prolonged vomiting and and chronic respiratory acidosis
Term
When is hyperchloremia seen
Definition
With prolonged diarrhea and certain kidney disease
Term
What does total CO2 measure
Definition
the amount of bicarb in the venous blood
Term
When is Co2 increased
Definition
with metabolic acidosis
Term
When is CO2 decreased
Definition
with metabolic alkalosis
Term
What is ion gap
Definition
helps determine cause of metabolic acidosis, normally 8 - 16 and is calculated by subtracting total of CO2 and bicarb from ABG from sodium level
Term
What is a good legitimate sputum sample
Definition
"few epithelial cells, little saliva and many leukocytes"
Term
What is bronchoalveolar lavage (BAL)
Definition
performed during bronchoscopy by injecting a large volume of sterile fluid into patient's lung which mixes with respiratory secretions deep in the lung and withdrawn for analysis
Term
What is the significance of organisms obtained by BAL
Definition
organisms obtained can help diagnose cause of pneumonia
Term
What is seen in congestive heart failure patients (medical microbiology)
Definition
low-protein pleural effusions (transudates)
Term
What are exudates
Definition
"high-protein effusions caused by cancer of pleura, infecions, lung infarctoin and chest wall trauma"
Term
What is urinalysis helpful in the diagnosis of
Definition
kidney disease and to screen for URI
Term
What does presence of protein in urine indicate
Definition
renal disease
Term
What does ketones indicate
Definition
diabetes
Term
What is cytology
Definition
study of fluids secretions and other body samples
Term
What is skin testing used for
Definition
"diagnosis of different things such as TB, sarcoidosis, and allergic disorders"
Term
What happens to skin 2-3 days after PPD injection in subcutaneous layer of skin if patient has been infected with TB
Definition
a subdermal nodule
Term
What is the criteria for a positive TB skin test
Definition
varies because patients with compromised immunity may generagte a smaller nodule
Term
What symptoms indicate obtaining ABG
Definition
"acute dyspnea, chest pain, hemoptysis, cough fever, sputum consistent with pneumonia, CO poisoning - (clinical presentation ABG)"
Term
Past medical history indication for obtaining ABG
Definition
"COPD, cystic fibrosis, pulmonary fibrosis, exposure to environmental dust, diabetes with ketoacidosis significant smoking history 20 pack/years"
Term
physical examination indication for ABG
Definition
"cyanosis, crackles or wheezing, abnormal breathing pattern, heavy use of accessory muscles, unexplained confusion, evidence of chest trauma"
Term
lab data indication for ABG
Definition
"unexplained polycythemia, severe electrolyte abnormality"
Term
Chest radiograph indication for ABG
Definition
"diffuse infliltrates, hyperinflation, atelactasis, pneumothorax, pleural effusion, enlarged heart, lobar consolidation"
Term
What is CaO2
Definition
function of amount of oxygen bound to hemoglobin and dissolved in plasma.
Term
what is most important parameter that reflects quantity of oxygen carried in arterial blood
Definition
CaO2 and an adequate hemoglobin concentration must be present fo rthis parameter to be normal
Term
What is P(A-a)O2
Definition
alveolar-arterial oxygen difference and is measurement of pressure difference between alveoli and arterial blood of oxygen.
Term
What is P(A-a)O2 affected by
Definition
"FIO2, age and presence of pulmonary disease"
Term
What is HbCO
Definition
Carboxyhemoglobin
Term
What is HbCo a reflection of
Definition
quantity of carbon monoxide bound to hemoglobin molecules and can be obtained only from co-oximeter.
Term
What does CO poisoning reduce
Definition
oxygen carrying capacity of hemoglobin and inhibits unloading of oxygen at the tissues
Term
What does assessment of oxygenation evaluate
Definition
ability of lungs to oxygenate the blood and the ability of cardiovascular system to distribute the blood
Term
What is pH
Definition
hydrogen ion concentration
Term
What does pH indicate
Definition
performance of numerous blood buffers and how well the respiratory and renal systems are functioning
Term
PaCo2
Definition
partial pressure of arterial carbon dioxide
Term
What is PaCO2 a reflection of
Definition
respiratory component of acid-base status and it identifies the degree of ventilation in relation to metabolic rate
Term
HCO3
Definition
arterial blood bicarbonate
Term
what is HCO3 a reflection of
Definition
metabolic component and is regulated by renal system.
Term
What is BE
Definition
base excess or base deficit and is a measurement reflecting nonrespiratory portion of acid-base balance. Standard deviation of standard HCO3 that takes buffering capabilities of red blood cells into account
Term
Vt
Definition
tidal volume - 350 - 600 in normal adults
Term
Ve
Definition
minute volume - Ve = Vt x respiratory rate and is volume of gas expired over one minute
Term
What is the range of Ve
Definition
4 - 12 L/min at rest
Term
What is the best index of ventilation whe used in conjunction with ABG
Definition
Ve
Term
VC
Definition
Vital capacity - maximal amount the patient can exhale after taking deepest breath possible
Term
What is FVC
Definition
forced vital capacity which is forcefully exhaling volume
Term
wHat can decrease VC and FVC
Definition
restrictive and obstructive
Term
how does restrictive lung disorder reduce FVC
Definition
shrinking the lung
Term
how does obstructive lung disorder decrese FVC
Definition
causing a slow rise in RV
Term
What is occurring if measured FVC is significntly smaller than SVC
Definition
air trapping
Term
what is an important indicator of patient's ventilatory reserve
Definition
VC - significant reduction indicates patient is at higher risk for respiratory failure esp after surgery
Term
What is TLC the sum of
Definition
VC and RV
Term
What is TLC the function of
Definition
"size, age and gender"
Term
what must be determined to meaure TLC
Definition
RV or FRC
Term
What are the two ways to detrmine RV or FRC
Definition
body plethsmography or open-circuit nitrogen washout
Term
What is body plethsmography
Definition
measures all gas in the chest - cost is high
Term
what is open-circuit nitrogen washout
Definition
less costly - meausures amount of nitrogen washed out of the lungs upon exhalation
Term
closed-system helium dilution
Definition
helium is inert and not absorbed from lungs by blood therefore if known volume and concentration of helium are added to patient's respiratory system helium will be diluted in proportion to the size of the lung volume to which it is added
Term
What is RV
Definition
Residual Volume and is the amount of gas left in the lung after the patient exhales all that is physically possible
Term
Which lung volume cannot be measured by the routine spirogram
Definition
RV
Term
"With regard to residual volume, what is the normal percentage to TLC and VC"
Definition
25% if TLC and 33% of VC
Term
"If RV is greater than 33% of VC, what does this indicate?"
Definition
COPD is probably present and the percentages are normal in restrictive disease
Term
What is ERV
Definition
Expiratory Reserve Volume - volume that can be maximally exhaled following a passive exhalation
Term
How is ERV calculated
Definition
by subtracting RV from FRV
Term
What is the clinical significance of ERV
Definition
"limited usefullness and is reduced in obese persons, those with poor efford and those with restrictive disease"
Term
What is FRC
Definition
Functional residual capacity - resting volume in lungs following exhalation of a Vt breath
Term
What makes up FRC
Definition
RV and ERV
Term
What represents a balance between the expanding chest wall forces and the contractile rebound forces of lung tissue
Definition
FRC
Term
What causes FRC to be increased
Definition
Disorders that cause a loss of lung tissue (emphysema)
Term
What causes FRC to be reduced
Definition
disorders that cause partial or more complete collapse of lung (pneumothorax)
Term
What is the significance of IRV and IC
Definition
"inspiratory reserve volume and inspiratory capacity are measured by the routine spirogram, not used widely in evaluating pulmonary dysfunction because these measurements can be normal in restrictive and obstructive disease"
Term
What is FEV1
Definition
forced expiratory volume at 1 second
Term
What does FEV1 measure
Definition
maximal volume of air exhaled during the first second of expiration
Term
What is the best indicator of obstructive disease
Definition
FEV1 it is a forced maneuver and highly significant
Term
What does FEV1 reflect
Definition
flow characteristics in the larger airways
Term
How is FEV1 best expressed
Definition
as a percentage of the observed FVC (FEV1/FVC)
Term
What is FEV3
Definition
3 second point of expired curve and gives an indication of the flow in smaller airways and is not as reproducible and sensitive as FEV1
Term
What is FEF25%-75%
Definition
"forced expiratory flow, midexpiratory phase"
Term
What does FEF 25%-75% look at
Definition
middle 50% of curve's slope
Term
What does FEF 25%-75% reflect and what is its primary usefulness
Definition
reflects degree of airway patency and is useful in evaluating obstructive disorders
Term
What is FEF25%-75% an early indicator of
Definition
early indicator of obstructive dysfunction and can also be reduced in restrictive disorder
Term
What is PEF
Definition
Peak expiratory flow which is th emaximal flow rate achieved by the patient during the FVC maneuver
Term
What is PEF a popular maneuver for
Definition
in pulmonary function testing of patients with obstructive disease and asthmatic patients can use it to monitor their condition at home
Term
What does PEF correlate well with in ashtmatics
Definition
FEV1 and can be used to identify the severity of airway obstruction
Term
What are the benefits of PEF
Definition
provides objective data regarding patient's response to therapy and use of a portable device allows rapid and repeatabl assessment of PEF in a variety of clinical settings
Term
What is MVV
Definition
"the status of respiratory muscles, compliance of the thorax-lung complex and airway resistance Raw"
Term
What is clinically significant with MVV
Definition
only large decreases
Term
What is MVV popular for
Definition
surgeons as a quick assessment of the state of the patient's lungs before surgery
Term
What does poor performance on the MVV suggest
Definition
that the patient may have significant respiratory problems postoperatively
Term
Why is the MVV of little use
Definition
because it is effort dependent
Term
What are Flow volume loops or Flow volume Curves
Definition
generated by integrating flow with volume on graph paper. Volume is plotted on the horizontal axis and flow on the vertical axis
Term
What is the significance of pulmonary function testing before and after aerosol bronchodilators
Definition
used to assess the reversibility of the airway obstructino seen on the initial spirogram
Term
What is the common drug used for PFT before and after bronchodilator
Definition
"B2 sympathomimetic drug, but not a specific one"
Term
What must happen for response to inhaled bronchodilator to be considered improved with regard to PFT before and after bronchodilator therapy?
Definition
"recommended that two out of the following three be improved FVC, FEV1, and FEF25%-75%"
Term
"What is the amount of improvement for FVC, FEV1, and FEF25%-75% in order to be considered?"
Definition
"FVC increase greater than 10%, FEV1 increase of 200 mL or 15% over baseline FEV1 and FEF25%-75% is 20% to 30% increase"
Term
What is thought to be most often predictive of subsequent usefulnes in asthmatic patients
Definition
positive response to bronchodilator
Term
What happens if there is no response to bronchodilator therapy
Definition
clinical control may be difficult
Term
What is DLCO
Definition
diffusion capacity
Term
How is DLCO useful
Definition
in determining the ability of the lungs to transfer gas to the blood
Term
What are the determinants of gas exchange across the membrane
Definition
"diffusion coefficient of the gas used, surface area of the membrane, thickness of membrane, blood volume and flow in pulmonary capillary tree, distribution of the inspired gas, hematocrit"
Term
What are the most common causes of reduced DlCO values
Definition
emphysema and pulmonary fibrosis
Term
How is diffusion most commonly measured
Definition
by using a single breath of carbon monoxide at minute levels
Term
What is normal DLCO
Definition
25mL/min/mm Hg
Term
What reduces the number of red blood cells that remove CO from the closed system and thereby reduced DLCO
Definition
severe anemia
Term
If pulmonary capillary blood flow to an area is reduced what happens to the diffusion of CO
Definition
"diffusion of CO will not occur, thus reducing DLCO"
Term
What affects the results of DLCO
Definition
size of the individual because large individuals will have larger diffusion capacities
Term
What is RQ
Definition
respiratory quotient and it is the ratio of carbon dioxide produced to oxygen consumed
Term
What is a normal RQ
Definition
0.8 to 0.85
Term
What is one of the most frequent uses of RQ
Definition
to assess which food group is being metabolized for energy
Term
What is RQ important for
Definition
a person who is being weaned from a ventilator
Term
What does knowledge of the patient's RQ allow intelligen tadjustment of
Definition
the patient's diet and may speed up th eprocess of weaning the patient from the ventilator
Term
What are common exercise tests that are used
Definition
"stress ECG, ventilatory capacity, blood gases, exercise challenge, anaerobic threshold, maximal oxygen uptake (VO2max) 6-minute walk test"
Term
What is done in smokers to reinforce the need for smoking cessation
Definition
PFT especially if considerable loss of lung function is documented
Term
What is the most useful single predictor of who will have cardiopulmonary disease as a result of smoking
Definition
PFT
Term
When do x-rays begin
Definition
when electromagnetic waves radiate from a tube through which an electric current has passed which results in electrons being emitted
Term
"Once electrons hit a target device in the x-ray machine, what happens?"
Definition
They are transformed into x-rays
Term
What are x-rays able to penetrate
Definition
matter and the density of the matter determines the resulting degree of penetration
Term
What aborbs more x-rays and what absorbs little x-rays
Definition
dense objects such as bones abosorb more and air-filled objects absorb little
Term
What causes the film to turn dark (radiolucent)
Definition
x-rays that pass through low-density objects such as the lungs
Term
what cause the film to remain white or radiopaque
Definition
x-rays that are absorbed by high-density objects
Term
what are the four densities seen on the chest x-ray
Definition
"bone, water, fat and air"
Term
What is the standard radiographic view
Definition
patient standing and the x-ray passing from back to front which creates a P-A view. Heart magnification is minimal with the p-a view
Term
"In the standard chest x-ray exam, what is included to allow viewing of the lung tissue behind the heart"
Definition
lateral view
Term
when would laterla decubitus view be obtained
Definition
when excesive pleural fluid may be present because this view allows better detection of the free fluid
Term
When is the apical lordotic view used
Definition
to evaluate the upper lung fields better. The x-ray tube is angled at approx 45 degrees from below midline
Term
when are oblique views helpful
Definition
in evaluating overlapping lesions
Term
what chest films are useful to detect a small pneumothorax
Definition
expiratory chest films
Term
when is portable chest film used
Definition
often needed in the ICU patient who is too ill to go to radiology
Term
how is the portable chest film generated
Definition
with the film cassette under the patient's back and with the x-ray machine in front of the patient thus thefilm is considered an A-P portable
Term
What does the portable chest x-ray result in
Definition
magnification of the heart and a larger heart shadow which can be misinterpreted as an enlarged heart
Term
Pros and cons of CT
Definition
computed tomography and results in very sharp images useful to detect and monitor lung and hed lesions but the cost is much higher than chest x-ray
Term
What conditions call for use of CT
Definition
"lung tumors, chronic interstitial lung disease, AIDS for pneumonia, pneumonia with certain lung infections that involve the pleura, bronchiectasis, COPD although not usually used"
Term
What value is MRI in evaluating lung disease
Definition
very little value
Term
what is MRI useful in imaging
Definition
hilar lymph node enlargement and is useful in certain types of lung cancer
Term
How is lung scanning accomplished
Definition
by injecting the patient with radiopharmaceuticals that lodge in the pulmonary circulatino and the patient also inhales a gas that is visible on x-ray
Term
what can be evaluated with lung scanning
Definition
degree of circulation and ventilation in each lung segment
Term
what is suggestive of pulmonary embolism when reviewing lung scan results
Definition
areas that have poor circulation but remain ventilated
Term
"When reviewing a chest radiograph, how is a good inspiratory effort verified?"
Definition
it results in 10 posterior ribs visible above the diaphragm. The depth f patint's inspiration is assessed to help determine the quality of chest film
Term
How is silhouette sign used
Definition
to determine if a pulmonary infiltrate is in contact with the heart border
Term
What is seen on the chest film with pneumothorax
Definition
pleural line may be seen on the lateral part of the chest and shift of mediastinal structures may be seen with tension pneumothorax
Term
With CHF what does the chest x-ray reveal
Definition
redistribution of pulmonary vasculature to the upper lobes
Term
What are disturbances in cardiac conduction called
Definition
arrythmia/dysrhythmias
Term
What is a key factor in reducing or eliminating cardiac irritability
Definition
application and improved delivery of oxygen
Term
What are some causes of arrythmias
Definition
"hypoxia, ischemia, sympathetic stimulation, drugs, electrolyte imbalances, rate and stretch"
Term
How many leads are used in order to obtain the most complete picture of electrical activity in the heart since it is a 3-dimentional organ
Definition
12 leads
Term
What are the two groups the 12 leads are broken down into
Definition
6 limb leads and 6 chest leads
Term
How are six limb leads obtained
Definition
two electrodes are placed on the patient's wrists and two on the ankles
Term
What are the six limb leads called
Definition
"I, II, III, aVr, aVL, and aVf"
Term
Which of the limb leads are bipolar
Definition
"I, II, and III"
Term
What are the augmented limb leads
Definition
"aVr, aVl and aVf"
Term
What do the six limb leads view the heart in?
Definition
a vertical plane called a frontal plane
Term
What are the chest leads and how are they placed across the chest
Definition
"unipolar, V1, V2, V3, V4, V5 and V6 and they are placed across the chest in a horizontal plane"
Term
"Under normal conditions, where do the chest leads lie?"
Definition
V1 and V2 lie directly over right ventricle V3 and V4 lie over the interventricular septum and V5 and V6 lie over the left ventricle
Term
What does the QRS axis represent
Definition
general direction of current flow during ventricular depolarization
Term
"With the QRS axis, what is the normal mean axis "
Definition
somewhere between 0 and 90 degrees
Term
"with the QRS axis, what does right axis deviation indicate and what does left axis deviation indicate"
Definition
right axis deviation indicates that the right ventricle is enlarged and left axis deviation indicates left ventricle is enlarged
Term
What is the normal width of the QRS complex
Definition
.12 second wide.
Term
When is a Q wave considered normal
Definition
if it is less than 0.4 second wide and less than one third the amplitude of the R wave.
Term
Sinus bradycardia
Definition
normal sinus rhythm except heart rate whch is less than 60 beats/min
Term
sinus tachycardia
Definition
when heart rate is 100 - 150 beats/min
Term
sinus arrythmia
Definition
benign arrythmia that meets all other criteria for being considered normal except rhythm is irregular
Term
What is PAT
Definition
"paroxymal atrial tachycardia. Occurs when an ectopic focus in the atrium usurps the pacemaking function of the SA node and paces the heart, usually at an abnormally rapid rate of 160 - 240 beats per minute"
Term
What is atrial flutter
Definition
produces very distinctive sawtooth pattern between normal-appearing QRS complexes
Term
What is atrial fibrillatin
Definition
electrical activity of the atria is completely chaotic without coordination and ECG tracing shows a chaotic baseline between QRS complexes with no regular pattern or organization
Term
PVC
Definition
"premature ventricular contraction which represent ectopic beats originating in one of the ventricles due to enhanced automaticity and they occur in normal and diseased heart and can be caused by anxiety, stimulants, etc"
Term
Ventricular tachycardia
Definition
broad QRS complexes occurring at a rapid rate without identifiable P waves which originate from an ectopic focus in the ventricles and are associated with enhjaced automaticity or reentry
Term
Ventricular fibrillation
Definition
chaotic completely unorganized electrical activity in the ventricular myocardial fibers
Term
asystole
Definition
cardiac standstill - straight and/or flatline
Term
ECG with chronic lung disease
Definition
COPD patients most likely have cardiac abnormality
Term
what do patients with chronic hypoxemic lung disease often have evidence of
Definition
right axis deviation on the ECG which is seen as a negative QRS in lead I
Term
"When is reduced voltage in the limb leads (I, II, III) seen"
Definition
when severe pulmonary hyperinflation (emphysema) is present
Term
What is the most common cause of auditory impairment in the US that affects 23% of adults 65-75
Definition
Bilateral hearing loss
Term
What is a quick way to assess hearing loss
Definition
whisper a simple question while stading about 2 feet away out of direct view
Term
What should you do to assess hearing loss compensation if hearing loss is suspected
Definition
face the patient and ask can you hear me?
Term
What can be used as an amplification device with a patient with hearing loss
Definition
use stethoscope by placing ear pieces in patient's ears and speaking through the bell
Term
What is the term used to describe the specific type of vision loss associated with adults over 40 with the characteristics of far sightedness
Definition
presbyopia
Term
What are some common eye disorders that frequently affect older patients
Definition
"cataracts, glaucoma, diabetic retinopathy, macular degeneration"
Term
Are RTs concerned with vision loss
Definition
not clinically relevant
Term
What are some compensations for vision loss with older adults
Definition
"verbal communication very important, keep everything in ""its place"", medcine bottles can be marked with large letter denoting the name of medicine"
Term
What are typical symptoms of pneumonia and do they differ in the elderly
Definition
"cough, fever, purulent sputum but these can be subtle in elderly specifically lack of an elevated temperature"
Term
Why is fever difficult to detect in the elderly
Definition
they have a lower base termperature and reduced ability to mount a febrile response
Term
What are some common extrapulmonary signs of pneumonia in the elderly patient
Definition
"nausea, vomiting, diarrhea, myalgia and arthralgia"
Term
What is the most sensitive sign of pneumonia in the elderly patient
Definition
increased respiratory rate (more than 28 breaths/min)
Term
"What is helpful in diagnosing the elderly patient's pneumonia, but not if they are dehydrated"
Definition
chest x-ray because the pneumonic infiltrate may be obscured by pulmonary edema or may not be detectable on the chest film until 24-48 hours after patient has rehydrated
Term
What is recommended in order to avoid empiric therapy wth a broad-spectrum antibiotic in the elderly patient with pneumonia
Definition
sputum specimens but a good sputum specimen from an older debilitated patient is difficult to obtain
Term
What is the major source of chronic disability in the US
Definition
heart failure
Term
What percentage of patients who die from myocardian infarction are over 75
Definition
50%
Term
What is the most common symptom of myocardial infarction
Definition
"chest pain but the pain may be referred such as shoulder pain, throat and abdominal pain or even bilateral elbow pain"
Term
What should the clinician suspect if the older patient complains of dizziness
Definition
heart problems because of the degeneration of the cardiac conduction of fibers
Term
What could cough and wheezing indicate with an elderly patient
Definition
early left-sided heart failure
Term
what may hemoptysis be indicative of in the elderly patient
Definition
heart failure or pulmonary embolus
Term
What may be the only presenting complaint of heart failure in the elderly patient
Definition
dyspnea
Term
What could dyspnea and lethargy be symptoms of
Definition
myocardial infarction
Term
What percentages of the elderly have asthma
Definition
5% older than 60 years old and 7% - 9% older than 70
Term
What is often misdiagnosed and/or underdiagnosed in the older patient
Definition
asthma
Term
What is possible when asthma and COPD occur together
Definition
only the COPD is diagnosed and not the asthma
Term
What are classic symptoms of asthma
Definition
"shortness of breath, wheezing and cough which are lso common in chf, emphysema, chronic bronchitis, gastroesophageal reflux, and transbrochial tumors"
Term
When should a diagnosis of asthma be considered in an elderly patient
Definition
wheezing or dyspnea
Term
When can inspection and palpation take place while assessing the elderly patient
Definition
"while taking a patient history, checking vital signs or auscultating lung sounds"
Term
What do the effects of pulmonary aging result in
Definition
"reduced vital capacity and expiratory flow rates, an increase in closing volume and reduced partial pressure of arterial oxygen"
Term
What is lung capacity in a 20 year old vs 70 year old
Definition
the closing capcity increases from about 30% of total lung capcity at 20 to 50% of total lung capacity at 70
Term
"What happens to P(A-a)02 alveolar-arterial oxygen partial pressure as a consequence of either intrapulmonary shunting, diffusion lmitatino of oxygen/carbon dioxide gas exchange or V/Q abnormalities in the elderly"
Definition
increased P(A-a)02
Term
What is the most common cause of auditory impairment in the US that affects 23% of adults 65-75
Definition
Bilateral hearing loss
Term
What is a quick way to assess hearing loss
Definition
whisper a simple question while stading about 2 feet away out of direct view
Term
What should you do to assess hearing loss compensation if hearing loss is suspected
Definition
face the patient and ask can you hear me?
Term
What can be used as an amplification device with a patient with hearing loss
Definition
use stethoscope by placing ear pieces in patient's ears and speaking through the bell
Term
What is the term used to describe the specific type of vision loss associated with adults over 40 with the characteristics of far sightedness
Definition
presbyopia
Term
What are some common eye disorders that frequently affect older patients
Definition
"cataracts, glaucoma, diabetic retinopathy, macular degeneration"
Term
Are RTs concerned with vision loss
Definition
not clinically relevant
Term
What are some compensations for vision loss with older adults
Definition
"verbal communication very important, keep everything in ""its place"", medcine bottles can be marked with large letter denoting the name of medicine"
Term
What are typical symptoms of pneumonia and do they differ in the elderly
Definition
"cough, fever, purulent sputum but these can be subtle in elderly specifically lack of an elevated temperature"
Term
Why is fever difficult to detect in the elderly
Definition
they have a lower base termperature and reduced ability to mount a febrile response
Term
What are some common extrapulmonary signs of pneumonia in the elderly patient
Definition
"nausea, vomiting, diarrhea, myalgia and arthralgia"
Term
What is the most sensitive sign of pneumonia in the elderly patient
Definition
increased respiratory rate (more than 28 breaths/min)
Term
"What is helpful in diagnosing the elderly patient's pneumonia, but not if they are dehydrated"
Definition
chest x-ray because the pneumonic infiltrate may be obscured by pulmonary edema or may not be detectable on the chest film until 24-48 hours after patient has rehydrated
Term
What is recommended in order to avoid empiric therapy wth a broad-spectrum antibiotic in the elderly patient with pneumonia
Definition
sputum specimens but a good sputum specimen from an older debilitated patient is difficult to obtain
Term
What is the major source of chronic disability in the US
Definition
heart failure
Term
What percentage of patients who die from myocardian infarction are over 75
Definition
50%
Term
What is the most common symptom of myocardial infarction
Definition
"chest pain but the pain may be referred such as shoulder pain, throat and abdominal pain or even bilateral elbow pain"
Term
What should the clinician suspect if the older patient complains of dizziness
Definition
heart problems because of the degeneration of the cardiac conduction of fibers
Term
What could cough and wheezing indicate with an elderly patient
Definition
early left-sided heart failure
Term
what may hemoptysis be indicative of in the elderly patient
Definition
heart failure or pulmonary embolus
Term
What may be the only presenting complaint of heart failure in the elderly patient
Definition
dyspnea
Term
What could dyspnea and lethargy be symptoms of
Definition
myocardial infarction
Term
What percentages of the elderly have asthma
Definition
5% older than 60 years old and 7% - 9% older than 70
Term
What is often misdiagnosed and/or underdiagnosed in the older patient
Definition
asthma
Term
What is possible when asthma and COPD occur together
Definition
only the COPD is diagnosed and not the asthma
Term
What are classic symptoms of asthma
Definition
"shortness of breath, wheezing and cough which are lso common in chf, emphysema, chronic bronchitis, gastroesophageal reflux, and transbrochial tumors"
Term
When should a diagnosis of asthma be considered in an elderly patient
Definition
wheezing or dyspnea
Term
When can inspection and palpation take place while assessing the elderly patient
Definition
"while taking a patient history, checking vital signs or auscultating lung sounds"
Term
What do the effects of pulmonary aging result in
Definition
"reduced vital capacity and expiratory flow rates, an increase in closing volume and reduced partial pressure of arterial oxygen"
Term
What is lung capacity in a 20 year old vs 70 year old
Definition
the closing capcity increases from about 30% of total lung capcity at 20 to 50% of total lung capacity at 70
Term
"What happens to P(A-a)02 alveolar-arterial oxygen partial pressure as a consequence of either intrapulmonary shunting, diffusion lmitatino of oxygen/carbon dioxide gas exchange or V/Q abnormalities in the elderly"
Definition
increased P(A-a)02
Term
What is the first type of sleep entered by healthy sleepers
Definition
NREM which is non rem
Term
What are the stages of NREM recognized by
Definition
EEG changes during a sleep study
Term
What is the lightest stage of sleep and the person is easily roused
Definition
Stage 1 NREM
Term
What is the most common stage of sleep in adults
Definition
Stage 2 NREM
Term
What are the deepest stages of sleep
Definition
Stages 3 and 4
Term
What stage is the deepest and most difficult to rouse
Definition
Stages 3 and 4 NREM
Term
What is diminished during NREM sleep
Definition
breathing
Term
What is irregular in the initial stages of NREM but steadies during deeper stages
Definition
breathing
Term
"What besides sleep is diminished during NREM, especially during the deeper stages"
Definition
muscle tone
Term
When does the first cycle of REM sleep occur
Definition
60 - 90 minutes after the onset of NREM
Term
What time of sleep does the sleeper dream
Definition
REM
Term
How many episodes of REM does the sleeper experience each night
Definition
four or five REM episodes
Term
"During REM, which episodes of dreams are short and which are long"
Definition
initial episodes are short (5 minutes) and subsequent are long (60 min)
Term
What physiologic changes occur during REM sleep
Definition
"muscle tone is at a minimum, respiratory efforts are chaotic, heart rate is irregular"
Term
What is OSA
Definition
Obstructive Sleep Apnea
Term
Definition of OSA
Definition
airflow reduction of greater than 70% in the presence of respiratory effort
Term
UARS
Definition
upper airway resistance syndrome
Term
What is the definition of UARS
Definition
When the upper airway is abnormally narrowed during sleep but breathing is adequate to maintain normal gas exchange
Term
Changes in heart rate and cardiac dysrthymias are more common in which patients
Definition
OSA
Term
"In patients with OSA, what often occurs during the apneic period and is followed by tachycardia immediately after the apnea"
Definition
bradycardia
Term
What occur in approximately 20% of patients with OSA and are the most common dysrhythmias
Definition
PVC
Term
What occurs in about 10% of cases and usually lasts for only a few seconds
Definition
asystole
Term
What is CSA
Definition
central sleep apnea and occurs when there is a cessation of airflow resulting from alck of movement of the diaphragm and is loss of ventilatory drive or rhythmicity
Term
What is the body habitus of CSA
Definition
normal
Term
does CSA occur most often with adults or children
Definition
children
Term
What is the cause of CSA in children
Definition
instability of breathing control centers in the brain is a possible primary factor
Term
"in children, various factors may play a role in precipitating an episode of CSA such as"
Definition
"cardiac, hematologic, infectious, metabolic, neurologic, hastrointestinal, neuromuscular abnormalities"
Term
What is the cause of SIDS
Definition
no known cause
Term
what is the leading cuase of death in children under one year
Definition
SIDS
Supporting users have an ad free experience!