TMC Respiratory Care Boards Study Guide #1 – Flashcards
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4 critical life functions
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1. Ventilation 2. Oxygenation 3. Circulation 4. Perfusion
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Findings that indicate patient's fluid intake exceeds urine output
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1. Weight gain 2. Electrolyte imbalance 3. Increased hemodynamic pressures 4. Decreased lung compliance
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Reading that indicates hypovolemia
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CVP < 2 mmHg
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Reading that indicates hypervolemia
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CVP > 6 mmHg
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Semicomatose
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Responds only to painful stimuli
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Lethargy or somnolence
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Sleepy
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Obtunded
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Drowsy state, may have decreased cough or gag reflex
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Orthopnea
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Difficulty breathing in upright position (heart problem, CHF)
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General malaise
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Run down feeling, nausea, weakness, fatigue, headache (electrolyte imbalance)
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Dyspnea
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Feeling of SOB/difficulty breathing
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Dysphagia
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Difficulty swallowing, hoarseness
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Peripheral edema
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Pitting edema in arms and ankles
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Causes of peripheral edema
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Fluid accumulation from CHF and renal failure
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Ascites
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Accumulation of fluid in the abdomen
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Causes ascites
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Fluid accumulation from liver failure
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Clubbing
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Angling of nail bed of thumbs, first finger and toes
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Causes of clubbing
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Effects of chronic hypoxemia on fingers and toes
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Venous distention
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Engorged jugular veins during exhalation
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Causes of venous distention
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Engorged jugular veins from CHF and COPD
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Capillary refill
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Indicates peripheral circulation
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Diaphoresis
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Profuse, heavy sweating
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Causes of diaphoresis
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Heart failure, fever, infection, anxiety, nervousness, TB
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Ashen/pallor skin
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Skin color caused by anemia or blood loss
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Erythema
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Redness of skin
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Causes of erythema
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Skin colore caused by capillary congestion, inflammation, infection
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Causes of Cyanosis
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Skin color caused by hypoxia from increased amount of reduced hemoglobin
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Kyphosis
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Convex curvature of spine (lean forward)
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Scoliosis
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Lateral curvature of spine (side to side)
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Eupnea
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Normal RR, depth, rhythm
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Causes of tachypnea
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Hypoxia, fever, pain CNS problems
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Cheyne-Stokes
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Gradual increase in RR, then gradual decrease in RR and depth
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Causes of Cheyne-Stokes
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Breathing pattern caused by increased ICP, meningitis, narcotic OD
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Kussmaul's
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Increased RR, increased depth, irregular rhythm, labored breathing
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Causes of Kussmaul's
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Breathing pattern caused by metabolic acidosis, renal failure, diabetic ketoacidosis
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Normal muscles of ventilation
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Diaphragm, external intercostals, passive exhalation
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Accessory muscle used to increase ventilation
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Intercostal, scalene, sternocleidomastoid, pectoralis major, abdominal muscles (oblique, rectus abdominus)
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Disease that causes hypertrophy of the accessory muscles
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COPD effects on accessory muscles
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Signs of respiratory distress in infants
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Retractions, nasal flaring
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Pulsus paradoxus
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Pulse and blood pressure varies with respirations
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Causes of tracheal shift toward pathology
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Atelectasis, pulmonary fibrosis, pneumonectomy, diaphragmatic paralysis
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Causes of tracheal shift away from pahtology
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Massive pleural effusion, tension pneumothorax, neck/thyroid tumors, large mediastinal mass
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Tactile fremitus
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Vibrations felt by hand on chest wall
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Resonant percussion note
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Hollow sound, normal
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Flat percussion note
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Heard over sternum, muscles, or areas of atelectasis
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Dull percussion note
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Thudding sound heard over fluid filled organs like the heart and liver, pleural effusion, PNA
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Tympanic percussion note
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Drum-like sound heard over air filled spaces like stomach. Heard over lungs= air trapping
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Hyperresonant percussion note
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Booming sound indicates pneumothorax or emphysema
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Egophony
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Patient instructed to say "E", but sound like "A". Indicates consolidation/PNA
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Bronchial breath sounds
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Indicates PNA
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Cause and treatment of coarse crackles
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Breath sounds indicating large airway secretions. Requires suctioning
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Cause and treatment of medium crackles
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Breath sounds indicating middle airway secretions. Requires CPT
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Cause and treatment of fine crackles
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Breath sounds indicating collapsed alveoli opening, or fluid in alveoli from CHF/pulmonary edema. Requires positive pressure, cardiac drugs, and/or diuretics
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Cause and treatement of wheezes
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Breath sounds indicating bronchospasm. Requires bronchodilator
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Cause and treatment of stridor
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Breath sounds indicating upper airway obstruction, epiglottitis, croup, post extubation, foreign body aspiration. Requires racemic epinephrine, therapeutic bronchosopy/suction, and/or intubation
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Cause and treatment for friction rub
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Breath sounds indicating pleurisy, TB, PNA, pulmonary infarct, lung cancer. Requires steroids and/or antibiotics
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Heart sound S1
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Heart sound (lub) caused by closure of mitral and tricuspid valves at beginning of ventricular contraction
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Heart sound S2
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Heart sound (dub) caused by relaxation of ventricles and closure of pulmonic and aortic valves
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Normal heart sounds
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S1 and S2 only
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Heart sound S3
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Heart sound that indicates CHF
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Heart sound S4
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Heart sound that indicates MI or cardiomegaly
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Heart murmur
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Sound of turbulent blood flow. Indicates heart valve defects and/or congenital heart defect
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Bruits
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Sound of turbulent blood flow through vein and/or artery
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Abnormal heart sounds
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S3, S4, murmur
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Possible causes for loss of airway patency
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Foreign body obstruction Edema (croup, epiglottitis, allergic reactions) Tracheal spasms
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Lateral chest x-ray
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Adds third dimensions to structures view on AP or PA film
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Lateral decubitus chest x-ray
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Helps diagnose pleural effusions
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Quickest way to determin adequate ventilation following ET intubation
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Observation of chest rise FIRST. Then auscultation
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Proper location of chest tube placement on chest x-ray
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Placed in pleural space surrounding lung to drain fluid and/or air
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Proper location of NG/feeding tube placement on chest x-ray
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Placed 2-5 cm below diaphragm
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Proper location of pulmonary artery catheter placement on chest x-ray
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Placed in right lower lung field
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Proper location of pacemaker placement on chest x-ray
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Placed in right ventricle of heart
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Proper location of central venous catheter on chest x-ray
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Placed in right or left subclavian or jugular vein. Rests in vena cava or right atrium
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Diagnostic test to determine upper airway obstruction in a child
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Lateral neck x-ray of child
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Croup
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Viral disorder common in infants and kids. Causes tracheal narrowing and subglottic swelling
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Epiglottitis
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Bacterial infection that causes life-threatening inflammation of supraglottic airway
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Radiolucent
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Dark pattern on chest x-ray indicating air. Seen with normal lungs
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Radiodense
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White pattern on chest x-ray representing solid or fluid. Normal for bones and organs
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Infiltrate
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Any ill-defined radiodensity on chest x-ray. Indicates atelectasis
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Consolidation
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Solid white area on chest x-ray. Indicates PNA or pleural effusion
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Hyperlucency
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Extra pulmonary air seen on chest x-ray. Indicates COPD, asthma, pneumothorax
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Vascular markings
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Seen on chest x-ray and represents lymphatics, vessels, lung tissue. Increased with CHF, absent with pneumothorax
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Diffuse pattern
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Spread throughout chest x-ray. Indicates atelectasis, PNA
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Opaque
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Indicates fluid and/or solid on chest x-ray. Indicates consolidation
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Fluffy infiltrates
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Diffuse whiteness on chest x-ray. Indicates pulmonary edema
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Butterfly/Batwing pattern
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Scattered densities on chest x-ray. Indicates pulmonary edema
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Patchy infiltrates
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Scattered densities on chest x-ray. Indicates atelectasis
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Platelike infiltrates
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Thin layered densities on chest x-ray. Indicates atelectasis
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Ground glass appearance
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Reticulogranualar on chest x-ray. Indicates ARDS/IRDS
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Honeycomb pattern
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Reticulonodular on chest x-ray. Indicates ARDS/IRDS
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Air bronchogram
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Sign of PNA on chest x-ray
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Basilar infiltrates with meniscus
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Sign of pleural effusion on chest x-ray
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Type of ventilator used with MRIs
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Fluidic ventilator (non-electric, gas powered)
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Indications for barium swallow
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Suspected esophageal malignancy Dysphagia Gastric reflux
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Bronchography (bronchogram)
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Test to help diagnose bronchiectasis
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PET scan
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Test helpful in diagnosing lung cancer, brain disorders, heart disease
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Pulmonary angiogram
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Most definitive test in diagnosis pulmonary embolism
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Echocardiogram
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Used when there is suspected cardiac abnormalities. Measures overall ventricular function, ventricular volume, ejection fraction
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Exhaled nitric oxide testing
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Test used to monitor asthma patients' response to corticosteroid treatment
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FEno level
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Measurement of nitric oxide concentration in exhaled breath
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Decreased FEno level
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Suggests a decrease in airway inflammation
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CBC
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Measures RBCs, hemoglobin, hematocrit, white blood cells, types of white blood cells
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Red blood cells (RBC)
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Component of hemoglobin necessary for oxygen transport
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Lab values indicating anemia
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Low RBCs, low hemoglobin, low hematocrit
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Lab values indicating polycythemia
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High RBCs, high hemoglobin, high hematocrit
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Lab values indicating leukocytosis and/or bacterial infection
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High WBCs
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Lab values indicating leukopenia and/or viral infections
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Low WBCs
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Hemoglobin
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Part of blood that carries oxygen
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Hematocrit
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Percent of RBCs in original blood volume
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Bands
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Immature cells. Make up 4% of WBCs. Increased with bacterial infections
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Segs
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Mature cells. Make up 60% of WBCs. Decreased with bacterial infections
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Shows an increase in eosinophils
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Allergic reactions effect on WBCs. Causes yellow sputum
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Electrolytes K+, Na+, Cl-, HCO3-
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Associated with fluid levels and kidney function. Required for normal metabolism
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Signs and symptoms of electrolyte imbalance
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Muscle weakness, soreness, nausea, mantal change, dizziness, drowsiness
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Sodium
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Major extracellular cation controlled by kidneys
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Potassium
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Major intracellular cation
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Chloride
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Major extracellular anion
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Bicarbonate
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Carries CO2 in blood
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High sodium level
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Lab value related to dehydration
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Low sodium level
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Lab value related to fluid loss or gain: CHF, IV therapy
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Low potassium level
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Lab value related to metabolic alkalosis, excessive excretion, renal loss, vomiting, flattened T wave
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High potassium level
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Lab value related to kidney failure, spiked T wave, metabolic acidosis
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Low chloride
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Lab value related to metabolic alkalosis
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High chloride
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Lab value related to metabolic acidosis
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Creatinine BUN
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Lab values that evaluate kidney function
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Increased BUN
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Lab value related to kidney failure
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Mucoid sputum
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White/gray sputum consistent with chronic bronchitis
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Yellow sputum
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Sputum color consistent with bacterial infection (increased WBCs)
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Green sputum
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Sputum color consistent with stagnant sputum suggesting bronchiectasis, pseudomonas (gram -)
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Brown sputum
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Sputum color consistent with old blood
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Bright red sputum
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Sputum color consistent with a bleeding tumor, TB
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Pink frothy sputum
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Sputum color consistent with pulmonary edema
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Culture and sensitivity
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Identifies bacteria present in specimen, and identifies antibiotics needed
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Platelet count
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Lab test that analyzes blood clot formation, number, size, and shape of platelets
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Partial thromboplastin time (PTT) Prothrombin time (PT)
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Lab test that measures length of time required for plasma to form a fibrin clot
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Indication for partial thromboplastin time (PTT)
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Used to monitor heparin therapy
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Indication for prothrombin time (PT)
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Used to monitor coumadin therapy
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Treating sinus tachycardia
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Administer oxygen to treat this rhythm
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Treating sinus bradycardia
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Administer oxygen and atropine to treat this rhythm
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Treating PVCs or multifocal PVCs
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Administer oxygen and lidocaine to treat this rhythm
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Treating pulseless V-tach or V-fib
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Defibrillate to treat this rhythm
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Treating V-tach with a pulse
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Administer lidocaine, cardioversion to treat this rhythm
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Treating asystole
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Administer epinephrine, atropine, begin CPR to treat this rhythm
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Treating 1st degree heart block
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Administer atropine to treat this rhythm
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Treating 2nd degree heart block
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Administer atropine, place ventricular pacemaker to treat this rhythm
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Treating 3rd degree heart block
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Place ventricular pacemaker to treat this rhythm
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2 factors that cause right axis deviation
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1. Left Hypertrophy 2. Right Infarction
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Direction of normal axis
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Axis is down and to the right
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Infarction
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Necrosis/death of tissue. Significant Q waves
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Ischemia
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Decreased blood flow to tissue. Inverted T wave
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Injury
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Acute damage to tissue. STEMI
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Junctional rhythm
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Looks normal but is missing a P wave
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Deformity of p wave
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Cardiac wave form that suggests atrial problem
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3 types of ECG cardiac contractions
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1. Normal sinus rhythm 2. Junctional rhythm 3. Ventricular rhythm
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Wide QRS
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Cardiac wave form that suggests ventricular arrhythmia
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When to perform APGAR score
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Performed at 1 and 5 minutes post-partum
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5 factors of APGAR score
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1. Appearance (color) 2. Pulse 3. Grimace (reflex, irritability) 4. Activity 5. Respiratory effort
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Good APGAR
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Score of 2 for each: A. completely pink P. >100 bpm G. cough or sneeze A. active motion R. regular, strong cry
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Bad APGAR
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Score of 1 for each: A. body pink, extremities blue (acrocyanosis) P. < 100 bpm G. grimace A. some flexion of extremities R. slow, irregular, weak cry
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Very bad APGAR
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Score of 0 for each: A. blue/pale all over P. absent G. no response A. limp, no movement R. absent, no cry
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APGAR score 0-3
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Begin to resuscitate infant
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APGAR score 4-6
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Support, stimulate, warm infant, deliver oxygen
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APGAR score 7-10
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Monitor, routine care of infant
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Lighted halo
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Indicates inflated lungs, normal transillumination
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Transillumination
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Light shined over infant's chest when pneumothorax is suspected
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Illumination of entire hemithorax
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Abnormal transillumination. Suggests pneumothorax or pneumomediastinum
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Normal infant vital signs
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Pulse 110-160 RR 30-60 BP 60/40 Temp 36.5 C
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2 methods to estimate gestational age
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1. Dubowitz 2. New Ballard Score
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New Ballard Score
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Estimates gestational age in very low birth weight infants
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Dubowitz score for full-term infant
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Score of 40 (40 weeks)
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L/S ratio
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Test to determine lung maturity, incidence of hyaline membrane disease (HMD) or IRDS
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L/S ratio indicating mature lungs
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2:1 ratio
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Reads lower than PaCO2
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PetCO2 value in relation to PaCO2 value
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Exhaled CO2 detection device purpose
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Helps to detect esophageal intubation
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Inaccurate pulse oximetry value
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70%
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Overnight pulse oximetry
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Useful in sleep related breathing disorders
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Can diagnose CO poisoning
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CO-oximetry
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Smoker's CO-oximetry value
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COHb 5-10%
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Heavy smoker's CO-oximetry value
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COHb 10-15%
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Transcutaneous measurement temp
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43-45 C
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Conditions that affect accuracy of transcutaneous electrode
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Shock, burns, vascular disease, cardiac defects in relation to transcutaneous monitoring
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Proper placement of transcutaneous electrodes
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Placement on chest, below right or left clavicles
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Change transcutaneous electrodes
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Change every 4 hours
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Heart chamber that serves systemic arteries
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Left ventricle
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Heart chamber that serves systemic veins
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Right atrium
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Heart chamber that serves pulmonary arteries
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Right ventricle
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Heart chamber that serves pulmonary veins
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Left atrium
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Swanz-Ganz catheter measurements
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Measures PAP, PCWP, CVP
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Arterial line (indwelling arterial catheter) measurements
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Measures MAP, systemic arterial system
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Hemodynamic pressures for right heart failure
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CVP- increased PAP/PCWP- normal or decreased Cardiac output- normal
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Hemodynamic pressures for lung disorders
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CVP- increased PAP- increased PCWP- normal or decreased Cardiac output- normal
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Hemodynamic pressures for left heart failure
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CVP- normal PAP/PCWP- increased Cardiac output- decreased
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Hemodynamic pressures for hypervolemia
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All hemodynamic pressures are increased
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Hymodynamic pressures for hypovolemia
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All hemodynamic pressures are decreased
