Test 1 Respiratory Therapy I (Physical Assessment) – Flashcards
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History of Present Illness
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a detailed interview prompted by the chief complaint or presenting symptom
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Past Medical History
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narrative or record of past events and circumstances that are or may be relevant to a patient's current state of health
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Family/Social/Environmental
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family medical history, hobbies, occupation, and life happenings such as vacation
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Dyspnea
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a patient perceived shortness of breath
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Orthopnea
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breathing is easier in an upright position
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Cough
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dry, loose, productive, or effective
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Sputum Production
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occurs when the respiratory tract secretions are beyond the ability of the mucociliary mechanism to deal with
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Hemoptysis
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blood in the sputum
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What is typical of pleuritic chest pain?
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locate laterally, sharp and stabbing in nature, and increases with breathing
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Fever
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have a temperature
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Orientation x 3
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time, space-place, person(who they are)
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Confused
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slow mental responses, decreased or dulled perception, incoherent thoughts, and exhibits slight decrease in consciousnous
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Delirious
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easily agitated, irritable, and exhibits hallucinations
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Lethargic
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sleepy, arouses easily, and responds appropriately when aroused
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Obtunded
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awakens only with difficulty and responds appropriately when aroused
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Stuporous
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does not awaken completely, has decreased mental and physical activity, responds to pain and exhibits deep tendon reflexes, and responds slowly to verbal stimuli
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Comatose
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unconscious, does not respond to stimuli, does not move voluntarily, exhibits signs of upper motor neuron dysfunction, and loses reflexes with deep or prolonged unconsciousness
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What are considered vital signs?
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temperature, respiratory rate, blood pressure, and heart rate
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Body Temperature
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normal is 37° C
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Febrile
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when the patient has a body temperature that is elevated which is caused by disease
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Afebrile
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when the patient has a body temperature that is normal
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Hyperthermia
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when the patient has a body temperature is above normal
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Hypothermia
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when the patient has a body temperature below normal
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Pulse Rate
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60 - 100 beats per minute
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Tachycardia
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pulse rate over 100 beats per minute
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Bradycardia
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pulse rate under 60 beats per minute
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Paradoxical Pulse
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abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration
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Blood Pressure
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the force exerted against the wall of the arteries as the blood moves through them
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Systole
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peak force, contraction of the left ventricle with a normal range of 90 - 140 mmHg
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Diastole
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force in major arteries during relaxation of the ventricle with a normal range of 60 - 90 mmHg
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Sphygmomanometer
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an instrument for measuring blood pressure, typically consisting of an inflatable rubber cuff that is applied to the arm and connected to a column of mercury next to a graduated scale, enabling the determination of systolic and diastolic blood pressure by increasing and gradually releasing the pressure in the cuff
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Korotkoff Sounds
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arterial sounds heard through a stethoscope applied to the brachial artery distal to the cuff of a sphygmomanometer
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Syncope
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temporary loss of consciousness caused by a fall in blood pressure
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Hypertension
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abnormally high blood pressure
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Hypotension
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abnormally low blood pressure
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Respiratory Rate
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normal range is 10 - 20 breaths per minute
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Tachypnea
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abnormally high respiratory rate over 20 breaths per minute caused by exertion, fever, hypoxemia, metabolic acidosis, anxiety, or pain
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Bradypnea
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abnormally low respiratory rate under 10 breaths per minute caused by head injuries, hypothermia, medications, or narcotics
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Apnea
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complete absence of spontaneous respiration
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Eupnea
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normal spontaneous respiration
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Biot's Respiration
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short episodes of rapid, uniformly deep inspirations followed by 10-30 seconds of apnea
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Hyperpnea
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is increased depth of breathing when required to meet metabolic demand of body tissues with or without an increased frequency
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Hyperventilation
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increased alveolar ventilation (decreased PaCO2)
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Hypoventilation
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decreased alveolar ventilation (increased PaCO2)
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Cheyne-Stokes Respiration
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10 - 30 seconds of apnea followed by a gradual increase in volume and frequency of breathing followed by a gradual decrease in volume of breathing until another apnea occurrence
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Kussmaul's Respiration
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deep and labored breathing pattern often associated with severe metabolic acidosis
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Nasal Flaring
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when the nostrils widen while a person is breathing and is a symptom of difficulty in breathing
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Cyanosis
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a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood; normally seen on earlobes, around the mouth, and fingernails
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Pursed Lip Breathing
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used during exhalation to cause back pressure in the small airways which prevents premature collapse
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Symptoms to look for around the head
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nasal flaring, cyanosis, and pursed lip breathing
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Symptoms to look for around the neck
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position of the trachea, suprasternal notch, accessory muscles
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Position of the Trachea
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midline of the neck
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Positions of the Suprasternal Notch
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shifts toward collapse and shifts away increased air-fluid
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Height of blood column (JVP)
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reflects volume and pressure in right side of the heart
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Internal and External Jugular (JVP)
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supine-full; 45° angle 2cm above clavicle
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What is the most common cause of jugular venous tension?
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congestive heart failure in the right of left side
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Thoracic(chest) Configuration
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is the front and back flat with no barrel chest
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Accessory Muscles
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are these being used for respiration; are they overdeveloped
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Retractions
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does suprasternal notch suck in on inspiration
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Respiratory Rate Ratio
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of inspiration to expiration is 1:3
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What to look at when inspecting the chest area of a patient?
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thoracic configuration (is he barrel chested), accessory muscles, retractions, and respiratory rate
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What do you check during palpation of the chest?
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vocal fremitus, thoracic expansion, and skin
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Vocal Fremitus
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check of sound transmitted (vibration) down the tracheobronchial tree and through the lungs
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Thoracic Expansion
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a check of the symmetry of expansion using the thumbs on the back
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Skin
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check for crepitus in the subcutaneous tissues
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Resonance to percussion
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increased is more air (hyperinflation); decreased is consolidation
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Auscultation
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the action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope, as a part of medical diagnosis
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Pitch
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is it high or low (breath sound component)
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Amplitude
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loudness (breath sound component)
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Duration
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length of inspiration (breath sound component)
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Tracheal Breath Sounds
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normal sounds that has a higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration; heard over trachea
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Bronchovesicular Breath Sounds
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normal sounds in the mid-chest area or in the posterior chest between the scapula; found over bronchi
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Vesicular Breath Sounds
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normal sounds heard over the thorax, lower pitched and softer than bronchial breathing; in the periphery and muffled
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Course Crackles
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rhonchi, low vibratory sounds that mean you need to cough
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Fine Crackles
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rales, fluid in alveolus, reopening of alveolus
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Rales
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fine crackles; fluid in the alveolus
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Wheezes
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high pitched, musical sounds due to narrowing of the lumen of the airway
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Rhonchi
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coarse crackles; fluid or mucus in the bronchi
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Stridor
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narrowing of the trachea(upper airway)
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Diminished
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can't hear breath sounds
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Bronchophony
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increased intensity, clarity, and transmission of vocal resonance
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Whispered Pectoriloquy
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an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso which means consolidation
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A patient displays the following symptoms: Tracheal deviation to the right, increased vocal fremitus in the right lung field, along with decreased resonance to percussion. The left lung displays normal vocal fremitus and resonance.
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right lung atelectasis
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A patient displays the following symptoms: Tracheal deviation to the left, decreased vocal fremitus in the right lung field along with increased resonance to percussion. The left lung displays normal vocal fremitus and resonance.
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right lung pneumothorax
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A patient displays the following symptoms: Tracheal deviation to the right, normal vocal fremitus in the right lung field along with resonance to percussion. The left lung displays decreased vocal fremitus and increased resonance.
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left lung pneumothorax
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A patient displays the following symptoms: Tracheal deviation to the left, normal vocal fremitus on the right lung field along with normal resonance to percussion. The left lung displays increased vocal fremitus and a decreased resonance to percussion.
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left lung atelectasis
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