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87 Cards in this Set
- Front
- Back
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What importance does the medical history have
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it provides sufficient information for an accurate diagnosis
75% of diagnosis are accurately obtained from the history before the physical examination begins |
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What are the 4 steps of correctly structure the patient interview
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* provide your patient with you undivided attention* Establish your professional role during intro *Professional conduct creates a good rapport* A relaxed conversational style
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Respiratory System dysfunctions are ____ manifestation of ______ systemic disease processes
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frequently
other |
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What is the importance of general background info
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tells who the pt is and what diseases they are likely to develop
provides a basic understanding of pts previous exp. & wiliness to health care Tells the pt's culture, attitudes, relationship, and level of education |
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What does screening information reveal?
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It reveals area that the pt forgot to mention or felt was not important
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What purpose does the ROS serve and is it Objective or Subjective
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It reviews the past and present info that may be relevant to the present problem that might have went unnoticed
Subjective |
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What is the Chief Compliant
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What brought them to the hospital
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What are constitutional symptoms
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fever, chills, excessive sweating, loss of appetite, nausea, vomiting, weight loss, fatigue, weakness, altered sleep patterns, and intolerance
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What is the formula for figuring out cigarettes in pack years
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# of yrs pt has smoked x # of packs smoked each day
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Why is family history impt
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to learn about the health status of the pt's blood relatives. (TB, colds, flu, pneumonia)
** exposure to people with infections can also result in pulmonary symptoms** |
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Why should you review the patients chart
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for the admission note- why they were admitted, who is the pt, clinical conditions and overall Tx plan
Physician orders- see the specific orders for respiratory care |
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What are progress notes what info do they contain?
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The attending physician visits the pt daily and will interview and examine the pt to identify the progress and response to tx
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Cardiopulmonary symptoms are asses to determine what?
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the seriousness of the pt.'s problem
the potential underlying cause of the problem the effectiveness of treatment |
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What causes a cough
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it can be caused by inflammatory mechanical chemical or thermal stimulation of cough receptors found between the oropharynx to the terminal bronchioles
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What are the 3 phases of a cough
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Inspiratory phase
Compression Phase Expiratory Phase |
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What happens during the Inspiratory phase of a cough
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reflex opening of the glottis and contraction of the diaphragm, throrax, and abdominal muscles causes a deep inspiration
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What happens during the compression phase
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closure of the glottis & relaxation of the diaphragm while, the expiratory muscles contract against the closed glottis can generate very high intrathoraicic pressures and narrowing of the trachea and bronchi
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What happens during the expiratory phase
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opening of the glottis explosive release of trapped intrathoracic air & vibration of the vocal cords and mucosal lining of the posterior laryngeal wall.
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What reduces the effectiveness of a cough
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weakness of inspiratory or expiratory muscles*Inability of the glottis to open/close correctly*Obstruction, collapsibility, or alternation in shape or contours of the airways*decrease in lung recoil (emphysema)*abnormal quantity or quality of mucous production
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What do respiratory tract secretions contain
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mucus, cellular debris, microorganisms, blood, pus, foreign particles
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what is the volume of normal secretions
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100 ml/ daily
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What is sputum
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a substance expelled from the tracheobronchial tree, pharynx, mouth, sinus, and nose by coughing or clearing the throat
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what is phlegm
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strictly secretion from the lungs and tracheobronchial tree
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what is the most common cause of sputum or phlegm
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inflammation of the mucous glands that line the T-B tree
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How is sputum described
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by its color, consistency, odor, quantity, time of day, & presence of blood or distinguishing matter
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what does scanty refer to
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a few tsps
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what does copious refer to
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a pint or more
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Explain the consistency of sputum
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thin, thick, viscous, gelatinous, tenacious- extremely sticky or frothy
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What is chronic sputum production related to
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irritation or disease of airways (asthma or chronic breathing)
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what does mucoid mean
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clear, thin, possibly viscid due to over secretion of bronchial mucus
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What does mucopurulent mean
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thick, viscous, colored and globule with an offensive odor
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What are some causes of hemoptysis
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history of pulmonary or cardiovascular disease cigarette smoking, and tobacco use, trauma, aspiration of a foreign body, bleeding disorder, use of anticoagulant agents, aspirin, non-steroidal anti inflammatory agents or chemotherapeutic agents
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Physical signs of Hemoptysis
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clots of blood
blood tinged sputum |
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what is hemoptysis
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spitting up blood
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what is hematemesis
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vomiting blood
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what is dyspnea?
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SOB , difficult breathing as perceived by the pt
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Dyspnea is associated with what diseases?
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metabolic disease
hematological disorders toxic ingestion or psychiatric conditions |
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Patients with asthma have what type of clinical dyspnea
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tightness in the chest
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Patients with CHF have what type of clinical dyspnea
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suffocation "air hunger"
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Patients with COPD & interstital lung disease have what type of clinical dyspnea
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increase effort to breath
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What is Paroxysmal nocturnal dyspnea (PND)
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sudden onset of difficult breathing that occurs when a sleeping patient is in the recumbent (flat) position
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What is orthopnea
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inability to breath when lying down, described as 2 or 3 pillow orthopnea
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What is Trepopnea
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dyspnea caused by lying on one side that does not occur when the patient turns to the other side
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What is Platypnea
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opposite of orthopnea dyspnea caused by upright posture and relived by recumbent position
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What is orthodeoxia
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arterial O2 desaturated that is produced by assuming an upright position and relived by returning to a recumbent position
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What is angina
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vice like pain down the arms most often the left and may radiate into the shoulder or up to the jaw
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What are some pulmonary causes of chest pain
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pneumonia, lung abscess and pulmonary infarction often involve the over lying pleura and may induce pleutritic pain
Inflammation of the tracheobronchitis |
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How is pleuritic pain recognized by examining the patient
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pt pain may be bent to the side taking shallow breaths and holding their chest to decrease movement
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How is pleuritic pain described
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sharp, stabbing, raw or burning progressing to excruitating when they breath or laugh
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How is esophageal pain described
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knot, like a big bubble trapped inside or burning
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How is spontaneous pneumothorax/dissecting aortic aneurysm
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excruciating tearing or knife like
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What is syncope
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temporary loss of consciousness caused by reduced blood flow and therefore a reduced supply of O2 and nutrients to the brain
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What are the pulmonary causes of syncope
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pulmonary embolism
prolonged bout of coughing hypoxia hypocapnea holding ones breath after deep inspiration |
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vasovagal syncope
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common dizziness and fainting results from a loss of peripheral venous tone
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Othrostatic hypotension
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excessive drop in blood pressure when a person stands up
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What is cough (tussive) syncope
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transient loss of consciousness after severe coughing
** common in middle age men with underlying COPD, moderately obese and have a great appetite of food, alcohol and smoking*** |
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What is edema and what diseases is it associated with
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soft tissue swelling resulting from an abnormal accumulation of fluid
disease: kidney, liver, cardiac, and pulmonary |
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What is peripheral (dependent) edema
( what is it caused by) |
caused by pulmonary diseas occurs when the disease process cause narrowing of the capillaries in the lungs requiring the right ventricle to generate higher and higher pressures to move blood through the lungs
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What does bilateral peripheral/dependent edema suggest
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pulmonary hypertension, heart failure, venous insuffiency
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What is unilateral peripheral edema caused by
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some type of venous obstruction in that extremity. Can be casued by clothing, jewerly, wound dressing. etc.... DVT
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Why do people with pulmonary disease c/o of headaches?
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headache are due to inadequate O2 supply in the blood
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What are some causes of Headaches?
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lung disease
low levels of )2 in the inspired air O2 to the brain is decreased |
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If you have high levels of CO2 in the blood what does that mean?
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dilation in the cerebral arterial vessels=vascular headaches
pts usually wake up with a terrible headache in the morning |
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what are the 4 vital sign measurements
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temperature
pulse respiration blood pressure |
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Name some other impt vital sign measurements
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height and weight
level of consciousness & responsiveness level and type of pain |
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what is a patients baseline
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initial setting
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Clinicians must have a knowledge base of what is normal vital signs for the pt's ______, disease, and _______
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age
environment |
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How do you recognizing that a pt. is experiencing a particular problem?
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by comparing changes in vital signs and other s/s
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Patients who are not maintaining adequate blood O2 levels develop specific changes in
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LOC, HR, RR, BP
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The key to expert assessment of vital signs at the bedside is to be ?
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constantly aware look, listen, question, validate, reassess, analyze, & trend
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What is a differential diagnosis
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comparison of mutliple signs and symptoms to arrive to the patients diagnosis
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What is the 5th vital sign
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Pain level and type
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Pain level and type should be evaluated as to
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location
intensity onset what relives or makes it worse |
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What must be present for the patients to be conciseness, alert, and well-orientated
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adequate cerebral oxygenation
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What is sensorium
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mental status
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A conscious pt should be evaluated for orientation to
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time, place, & person
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Abnormal sensorium & loss of consciousness may occur when?
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Cerebral perfusion is inadequate or when poorly oxygenated blood is delivered to the brain
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when cerebral oxygenation deteriorates pt is initially
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restless, confused, and disoriented
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what is the Glasgow Coma Scale based on
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behavioral response
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What is know as the Gold Standard for assessing neurological functions of patients who have been sedated, anesthetized, head trauma or comatose
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Glasgow Coma Scale
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What does the GCS Test
What is its scale |
test best motor response, verbal response and eye opening
3=deep coma 15= fully awake |
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What type pf blood pressure typically decreases slighting with normal inhalation
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systolic
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Decrease in systolic BP is greater during a _________?
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forced maximal inhalation
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an abnormal pulse is also known as what?
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Paradoxical Pulse
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what type of pressure promotes venous blood return to the right ventricle and discourages arterial blood flow out of the left ventricle
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Negative Intrathoracic Pressure
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What could cause the interventricular septum to distend toward the left ventricle
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increased venous return to the right ventricle during importation increase the right ventricular filling pressures
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If there is a reduction in the left ventricle filling was else is reduced?
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stroke volume, systolic blood pressure
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