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475 Cards in this Set
- Front
- Back
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GETTING O2 FROM THE AIR TO THE BODY TISSUE CELLS.
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LIFE FUNCTIONS
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BREATHING AIR IN AND OUT OF THE LUNGS
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VENTILATION
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MOVING THE BLOOD THROUGH THE BODY
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CIRCULATION
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GETTING BLOOD AND O2 INTO THE TISSUE
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PERFUSION
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HOW TO MEASURE VENTILATION
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RR, VT, CHEST MOVEMENT, BS
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HOW TO MEASURE OXYGENATION
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HR, COLOR SENSORIUM
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HOW TO MEASURE CIRCULATION
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PULSE/HR AND STRENGTH, C.O.
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HOW TO MEASURE PERFUSION
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BP, SENSORIUM, TEMP, U.O., HEMODYNAMICS
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FIRST (LIFE FUNCTION) PRIORITY WHEN YOU HAVE AN EMERGENGY
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VENTILATION- ESTABLISH AN OPEN AIRWAY AND BREATHE
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2ND (LIFE FUNCTION) PRIORITY
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OXYGENATION- INCREASE FIO2
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3RD LIFE FUNCTION PRIORIY
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CIRCULATION- CHEST COMPRESSION, DEFIBRILLATE, HEART DRUGS
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4TH LIFE FUNCTION PRIORITY
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PERFUSION- INCREASE BLOOD PRESSURE
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MOST COMMON PROBLEM OF ALL THE LIFE FUNCTIONS IS
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OXYGENATION
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THOSE THINGS THAT YOU CAN SEE OR MEASURE IN A PATIENT.
EX. COLOR, PULSE, EDEMA, BP |
SIGNS/OBJECTIVE INFORMATION
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THOSE THINGS THAT A PT. MUST TELL YOU.
EX. DYSPNEA, PAIN, NAUSEA |
SYMPTOMS/SUBJECTIVE INFORMATION
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HOW TO COMPUTE SMOKING HISTORY
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IN PACK YEARS.
PACK YRS= # OF PACK/DAY X # OF YRS. SMOKED. EX. 4 PACKS/DAY X 10 YRS.= 40 PACK YEAR |
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NORMAL URINE OUTPUT
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40 CC/HR
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SENSIBLE H2O LOSS
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URINE, VOMITING
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INSENSIBLE H20 LOSS
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LUNGS AND SKIN
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IF INTAKE EXCEEDS OUTPUT, THIS COULD RESULT IN?
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WEIGHT GAIN
ELECTROLYTE IMBALANCE INCRESED HEMODYNAMIC PRESSURES DECREASED LUNG COMPLIANCE |
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NORMAL FOR LEVEL OF CONCIOUSNESS
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PT IS ALERT AND RESPONSIVE
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LEVEL OF CONCIOUSNESS FOR A PT. WHO RESPONDS INAPPROPRIATELY, HAVE DRUG OVERDOSE OR INTOXICATION
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STUPOROUS OR CONFUSED.
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LEVEL OF CONCIOUSNESS FOR A COPD OR O2 OVERDOSE PT.
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LETHARGIC, SOMLOLENT OR SLEEPY
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LEVEL OF CONCIOUSNESS FOR A PT. WHO RESPONDS ONLY TO PAINFUL STIMULI
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SEMICOMATOSE
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LEVEL OF CONCIOUSNESS FOR A PT. WHO DOES NOT RESPOND TO PAINFUL STIMULI
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COMATOSE
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LEVEL OF CONCIOUSNESS FOR A PT. IN DROWSY STATE AND MAY HAVE A DECREASED COUGH OR GAG REFLEX.
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OBTUNDED
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DIFFICULTY BREATHING WHILE LAYING DOWN EXCEPT IN THE UPRIGHT POSITION
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ORTHOPNEA
PTS WITH HEART PROBLEM CHF |
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RUN DOWN FEELING, NAUSEA, WEAKNESS, FATIGUE, HEADACHE
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GENERAL MALAISE
MAYBE DUE TO ELECTROLYTE IMBALANCE |
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A FEELING OF SHORTNESS OF BREATH OR DIFFICULTY BREATHING
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DYSPNEA
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GRADE FOE NORMAL DYSPNEA THAT OCCURS AFTER UNUSUAL EXERTION
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GRADE 1
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GRADE OF DYSPNEA WHEN PT. IS BREATHLESS AFTER GOING UP HILLS OR STAIRS
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GRADE 2
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GRADE OF DYSPNEA WHEN PT. HAS DYSPNEA WHILE WALKING AT NORMAL SPEED
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GRADE 3
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GRADE OF DYSPNEA WHEN PT. HAS DYSPNEA WHILE SLOWLY WALKING SHORT DISTANCES
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GRADE 4
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GRADE OF DYSPNEA WHEN PT. HAS DYSPNEA AT REST, SHAVING, DRESSING
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GRADE 5
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A REACTION OF A SPECIFIC NERVOUS TISSUE.
MAY INCREASE BP AND HR. |
PAIN
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DIFFICULTY SWALLOWING
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DYSPHAGIA
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PRESENCE OF EXCESSIVE FLUID IN THE TISSUE
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PITTING EDEMA
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*FLUID THAT OCCURS PRIMARILY IN ARMS AND ANKLES.
*CAUSED FROM CHF AND RENAL FAILURE *RATED +1, +2, +3, ETC. THE HIGHER THE NUMBER THE GREATER THE SWELLING |
PERPHERAL EDEMA
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*PRESENCE OF THIS IS SUGGESTIVE OF PULMONARY DISEASE.
*CAUSED BY CHRONIC HYPOXEMIA *THE THUMB AND FINGERS ARE AFFECTED. *TOES ARE ALSO AFFECTED *THE CONDITION IS PRESENT WHEN THE ANGLE OF THE NAIL BED AND SKIN INCREASES |
CLUBBING OF FINGERS.
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SEEN DURING EXPIRATION BECAUSE OF THE OBSTRUCTIVE COMPONENT(LUNG DISEASE).
OCCURS WITH CHF |
INCREASED VENOUS DISTENSION
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INDICATION OF PERIPHERAL CIRCULATION.
BLANCHING THE HAND AND WATCH THE BLOOD RETURN. COMMONLY DONE FOR THE ALLEN'S TEST BEFORE DRAWING ABG'S |
CAPILLARY REFILL
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A STATE OF PROFUSE/HEAVY SWEATING (NIGHT SWEATS).
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DIAPHORESIS
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PT'S SKIN COLOR IS PINK, TAN, BROWN, BLACK. THIS INDICATES THAT THE PT'S SKIN COLOR IS...
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NORMAL
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DECREASE IN PT'S SKIN COLOR (ASHEN, PALLOR) MAYBE DUE TO:
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ANEMIA OR BLOOD LOSS WHICH IS ABNORMAL
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DIAPHORESIS MAY BE DUE TO:
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HEART FAILURE
FEVER, INFECTION ANXIETY, NERVOUSNESS. |
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COLOR CHANGE BY REDUCING BLOOD FLOW IS CAUSED BY:
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VASOCONSTRICTION
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INCREASE IN BILIRUBIN IN BLOOD AND TISSUE WHICH APPEARS MOSTLY IN THE FACE AND TRUNK.
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JAUNDICE
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REDNESS OF THE SKIN THAT MAYBE DUE TO CAPILLARY CONGESTION, INFLAMATION OR INFECTION
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ERYTHEMA
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BLUE OR BLUE-GRAY DISCOLORATION OF SKIN AND MUCOUS MEMBRANES.
CAUSED BY HYPOXIA FROM INCREASED AMOUNT OF REDUCED HEMOGLOBIN.(5G OF REDUCED HG) |
CYANOSIS
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*STRAIGHT SPINE, NO ALTERATIONS IN CHEST SIZE.
*NO LEANING FORWARD OR SIDE TO SIDE. |
NORMAL A-P DIAMETER
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ANTERIOR POTRUSION OF THE STERNUM
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PECTUS CARINATUM
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DEPRESSION OF PART OR ALL OF THE STERNUM
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PECTUS EXCAVATUM
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HUNCHBACK OR CONVEX SPINAL CURVE
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KYPHOSIS
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LATERAL CURVATURE OF THE SPINE
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SCOLIOSIS
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IS A COMBINATION OF BOTH KYPHOSIS AND SCOLIOSIS AND CAUSES SEVERE RESTRICTIVE IMPAIRMENT.
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KYPHOSCOLIOSIS
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*A RESULT OF AIR TRAPPING IN THE LUNGS FOR A LONG PERIOD OF TIME.
*GENERALLY DUE TO COPD *INCREASE IN A-P DIAMETER |
BARREL CHEST
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INCREASE IN A-P DIAMETER/BARREL CHEST IS DUE TO...
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COPD
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BOTH SIDES OF THE CHEST MOVE AT THE SAME TIME
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SYMMETRICAL CHEST MOVEMENT
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UNEQUAL MOVEMENT OF THE CHEST/DIAPHRAGM
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ASYMMETRICAL
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ASYMMETRICAL MOVEMENT MAY SHOW UNDERLYING PATHOLOGY SUCH AS:
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CHRONIC LUNG DISEASE
ATELECTASIS PNEUMOTHORAX FLAIL CHEST-PARADOXICAL INTUBATED PT'S WITHH ETT IN ONE LUNG |
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NORMAL RESPIRATORY RATE, DEPTH AND RHYTHM
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EUPNEA
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INCREASED RR (OVER 20 BPM)
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TACHYPNEA
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TACHYPNEA IS CAUSED BY:
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FEVER
HYPOXIA PAIN CNS PROBLEM |
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OTHER NAME FOR BRADYPNEA
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OLIGOPNEA
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DECREASED RR(<8 BPM)
VARIABLE DEPTH IRREGULAR RHYTHM |
BRADYPNEA
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BRADYPNEA IS CAUSED BY...
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SLEEP(NORMAL)
DRUGS ALCOHOL METABOLIC DISORDERS |
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CESSATION OF BREATHING
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APNEA
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INCREASED RR
INCREASED DEPTH REGULAR RHYTHM |
HYPERPNEA
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HYPERPNEA IS CAUSED BY...
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METABOLIC DISORDERS
CNS DISORDERS |
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GRADUALLY INCREASING THEN DECREASING RATE AND DEPTH IN A CYCLE LASTING FROM 30-180 SECONDS, WITH PERIODS OF APNEA LASTING UP TO 60 SECONDS
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CHEYNE-STOKES
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CHEYNE-STOKES IS CAUSED BY...
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INCRESED ICP
MENINGITIS DRUG OVERDOSE |
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INCREASED RR
INCREASED DEPTH IRREGULAR PERIODS OF APNEA EACH BREATH HAS THE SAME DEPTH |
BIOTS
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BIOTS IS CAUSED BY...
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CNS PROBLEM
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INCREASED RR(USUALLY >20BPM)
INCREASED DEPTH IRREGULAR RHYTHM BREATHING SOUNDS LABORED |
KUSSMAUL'S
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KUSSMAUL'S IS CAUSED BY...
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METABOLIC ACIDOSIS
RENAL FAILURE DIABETIC KETOACIDOSIS |
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PROLONGED GASPING INSPIRATION FOLLOWED BY EXTREMELY SHORT, INSUFFICIENT EXPIRATION
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APNEUSTIC
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APNEUSTIC IS CAUSED BY...
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*PROBLEM WITH RESPIRATORY CENTER
*TRAUMA *TUMOR |
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NORMAL VENTILATION MUSCLES USED DURING INSPIRATION
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DIAPHRAGM
EXTERNAL INTERCOSTALS |
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EXHALATION IS NORMALLY
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PASSIVE
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MUSCLES USED TO INCREASE VENTILATION(ACCESSORY MUSCLES)
ARE |
1. MUSCLES OF NORMAL VENTILATION PLUS.
2.INTERCOSTAL, SCALENE, STERNOCLEIDOMASTOID, PLUS 3. ABDOMINAL MUSCLES |
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HYPERTROPHY OF ACCESSORY MUSCLES OCCURS IN WHICH PT.?
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COPD
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MUSCLE WASTING OR LOSS OF MUSCLE TONE IS CALLED
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ATROPHY
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ATROPHY OCCURS IN PT'S WITH
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PARALYSIS
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INCREASE IN MUSCLE SIZE DUE TO COPD IS CALLED
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HYPERTROPHY
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WHEN THE CHEST MOVES INWARD DURING INSPIRATORY EFFORTS INSTEAD OF OUTWARD IS CALLED
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INTERCOSTAL AND/OR STERNAL RETRACTIONS
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INTERCOSTAL AND/OR STERNAL RETRACTIONS IS DUE TO A
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BLOCKED (OBSTRUCTED) AIRWAY
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INTERCOSTAL AND/OR STERNAL RETRACTIONS IS A SIGN OF RESPIRATORY DISTRESS IN
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INFANTS
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NASAL FLARING IS A SIGN OF RESPIRATORY DISTRESS IN
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INFANTS
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EXPIRATORY GRUNTING AND RETRACTIONS OCCUR IN NEWBORNS TO PREVENT
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ATELECTASIS
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A DRY OR NON-PRODUCTIVE COUGH MAY INDICATE
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TUMOR IN THE LUNGS
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A PRODUCTIVE COUGH MAY INDICATE
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INFECTION
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NORMAL ADULT PULSE RATE
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60-100 BEATS/MIN
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ADULT PULSE RATE >100
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TACHYCARDIA
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ADULT PULSE RATE >100 INDICATES
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HYPOXEMIA
ANXIETY STRESS |
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ADULT PULSE RATE <60
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BRADYCARDIA
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ADULT PULSE RATE <60 INDICATES
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HEART FAILURE
SHOCK CODE EMERGENCY |
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IF HR INCREASED TO 20 BPM DURING TREATMENT YOU SHOULD
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STOP THERAPY
NOTIFY NURSE/DOCTOR DUE TO ADVERSE REACTION |
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ANY CHANGE IN RHYTHM IS INDICATION FOR
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FURTHER MONITORING
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PULSE/BLOOD PRESSURE VARIES WITH RESPIRATION IS CALLED
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PARADOXICAL PULSE/PULSUS PARADOXUS
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PARADOXICAL PULSE/PULSUS PARADOXUS MAY INDICATE
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SEVERE AIR TRAPPING AS IN STATUS ASTHMATICUS
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TO DETERMINE PROPER TRACHEAL POSITIONING YOU SHOULD
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1. PLACE INDEX FINGER THRU SUPRA STERNAL NOTCH
2. COMPARE THE SPACE BETWEEN THE CLAVICLE AND LEFT BORDER OF THE TRACHEA |
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CAUSES OF TRACHEAL DEVIATION WHEN PULLED TOWARD THE AFFECTED SIDE
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PULMONARY ATELECTASIS
PULMONARY FIBROSIS PNEUMONECTOMY DIAPHRAGNATIC PARALYSIS |
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CAUSES OF TRACHEAL DEVIATION WHEN PUSHED AWAY FROM AFFECTED SIDE
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MASSIVE PLEURAL EFFUSION
TENSION PNEUMOTHORAX ENLARGED LYMPH NODES LARGE MEDIASTINAL MASS NECK OR THYROID TUMORS |
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THIS IS VIBRATIONS THAT ARE FELT BY THE HAND ON THE CHEST WALL
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TACTILE FREMITUS
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VOICE VIBRATIONS ON THE CHEST WALL
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VOICE FREMITUS
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A GRATING SENSATION FELT ON THE CHEST WALL DUE TO ROUGHENED PLEURAL SURFACES RUBBING TOGETHER
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PLEURAL RUB FREMITUS
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PALPABLE RONCHI/SECRETIONS IN AIRWAY
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RHONCHIAL FREMITUS
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NORMAL AIR FILLED LUNGS.
THIS GIVES A HOLLOW SOUND |
RESONANCE
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AREAS OVER THE STERNUM, MUSCLE OF AREAS OF ATELECTASIS GIVE A FULL SOUND.
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FLATNESS
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AREAS OVER FLUID FILLED ORGANS SUCH AS THE HEART OR LIVER.
PNEUMONIA AND PLEURAL EFFUSION WILL GIVE THIS THUDDING SOUND. |
DULLNESS
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AREA OVER AIR-FILLED STOMACH.
THIS IS A DRUM-LIKE SOUND AND WHEN HEARD OVER THE LUNGS INDICATES INCREASED VOLUME. |
TYMPANY
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FOUND IN AREAS OF THE LUNG WHERE PNEUMOTHORAX OR EMPHYSEMA ARE PRESENT.
THIS IS A BOOMING SOUND |
HYPERRESONANCE
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DIAPHRAGMATIC EXCURSION IS MEASURED...
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3 TO 5 CM
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NORMAL BREATH SOUNDS
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VESICULAR
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NORMAL SOUNDS IN BOTH LUNGS
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BILATERAL VESICULAR SOUNDS
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NORMAL SOUNDS OVER THE TRACHEA OR BRONCHI.
THESE BREATH SOUNDS OVER THE LUNG PERIPHERY WOULD INDICATE LUNG CONSOLIDATION |
BRONCHIAL BREATH SOUNDS
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THE PT. IS INSTRUCTED TO SAY "E" AND IT SOUNDS LIKE AN "A".
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EGOPHONY
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EGOPHONY WOULD INDICATE...
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CONSOLIDATION OF THE LUNG TISSUE AS WITH A PNEUMONIA LIKE CONDITION.
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ARE TERMS THAT INDICATE INCREASED INTENSITY OR TRANSMISSION OF THE SPOKEN VOICE AND INDICATE CONSOLIDATION AND PNEUMONIA.
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BRONCHOPHONY AND WHISPERED PECTORILOQUY
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FLATNESS WOULD INDICATE...
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ATELECTASIS
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DULLNESS WOULD INDICATE...
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PNEUMONIA AND PLEURAL EFFUSION
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BRONCHOPHONY AND WHISPERED PECTORILOQUY WOULD INDICATE...
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CONSOLIDATION AND PNEUMONIA
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TYMPANY WOULD INDICATE...
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INCREASED VOLUME IN THE LUNGS
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HYPERRESONANCE WOULD INDICATE...
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PNEUMOTHORAX OR EMPHYSEMA ARE PRESENT
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ANY INCREASE ABNORMALITY IN THE SPOKEN VOICE INDICATES...
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CONSOLIDATION
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ANY DECREASE ABNORMALITY IN THE SPOKEN VOICE WOULD INDICATE...
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OBSTRUCTED BRONCHI
PNEUMOTHORAX EMPHYSEMA |
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ABNORAL BREATH SOUNDS
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ADVENTITIOUS
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ANOTHER TERM FOR CRACKLES
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RALES
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ANOTHER TERM FOR RALES
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CRACKLES
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ANOTHER TERM FOR RONCHI
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COARSE RALES
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ANOTHER TERM FOR COARSE RALES
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RONCHI
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RALES/CRACKLES ARE HEARD DUE TO
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SECRETION/FLUID
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LARGE AIR WAY SECRETION
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COARSE RALES/RONCHI
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MIDDLE AIR WAY SECRETION
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MEDIUM RALES
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IF A PT HAS COARSE RALES/RONCHI WHAT SHOULD YOU DO?
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PATIENT NEEDS SUCTIONING
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IF A PT HAS MEDIUM RALES WHAT SHOULD YOU DO?
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PT NEEDS CPT
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FINE RALES IS ALSO CALLED
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MOIST CREPITANT RALES
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FINE RALES WOULD INDICATE...
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FLUID IN THE ALVEOLI
THEREFORE PT. HAS CHF/PULMONARY EDEMA |
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TX FOR PT. WITH FINE RALES
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PT. NEEDS IPPB
HEART DRUGS DIURETICS O2 |
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WHEEZE IS DUE TO
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BRONCHOSPASM
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TX FOR WHEEZE
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BRONCHODILATOR
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TX FOR BRONCHOSPASM
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BRONCHODILATOR
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A UNILATERAL WHEEZE WOULD INDICATE...
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FOREIGN BODY OBSTRUCTION
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STRIDOR IS DUE TO....
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UPPER AIRWAY OBSTRUCTION
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UPPER AIRWAY OBSTRUCTION IS CAUSED BY...
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1. SUPRAGLOTTIC SWELLING (EPIGLOTTITIS)
2. SUBGLOTTIC SWELLING (CROUP, POST EXTUBATION) 3. FOREIGN BODY ASPIRATION(SOLIDS OR FLUIDS) |
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SUPRAGLOTTIC SWELLING IS CAUSED BY...
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EPIGLOTTITIS
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SUBGLOTTIC SWELLING IS CAUSED BY...
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CROUP
POST EXTUBATION |
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FOREIGN BODY ASPIRATION IS CAUSED BY...
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SOLIDS OR FLUIDS
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SPECIFIC TX FOR STRIDOR
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1. TOPICAL DECONGESTANT (RACEMIC EPINEPHRINE) FOR SWELLING AND EDEMA.
2. SUCTIONING AND/OR BRONCHOSCOPY FOR SECRETIONS AND FOREIGN BODY ASPIRATION. 3. INTUBATION FOR SEVERE SWELLING AND EPIGLOTTITIS. |
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A COURSE GRATING OR CRUNCHING SOUND
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PLEURAL FRICTION RUB
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PLEURAL FRICTION RUB IS DUE TO....
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INFLAMED SURFACE OF THE VISCERAL AND PARIETAL PLEURA RUBBING TOGETHER
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PLEURAL FRICTION RUB MAY BE ASSOCIATED WITH
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PLEURISY
TB PNEUMONIA PULMONARY INFRACTION CANCER |
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DRUGS USED FOR PLEURAL FRICTION RUB
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STEROIS
ANTIBIOTICS |
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SOUNDS CREATED BY THE CLOSURE OF THE HEART VALVES
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HEART SOUNDS
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IS HEARD BY THE CLOSURE OF THE MITRAL AND TRICUSPID VALVES DURING CONTRACTION OF THE VENTRICLES.
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FIRST SOUND(S1)
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OCCURS WHEN SYSTOLE ENDS, THE VENTRICLES RELAX AND THE PULMONIC AND AORTIC VALVES CLOSE
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SECOND SOUND (S2)
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IS HEARD DURING EARLY DIASTOLE AND IS PRODUCED BY RAPID VENTRICULAR FILLING IMMEDIATELY AFTER SYSTOLE.
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THIRD SOUND (S3)
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S3 SOUND IS NORMAL IN
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YOUNG HEALTHY CHILDREN ONLY
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S3 SOUND IS ABNORMAL IN
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ADULTS
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OCCURS LATE IN DIASTOLE AND IS PRODUCED BY ACTIVE FILLING OF THE VENTRICLES
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FOURTH SOUND (S4)
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FOURTH SOUND (S4) MAY OCCUR IN
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NORMAL INDIVIDUALS OR CAN BE CONSIDERED A SIGN OF HEART DISEASE
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OCCURS WHENEVER THE HEART VALVES ARE STENOTIC OR INCOMPETENT
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MURMURS
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MURMURS ARE USUALLY CLASSIFIED AS
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SYSTOLIC OR DIASTOLIC
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AN INCOMPETENT ATRIOVENTRICULAR VALVE OR STENOTIC SEMILUNAR VALVE WOULD CAUSE...
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SYSTOLIC MURMURS
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AN INCOMPETENT SEMILUNAR VALVE OR A STENOTIC ATRIOVENTRICULAR VALVE WOULD CAUSE...
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DIASTOLIC MURMURS
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A SOUND HEARD ON AUSCULTATION CAUSED BY TURBULENT BLOOD FLOW.
SIMILAR TO A MURMUR |
BRUITS
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NORMAL BP
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120/80
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INCREASED BP INDICATES
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CARDIAC STRESS-HYPOXEMIA
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DECREASED BP INDICATES
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POOR PERFUSION-SHOCK
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PROPER ETT PLACEMENT
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THE TIP OF THE ETT SHOULD BE POSITIONED BELOW THE VOCAL CORDS AND NO CLOSER THAN 2CM ABOVE THE CARINA, APPROXIMATELY AT THE SAME LEVEL OF THE AORTIC KNOB OR AORTIC ARCH; THIS WILL ENSURE BILATERAL VENTILATION (CLAVICLE IS TOO HIGH)
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WILL QUICKLY DETERMINE ADEQUATE VENTILATION BEFORE CXR IS DONE
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OBSERVATION AND AUSCULTATION
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SEEN AS A DARK AREA MIDLINE ON CXR
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TRACHEA
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TRACHEA SHOULD BE THE SAME SIZE AS THE_____ON CXR
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VERTEBRAL COLUMN
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IF NARROWING OF THE MAJOR BRONCHI AT THE CARINA OR AT THE DISTAL END MAY INDICATE
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BRONCHOGENIC CARCINOMA
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THE AREA BETWEEN THE LUNGS WHERE THE HEART, LYPHATICS, BLOOD VESSELS AND MAJOR BRONCHI ARE FOUND
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MEDIASTINUM
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MEDIASTINUM MAY SHIFT IN PT'S WITH.....
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PLEURAL EFFUSION OR
PNEUMOTHORAX |
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A-P DIAMETER IS INCREASED IN PT'S WITH......
|
COPD
BARREL CHEST HYPERINFLATION |
|
|
ANGLE MADE BY THE OUTER CURVE OF THE DIAPHRAGM AND THE CHEST WALL
|
COSTOPHRENIC ANGLES
|
|
|
COSTOPHRENIC ANGLES ARE OBLITERATED BY
|
PLEURAL EFFUSIONS
|
|
|
DOME SHAPED NORMALLY
|
DIAPHRAGM
|
|
|
DIAPHRAGM IS FLATTENED WITH...
|
COPD
|
|
|
LEFT OR RIGHT HEMIDIAPHRAGMS MAY SHIFT DOWNWARD WITH; APPEARING FLATTENED ON ONE SIDE
|
LEFT OR RIGHT PNEUMOTHORAX
|
|
|
VASCULAR MARKINGS ON CXR WOULD SHOW
|
BLOOD VESSELS
LYMPHATICS LUNG TISSUE |
|
|
LEFT VENTRICLE NORMALLY SEEN
|
HEART SHADOW
|
|
|
ENLARGED HEART
|
CARDIOMEGALY
|
|
|
CARDIOMEGALY IS SEEN IN PT'S WITH
|
COPD
|
|
|
TISSUE SURROUNDING THE CHEST AND ABOVE IN THE NECK AREA
|
SOFT TISSUE
|
|
|
WHEN AIR (HYPERLUCENCY) IS SEEN IN THE SURROUNDING SOFT TISSUE ON CXR. THIS INDICATES
|
SUBCUTANEOUS EMPHYSEMA
|
|
|
CXR FILM BEHIND BACK
USED WITH BEDRIDDEN PT'S |
AP POSITION
|
|
|
FILM TOUCHING THE CHEST WITH BACK TO X-RAYS
USED WITH NORMAL PT'S |
PA POSITION
|
|
|
PROJECTION FROM EITHER THE RIGHT OR LEFT SIDE
ADDS A 3RD DIMENSION TO STRUCTURES VIEWED ON AP OR PA FILMS |
LATERAL POSITION
|
|
|
LATERAL NECK XRAY IS DONE TO DETERMINE
|
EPIGLOTTITIS-SWOLLEN EPIGLOTTIS (SUPRAGLOTIC)
CROUP-SUBGLOTTIC EDEMA FOREIGN BODIES-PRESENCE OR POSITION |
|
|
SLANTING OR DIAGONAL VIEW
AID IN LOCALIZING LESIONS |
OBLIQUE POSITION
|
|
|
PT LYING ON THE AFFECTED SIDE
VALUABLE FOR DETECTING SMALL PLEURAL EFFUSIONS |
LATERAL DECUBITUS
|
|
|
PROJECTION OF THE LUNG APICES
|
APICAL LORDOTIC
|
|
|
1. BOTH HEMIDIAPHRAGMS ARE ROUNDED(DOME-SHAPED)
2. THE RIGHT HEMIDIAPHRAGM IS SLIGHTLY HIGHER THAN THE LEFT 3. THE RIGHT HEMIDIAPHRAGM IS AT THE LEVEL OF THE SIXTH ANTERIOR RIB 4. TRACHEA IS MIDLINE, BILATERAL RADIOLUCENCY, WITH SHARP COSTROPHENIC ANGLES |
NORMAL CXR
|
|
|
CHEST TUBES SHOULD BE LOCATED IN
|
THE PLEURAL SPACE SURROUNDING THE LUNG
|
|
|
NASOGASTRIC TUBES AND FEEDING TUBES SHOULD BE POSITIONED IN
|
THE STOMACH AND SMALL BOWEL BELOW THE DIAPHRAGM
|
|
|
PULMONARY ARTERY CATHETERS SHOULD APPEAR IN THE
|
RIGHT LOWER LUNG FIELD
|
|
|
PACEMAKER SHOULD BE NORMALLY POSITIONED IN THE
|
RIGHT VENTRICLE
|
|
|
CENTRAL VENOUS CATHETERS ARE PLACED IN THE
|
RIGHT OR LEFT SUBCLAVIAN OR JUGULAR VEIN AND SHOULD REST IN THE VENA CAVA OR RIGHT ATRIUM OF THE HEART
|
|
|
DARK PATTERN(AIR) ON CXR
NORMAL FOR LUNGS |
RADIOLUCENT
|
|
|
WHITE PATTERN (SOLID OR FLUID)ON CXR
NORMAL FOR BONES AND ORGANS |
RADIODENSE
|
|
|
ANY ILL DEFINED RADIODENSITY
|
INFILTRATE
|
|
|
INFILTRATES ON CXR INDICATES
|
ATELECTASIS
|
|
|
SOLID WHITE AREA ON CXR
|
CONSOLIDATION
|
|
|
CONSOLIDATION ON CXR INDICATES
|
PNEUMONIA
PLERAL EFFUSION |
|
|
EXTRA PULMONARY AIR ON CXR
|
HYPERLUCENCY
|
|
|
HYPERLUCENCY ON CXR INDICATES
|
COPD
ASTHMA ATTACK PNEUMOTHORAX |
|
|
LYMPHATICS, VESSELS, LUNG TISSUES ON CXR
|
VASCULAR MARKINGS
|
|
|
VASCULAR MARKINGS ARE INCREASED IN
|
CHF
|
|
|
VASCULAR MARKINGS ARE ABSENT IN
|
PNEUMOTHORAX
|
|
|
SPREAD THROUGOUT ON CXR
|
DIFFUSE
|
|
|
DIFFUSE ON CXR INDICATES
|
ATELECTASIS
PNEUMONIA |
|
|
FLUID OR SOLID ON CXR
|
OPAQUE
|
|
|
OPAQUE ON CXR INDICATES
|
CONSOLIDATION
|
|
|
ON BOTH SIDES
|
BILATERAL
|
|
|
ON ONE SIDE
|
UNILATERAL
|
|
|
FLUFFY INFILTRATES (DIFFUSE WHITENESS) ON CXR INDICATES
|
PULMONARY EDEMA
|
|
|
BUTTERFLY/BATWING PATTERN (INFILTRATE IN SHAPE OF BUTTERFLY) ON CXR INDICATES
|
PULMONARY EDEMA
|
|
|
PATCHY INFILTRATES (SCATTERED DENSITIES) ON CXR INDICATES
|
ATELECTASIS
|
|
|
PLATELIKE INFILTRATES (THIN LAYERED DENSITIES) ON CXR INDICATES
|
ATELECTASIS
|
|
|
GROUND GLASS APPEARANCE (RETICULOGRANULAR) ON CXR INDICATES
|
ARDS/IRDS
|
|
|
HONEYCOMB PATTERN (RETICULOGRANULAR) ON CXR INDICATES
|
ARDS/IRDS
|
|
|
AIR BRONCHOGRAM ON CXR INDICATES
|
PNEUMONIA
EDEMA |
|
|
PERIPHERAL WEDGE-SHAPED INFILTRATE
|
PULMONARY EMBOLUS
INFARCTION |
|
|
CONCAVE SUPERIOR INTERFACE/BORDER
|
PLEURAL EFFUSION
|
|
|
BASILAR INFILTRATES WITH MENISCUS
|
PLEURAL EFFUSION
|
|
|
INJECTION OF RADIO-OPAQUE CONTRAST MEDIUM INTO THE TRACHEOBRONCHIAL TREE
|
BRONCHOGRAPHY (BRONCHOGRAMS)
|
|
|
MULTIFOCAL PVC
|
MULTIFOCAL
|
|
|
MAIN INDICATION OF BRONCHOGRAPHY(BRONCHOGRAMS)
|
BY OUTLINING THE AIRWAYS IT WILL ALLOW SYUDY OF BRONCHIECTASIS(MAIN)/OBSTRUCTING LESIONS(2ND)
|
|
|
IDENTIFIES THE LOCATION OF INVOLVED AREAS THAT WILL ALLOW BETTER ADMINISTRATION OF POSTURAL DRAINAGE IN BRONCHIECTASIS
|
BRONCHOGRAM
|
|
|
HAZARDS OF BRONCHOGRAMS
|
ALLERGIC REACTION AND IMPAIRMENT OF RESPIRATORY STATE
|
|
|
A. RADIOISOTOPES XENON GAS IS INHALED AND THE LOCATION OF THE GAS IS RECORDED PRODUCING A PHOTGRAPHIC PATTERN OF DISTRIBUTION T/O LUNGS
B. ANY OBSTRUCTION TO AIRFLOW WILL ALLOW LITTLE GAS TO ENTER THAT AREA |
VENTILATION SCANS
|
|
|
ALBUMIN, TAGGED WITH RADIOACTIVE IODINE IS INJECTED INTO A PERIPHERAL VEIN AND WHEN IT PASSES INTO THE PULMONARY CIRCULATION, THEY IMPACT ON THE CAPILLARIES
B. A SCANNING DEVICE IS PASSED OVER THE CHEST AND PRODUCES A PATTERN OF RADIATION THAT INDICATES THE DISTRIBUTION AND VOLUME OF PERFUSION |
PERFUSION SCANS
|
|
|
NORMAL VENTILATION SCAN BUT ABNORMAL PERFUSION SCAN INDICATES
|
PULMONARY EMBOLI
|
|
|
MRI
|
MAGNETIC RESONANCE IMAGING
|
|
|
MRI IS USEFUL FOR DETERMINING WHAT?
|
THORACIC ANEURYSMS
CONGENITAL ANOMALIES OF THE AORTA MAJOR THORACIC VESSELS ESPECIALLY IN THE HILAR AREA |
|
|
MRI HAS THE ABILITY TO?
|
1. DETERMINE THE PRECISE POSITION OF TUMORS AND
2. THE INVOLVEMENT OF SURROUNDING STRUCTURES |
|
|
WHAT TYPES OF VENTILATOR SHOULD WE USE ON A VENT PT REQUIRING AN MRI DONE?
|
1. FLUIDIC (NON-ELECTRIC, GAS POWERED) VENTILATORS IS USED BECAUSE THE MAGNETIC FIELDS WOULD DISRUPT ELECTRONIC DEVICES.
2. MANUAL VENTILATORS-SHOULD HAVE DETACHABLE NON-REBREATHING VALVES MADE OF NON-FERROUS(NON-METALLIC) MATERIALS. |
|
|
PROVIDES A CROSS SECTIONAL VIEW (SLICES) OF BODY STRUCTURES AT MULTIPLE LEVELS
|
COMPUTERIZED TOMOGRAPHY
|
|
|
CT
|
COMPUTERIZED TOMOGRAPHY
|
|
|
CT SCAN IS USEFUL IN DETECTING THE PRESENCE OF WHAT?
|
MEDIASTINAL MASS
PLEURAL MASS PARENCHYMAL MASS PULMONARY NODULES LESIONS THAT CANNOT BE VISUALIZED ON A CXR |
|
|
RADIOGRAPHIC EXAMINATION OF THE ESOPHAGUS BY INJECTING CONTRAST OF BARIUM SULFATE
|
BARIUM SWALLOW
|
|
|
BARIUM SWALLOW IS INDICATED FOR DIAGNOSING WHAT?
|
ESOPHAGEAL VARICES
|
|
|
CBC
|
COMPLETE BLOOD COUNT
|
|
|
MEASUREMENT OF ALL MAJOR INGREDIENTS OF THE BLOOD
|
CBC
|
|
|
RBC
|
RED BLOOD CELLS
|
|
|
CARRIES THE HG/O2
|
RBC
|
|
|
RBC NORMAL VALUE
|
4-6 MILL/CU MM
|
|
|
RBC ARE INCREASED(POLYCYTHEMIA) IN PT'S WITH
|
CHRONIC TISSUE HYPOXEMIA (COPD)
|
|
|
HIGH RBC IS CALLED
|
POLYCYTHEMIA
|
|
|
LOW RBC (ANEMIA)OCCURS IN PT'S WITH
|
BLOOD LOSS
HEMORRHAGE |
|
|
LOW RBC IS CALLED
|
ANEMIA
|
|
|
CARRIES O2 (1.34 ML/GRAM Hb)
|
HEMOGLOBIN
|
|
|
Hb
|
HEMOGLOBIN
|
|
|
NORMAL VALUE OF Hb
|
12-16 gm/100 mL blood (gm/dl)
|
|
|
LOW Hb RESULTS IN?
|
ANEMIA
|
|
|
HIGH Hb RESULTS IN?
|
POLYCYTHEMIA
|
|
|
Hct
|
HEMATOCRIT
|
|
|
HOW TO MEASURE Hct
|
SPIN THE WHOLE BLOOD AND MEASURE THE % OF RBC TO THE ORIGINAL BLOOD VOLUME
|
|
|
NORMAL VALUE OF Hct
|
40-50%
|
|
|
LOW Hct RESULTS IN
|
ANEMIA
|
|
|
HIGH Hct RESULTS IN
|
POLYCYTHEMIA
|
|
|
WBC
|
WHITE BLOOD CELLS
|
|
|
ARE USED BY THE BODY TO FIGHT BACTERIAL INFECTIONS
|
WBC
|
|
|
NORMAL VALUE OF WBC
|
5,000-10,000 PER CU MM
|
|
|
INCREASED WBC IS CALLED
|
LEUKOCYTOSIS
|
|
|
DECREASED WBC IS CALLED
|
LEUKOPENIA
|
|
|
INCREASED WBC IS DUE TO
|
BACTERIAL INFECTION
|
|
|
DECREASED WBC IS DUE TO
|
VIRAL INFECTION
|
|
|
TYPES OF WBC'S
|
1. NEUTROPHILS
2. EOSINOPHILS 3. MONOCYTES 4. LYMPHOCYTES 5. BASOPHILS |
|
|
MAJOR WBC'S
|
NEUTROPHILS
|
|
|
IMMATURE CELLS NORMALLY 4% OF WBC'S
|
BANDS
|
|
|
MATURE CELLS NORMALLY 60% OF WBC'S
|
SEGS
|
|
|
WHEN BANDS(PART OF WBC) NORMALLY 4% OF WBC'S INCREASED THIS IS DUE TO
|
BACTERIAL INFECTIONS
|
|
|
WHEN SEGS (PART OF WBC) NORMALLY 60% OF WBC'S DECREASED THIS IS DUE TO
|
BACTERIAL INFECTIONS
|
|
|
ASSOCIATED WITH ASTHMA 2% OF WBC'S INCREASED WITH ALLERGIC REACTIONS(PRODUCE A "YELLOW" SPUTUM)
|
EOSINOPHILS
|
|
|
ASSOCIATED WITH TB 3% OF WBC'S
|
MONOCYTES
|
|
|
30% OF WBC'S
|
LYMPHOCYTES
|
|
|
1% OF WBC'S
|
BASOPHILS
|
|
|
ELECTROLYTES
|
K+
Na+ Cl- HCO3-(CO2 content) |
|
|
ELEMENTS REQUIRED BY THE BODY FOR NORMAL METABOLISM
|
ELECTROLYTES
|
|
|
ABNORMAL ELECTROLYTE LEVELS INDICATE
|
ABNORMAL BODY FUNCTION
|
|
|
ELECTROLYTES ARE CLOSELY ASSOCIATED WITH
|
FLUID LEVELS
KIDNEY FUNCTION |
|
|
ELECTROLYTE IMBALANCE ARE ASSOCIATED WITH
|
1. MUSCLE WEAKNESS
2. SORENESS 3. NAUSEA 4. MENTAL CHANGES (I.E. LETHARGY, DIZZINESS, AND DROWSINESS) |
|
|
K+
|
POTASSIUM
|
|
|
MAJOR INTRACELLULAR CATION
|
K+
|
|
|
K+ IS IMPORTANT FOR
|
ACID-BASE BALANCE
|
|
|
NORMAL K+ VALUE
|
4.0 mEq/L (305-5.0 range)
|
|
|
low k+ will result in
|
hypokalemia
metabolic alkalosis excessive excretion renal loss vomitting flattened T waves on EKG |
|
|
high k+ will result in
|
hyperkalemia
kidney failure spiked T wave metabolic acidosis |
|
|
low k+ IS CALLED
|
hypokalemia
|
|
|
high k+ IS CALLED
|
hyperkalemia
|
|
|
Na+
|
SODIUM
|
|
|
MAJOR EXTRACELLULAR CATION CONTROLLED BY KIDNEYS
|
Na+
|
|
|
NORMAL Na+ VALUE
|
140 mEq/L (135-145 range)
|
|
|
LOW Na+ IS CALLED
|
HYPONATREMIA
|
|
|
HIGH Na+ IS CALLED
|
HYPERNATREMIA
|
|
|
LOW Na+ FLUID LOSS FROM
|
DIURETICS
VOMITTING DIARRHEA |
|
|
LOW Na+ FLUID GAIN FROM
|
CHF
IV THERAPY |
|
|
HIGH Na+ RESULTS IN
|
DEHYDRATION
|
|
|
Na+ IS RETAINED IN EXCHANG FOR
|
K+
|
|
|
Cl-
|
CHLORIDE
|
|
|
MAJOR EXTRACELLULAR ANION
|
Cl-
|
|
|
Cl- LEVELS ARE CLOSELY ASSOCIATED WITH
|
Na+
|
|
|
NORMAL Cl- VALUE
|
90 mEq/L (85-100 range)
|
|
|
LOW Cl- IS CALLED
|
HYPOCHLOREMIA
|
|
|
HIGH Cl- IS CALLED
|
HYPERCHLOREMIA
|
|
|
LOW Cl- RESULTS TO
|
METABOLIC ALKALOSIS
|
|
|
HIGH Cl- RESULTS TO
|
METABOLIC ACIDOSIS
|
|
|
HCO3
|
BICARBONATE (TOTAL CO2 CONTENT)
|
|
|
MOST OF THE CO2 IN THE BLOOD IS CARRIED AS
|
HCO3
|
|
|
TOTAL CO2 CONTENT REFLECT CHANGES IN
|
BLOOD BASE
*INC CO2 CONTENT=INC HCO3=METABOLIC ALKOLOSIS *DEC CO2 CONTENT=DEC HCO3=METABOLIC ACIDOSIS THIS IS OPPOSITE OF PCO2 CHANGES INC PCO2=RESP ACIDOSIS DEC PCO2=RESP ALKALOSIS |
|
|
EXCRETED BY KIDNEYS
|
CREATININE
|
|
|
CREATININE EVALUATES
|
KIDNEY FUNCTION
|
|
|
NORMAL VALUE FOR CREATININE
|
0.7-1.3 MG/DL
|
|
|
CREATININE IS MORE SPECIFIC FOR_______THAN THE____.
|
KIDNEY FAILURE
BUN |
|
|
BUN
|
BLOOD UREA NITROGEN
|
|
|
BUN EVALUATES
|
KIDNEY FUNCTION
|
|
|
BUN NORMAL VALUE
|
8-25 MG/DL
|
|
|
INCREASED BUN INDICATES
|
KIDNEY FAILURE
|
|
|
NORMAL SPUTUM COLOR
|
CLEAR
|
|
|
MUCOID(WHITE/GRAY) SPUTUM INDICATES
|
CHRONIC BRONCHITIS
|
|
|
YELLOW SPUTUM INDICATES
|
PRESENCE OF WBC'S
BACTERIAL INFECTION |
|
|
GREEN SPUTUM INDICATES
|
STAGNANT SPUTUM
GRAM NEGATIVE BACTERIA(BRONCHIECTASIS) |
|
|
BROWN/DARK SPUTUM INDICATES
|
OLD BLOOD
|
|
|
BRIGHT RED SPUTUM INDICATES
|
HEMOPTYSIS(BLEEDING TUMOR, TB)
|
|
|
PINK FROTHY SPUTUM INDICATES
|
PULMONARY EDEMA
|
|
|
TEST DONE TO IDENTIFY THE BACTERIA PRESENT
|
SPUTUM CULTURE
|
|
|
TEST DONE TO IDENTIFY WHAT DRUGS WILL KILL BACTERIA
|
SENSITIVITY TEST
|
|
|
TEST DONE TO IDENTIFY WHETHER IT IS GRAM POSITIVE OR GRAM NEGATIVE
|
GRAM STAIN
|
|
|
ACID FAST STAIN IS DONE TO IDENTIFY
|
MYCOBACTERIUM TB
|
|
|
APTT
|
ACTIVATED PARTIAL THROMBOPLASTIN TIME
|
|
|
MEASURES THE LENGTH OF TIME REQUIRED FOR PLASMA TO FORM A FIBRIN CLOT
|
APTT
|
|
|
APTT NORMAL VALUE
|
24-32 SECONDS
|
|
|
APTT IS USED FOR MONITORING
|
HEPARIN THERAPY
|
|
|
PT
|
PROTHROMBIN TIME
|
|
|
SIMILAR TO APTT/MEASURES THE LENGTH OF TIME REQUIRED FOR PLASMA TO FORM A FIBRIN CLOT
|
PT
|
|
|
PROTHROMBIN TIME IS USED TO MONITOR
|
WARFARIN (COUMADIN) THERAPY
|
|
|
PROTHROMBIN TIME NORMAL VALUE
|
12-15 SECONDS
|
|
|
REFLECTS METABOLIC STATUS OF PT.
|
URINALYSIS
|
|
|
URINALYSIS IS A SCREENING TEST FOR
|
KIDNEY DISEASE
|
|
|
URINALYSIS CAN INDICATE_____BEFORE BLOOD CULTURE RESULTS.
|
URINARY TRACT INFECTIONS
|
|
|
URINALYSIS ALSO MEASURES
|
APPEARANCE
SPECIFIC GRAVITY pH GLUCOSE KETONES BLOOD BILIRUBIN SEDIMENTATION |
|
|
HEMODYNAMICS IS SIMPLY THE MONITORING OF
|
BLOOD PRESSURES
|
|
|
BLOOD MOVEMENT(CIRCULATION/PERFUSION) OCCURS BECAUSE OF
|
BLOOD PRESSURES
|
|
|
HEMO MEANS
|
BLOOD
|
|
|
DYNAMIC MEANS
|
MOVEMENT
|
|
|
REFERS TO THE TWO LIFE FUNCTIONS CIRCULATION AND PERFUSION
|
HEMODYNAMICS
|
|
|
WITHOUT SUFFICIENT BP THE TISSUE WILL
|
NOT RECEIVE THE O2 AND NUTRIENTS IT NEEDS TO SURVIVE
|
|
|
WHAT WOULD HIGH BP DO TO THE HEART?
|
STRAIN THE HEART AND EVENTUALLY CAUSE HEART FAILURE
|
|
|
IS THE PUMP THAT CREATES THE BP
|
HEART
|
|
|
CHANGES IN THE HEART WILL EFFECT THE
|
BP DIRECTLY
|
|
|
INCREASE IN THE HR/STRENGTH
WILL INCREASE THE |
BP
|
|
|
DECREASE IN THE HR/STRENGTH
WILL DECREASE THE |
BP
|
|
|
THE AMOUNT OF FLUID(BLOOD) IN THE CIRCULATORY SYSTEM WILL EFFECT THE
|
BP
|
|
|
EXCESSIVE FLUIDS(BLOOD) WILL RESULT IN
|
INCREASE PRESSURES
|
|
|
LOSS OF FLUIDS(BLOOD)WILL RESULT IN
|
DECREASE PRESSURES
|
|
|
THE CONDITION OF THE BLOOD VESSELS WILL CAUSE
|
THE BP TO CHANGE
|
|
|
VESSEL CONSTRICTION WILL RESULT IN
|
INCREASE PRESSURES
|
|
|
VESSEL DILATION WILL RESULT IN
|
DECREASE PRESSURES
|
|
|
SYSTEMIC ARTERIAL SYSTEM
MEAN AIRWAY PRESSURE(MAP) NORMAL VALUE |
90 mmHg (80-100)
|
|
|
SYSTEMIC VENOUS SYSTEM
CENTRAL VENOUS PRESSURE(CVP) NORMAL VALUE |
1-6 mmHg
|
|
|
PULMONARY ARTERIAL SYSTEM
PULMONARY ARTERY PRESSURE(PAP) NORMAL VALUE |
SYSTOLIC 18-30 mmHg
DIASTOLIC 6-15 mmHg |
|
|
MEAN PULMONARY ARTERY PRESSURE
NORMAL VALUE |
10-20 mmHg
|
|
|
FORMULA FOR MEAN PULMONARY ARTERY PRESSURE
|
PAP SYSTOLIC + (2 X PAP DIASTOLIC)/3
|
|
|
PULMONARY VENOUS SYSTEM
PULMONARY(CAPILLARY) WEDGE PRESSURE(PWP) NORMAL VALUE |
4-12 mmHg
|
|
|
ESTIMATES LEFT VENTRICLE FILLING AND PRELOAD
EQUAL TO LEFT ATRIAL PRESSURES |
PCWP
|
|
|
IF PCWP IS ELEVATED THIS INDICATES
|
LEFT HEART FAILURE
|
|
|
MEAN RIGHT ATRIAL PRESSURE
ESTIMATES RIGHT VENTRICLE PRELOAD |
CVP
|
|
|
THE OUTPUT OF THE LEFT VENTRICLE IS MEASURED AND IS CALLED?
|
L/MIN
CARDIAC OUTPUT(QT) |
|
|
QT NORMAL VALUE
|
4-8 L/MIN
|
|
|
QT/BSA OF THE PT IS CALLED?
|
CARDIAC INDEX(CI)
|
|
|
NORMAL CI IS
|
2-4 L/min/m2
|
|
|
TYPE OF DISORDERS
CVP=uu PAP=N/d PCWP=N/d QT=N |
RIGHT HEART FAILURE
COR PULMONALE |
|
|
TYPE OF DISORDERS
CVP=u PAP=uu PCWP=N/d QT=N |
LUNG DISORDERS
PULMONARY EMBOLISM PULMONARY HYPERTENSION AIR EMBOLISM |
|
|
TYPES OF DISORDERS
CVP=N PAP=u PCWP=uu QT=d |
LEFT HEART FAILURE
MITRAL VALVE STENOSIS CHF/PULMONARY EDEMA HIGH PEEP EFFECTS |
|
|
TYPE OF DISORDERS
CVP=uu PAP=u PCWP=u QT=u |
HYPERVOLEMIA
|
|
|
TYPES OF DISORDERS
CVP=dd PAP=d PCWP=d QT=d |
HYPOVOLEMIA
|
|
|
PACEMAKER OF THE HEART
|
SA NODE
|
|
|
ELECTRICAL IMPULSES IS GENERATED BY THE
|
SA NODE
|
|
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1. THE ELECTRICAL IMPULSE IS GENERATED BY THE SA NODE
2. THE WAVE OF DEPOLARIZATION MOVES TROUGH THE ATRIA CAUSING CONTRACTION(P WAVE) 3. THE IMPULSE IS RECEIVED BY THE AV NODE WHERE IT IS DELAYED FOR A SHORT TIME. (P-R INTERVAL) 4. THE STIMULUS IS SENT THROUGH THE BUNDLE OF HIS AND THE LEFT AND RIGHT BUNDLE BRANCHES TO THE PURKINJE FIBERS. THIS PRODUCES VENTRICULAR DEPOLARIZATION AND CONTRACTION. (QRS COMPLEX) 5. AFTER A SHORT DELAY(S-T SEGMENT)THE HEART REPOLARIZES.(T WAVE) |
Electrophysiology of the Heart
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LIMB LEADS(ELECTRODES) ARE PLACED ON THE
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ARMS AND LEGS
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PRECORDIAL LEADS ARE PLACED...
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ON THE CHEST AROUND THE HEART
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THE ECG ADJUSTS WHAT?
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WHICH ELECTRODE WILL BE POSITIVE AND WHICH ONE WILL BE NEGATIVE
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AN UPWARD DEFLECTION IS MADE ON THE ECG PAPER WHEN...
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THE IMPULSE OF THE HEART MOVES TOWARD THE POSITIVE ELECTRODE
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A DOWNWARD DEFLECTION IS MADE ON THE ECG PAPER WHEN
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THE MOVEMENT OF THE IMPULSE IS AWAY FROM THE POSITIVE ELECTRODE
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HOW MANY LEADS ARE USED FOR EKG?
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12 LEADS
6(LIMB LEADS) 6(PRECORDIAL CHEST LEADS) |
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LT. ARM POSITIVE/RIGHT ARM NEGATIVE
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LEAD 1
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LT LEG POSITIVE/RT. ARM NEGATIVE
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LEAD 2
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LT. LEG POSITIVE/LT. ARM NEGATIVE
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LEAD 3
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RT. ARM POSITIVE/EVERYTHING ELSE NEGATIVE
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AVR
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LT. ARM POSITIVE/EVERYTHING ELSE NEGATIVE
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AVL
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LT.LEG(FOOT)POSITIVE/EVERYTHING ELSE NEGATIVE
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AVF
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IS THE ONLY LIMB LEAD THAT PRODUCES AN UPSIDE DOWN (NEG.)PATTERN
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AVR
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NORMAL ELECTRICAL IMPULSE MOVES
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DOWNWARD AND TOWARD THE LEFT THROUGH THE HEART
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AN INVERTED PATTERN WILL SHOW ON THE EKG IF
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ANY POSITIVE ELECTRODE IS PLACED ABOVE AND TO THE RIGHT OF THE HEART(AVR)
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ALL OF THESE LEADS ARE POSITIVE AND IS PLACED DIRECTLY OVER THE HEART IN SIX POSITIONS AROUND THE HEART
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CHEST LEADS
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PLACEMENT OF V1 CHEST LEAD
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4TH INTERCOSTAL SPACE ON RIGHT SIDE OF STERNUM
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PLACEMENT OF V2 CHEST LEAD
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4TH INTERCOSTAL SPACE ON LEFT SIDE OF STERNUM
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PLACEMENT OF V3 CHEST LEAD
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BETWEEN V2 AND V4 ON LEFT SIDE
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PLACEMENT OF V4 CHEST LEAD
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5TH INTERCOSTAL SPACE, LEFT MID-CLAVICULAR LINE
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PLACEMENT OF V5 CHEST LEAD
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BETWEEN V4 AND V6 ON THE LEFT SIDE
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PLACEMENT OF V6 CHEST LEAD
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5TH INTERCOSTAL SPACE, LEFT MID-AXILLARY LINE
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V1 AND V2 CHEST LEADS MONITORS
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THE RIGHT HEART
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V3 AND V4 CHEST LEADS MONITORS
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THE VENTRICULAR SEPTUM
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V5 AND V6 CHEST LEADS MONITORS
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THE LEFT HEART
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NORMAL HR
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60-100 BPM
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HR <60
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BRADYCARDIA
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HR >100
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TACHYCARDIA
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HR >200
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FLUTTER
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HR TOO FAST TO COUNT
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FIBRILLATION
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IF THE TWO R WAVES ARE BETWEEN 3 AND 5 LARGE BLOCKS
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THE HR IS NORMAL
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IF THE TWO R WAVES ARE CLOSER THAN 3 LARGE BLOCKS(15 SMALL SQUARES)
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THE HR IS >100(TACHYCARDIA)
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IF THE TWO R WAVES ARE WIDER THAN 5 LARGE BLOCKS(25 SMALL SQUARES)
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THE HR <60(BRADYCARDIA)
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FORMULA TO GET HR ON EKG
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HR=300/# OF LARGE BLOCKS BETWEEN R WAVES OR
=1500/# OF SMALL BLOCKS BETWEEN R WAVES EX. 300/4=75 1500/20=75 |
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NORMAL SINUS RHYTHM(NSR)
NORMAL RATE NO SKIPS NO EXTRA BEATS |
IDENTIFY STRIP
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SINUS TACHYCARDIA
SINUS RHTHM WITH RATE>100 GIVE O2 TREAT SYMPTOMS |
IDENTIFY STRIP AND TYPE OF TX THAT SHOULD BE GIVEN
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SINUS BRADYCARDIA
SINUS RHYTHM WITH RATE <60 GIVE 100% O2 ATROPINE |
IDENTIFY STRIP AND TYPE OF TX THAT SHOULD BE GIVEN
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PVC'S-PREMATURE VENTRICULAR CONTRACTIONS
GIVE 100% O2 LIDOCAINE |
IDENTIFY STRIP AND TX THAT SHOULD BE GIVEN
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V-TACH-VENTRICULAR TACHYCARDIA
VENTRICULAR RHYTHM WITH RATE >100 DEFIBRILLATE 200 JOULES(IF NO PULSE) |
IDENTIFY STRIP AND TX THAT SHOULD BE GIVEN
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V-FIB-VENTRICULAR FIBRILLATION
COMPLETELY IRREGULAR VENTRICULAR RHYTHM DEFIB@ 200 JOULES |
IDENTIFY AND TYPE OF TX THAT SHOULD BE GIVEN
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IF DEFIB DOES NOT CHANGE ARRHYTHMIA AFTER 3 COUNTER SHOCKS WHAT SHOULD YOU DO?
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ADMINISTER 1 MG OF EPINEPHRINE
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1ST DEGREE AV BLOCK
PR INTERVAL >.20 SEC, >200 MILLISECONDS OR 5mm(MEASURED FROM THE BEGINNING OF THE P WAVE TO THE BEGINNING OF THE QRS MAY BE CAUSED BY ISCHEMIA OR DIGITALIS (NOT AN EMERGENCY) TX GIVE/ATROPINE/ISUPREL |
IDENTIFY STRIP AND TYPE OF TX NEEDED
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1ST DEGREE AV BLOCK MAY BE CAUSED BY
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ISCHEMIA OR DIGITALIS (NOT AN EMERGENCY)
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IRREGULAR RHYTHM
NORMAL P WAVES BUT QRS COMPLEX IS MISSING |
2ND DEGREE AV BLOCK
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TX FOR 2ND DEGREE AV BLOCK(POTENTIAL EMERGENCY)
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ATROPINE
ISUPREL ELECTRICAL PACEMAKER |
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ATRIAL RATE >60
VENTRICULAR RATE <40/MIN PR INTERVAL CANNOT BE DETERMINED QRS COMPLEX WILL BE WIDENED (AN EMERGENCY, CIRCULATORY FAILURE) |
3RD DEGREE AV BLOCK
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TX FOR 3RD DEGREE AV BLOCK
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ELECTRICAL PACEMAKER
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MEASURES THE NET DIRECTION OF ALL THE ELECTRICITY THROUGH THE HEART DURING CONTRACTION
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THE AXIS OF AN ECG
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THE NORMAL AXIS IS IN A DIRECTION OF
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DOWN AND TO THE LEFT
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2 FACTORS THAT AFFECT THE DIRECTION OF THE AXIS
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HYPERTROPHY
INFARCTION |
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AXIS WILL SHIFT TOWARD IF PT HAS
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HYPERTROPHY
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AXIS WILL SHIFT AWAY IF PT HAS
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INFARCTION
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THIS DISORDER WILL INCREASE ELECTRICAL ACTIVITY TO THE RIGHT SIDE OF THE HEART
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RIGHT VENTRICULAR HYPERTROPHY FROM PULMONARY HYPERTENSION(COPD)
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THIS WOULD DECREASE THE ELECTRICAL ACTIVITY ON THE LEFT SIDE AND SHIFT THE AXIS TO THE RIGHT
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MYOCARDIAL INFARCTION(DEAD TISSUE)
MOST OFTEN OCCURS IN THE LEFT VENTRICLE |
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REDUCED BLOOD FLOW TO TISSUE
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ISCHEMIA
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ACUTE DAMAGE TO TISSUE(OFTEN FROM ISCHEMIA)
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INJURY
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NECROSIS OR DEATH OF TISSUE(END RESULT OF ISCHEMIA AND INJURY)MAY BE RECENT, ACUTE OR OLD
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INFARCTION
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DEPRESSED OR INVERTED T WAVE INDICATES
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ISCHEMIA
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ELEVATED S-T SEGMENT INDICATES
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INJURY
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DIAGNOSED BY SIGNIFICANT Q WAVES
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INARCTION
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Q WAVES ARE SIGNIFICANT IF IT IS
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1/2 THE HEIGHT OF THE R WAVE OR
1 SMALL SQUARE WIDE(0.04 MM) |
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ELEVATED OR SPIKED T WAVES ARE CAUSED BY
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HYPERKALEMIA
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NONINVASIVE METHOD FOR MONITORING CARDIAC PERFORMANCE. USES A DOPPLER FLOW MAPPING WITH TWO DIMENSIONAL AND M MODE ECHOCARDIOGRAPHY TO ASSESS OVERALL VENTRICULAR FUNCTION INCLUDING LEFT VENTRICULAR VOLUME AND EJECTION FRACTION
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ECHOCARDIOGRAPHY
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ELECTROCARDIOGRAPHY CAN ALSO BE USED TO
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EVALUATE CARDIAC ANOMALIES IN THE INFANT
TETRALOGY OF FALLOT COARCTATION OF THE AORTA TRANSPOSITION OF THE GREAT VESSELS ASD VSD PDA AND OTHERS |
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MOTHERS WITH_______ARE PRONE TO HAVE PROBLEMS WITH PREMATURE INFANTS
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DIABETES
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TIME SINCE THE ESTIMATED DATE OF CONCEPTION
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GESTATIONAL AGE
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FROM 38 TO 42 WEEKS GESTATIONAL AGE
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TERM INFANT
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ETT SIZE FOR A TERM INFANT
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3mm
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LESS THAN 38 WEEKS GESTATIONAL AGE
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PRETERM INFANT(PREMATUR)
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MORE THAN 42 WEEKS GESTATIONAL AGE
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POST TERM INFANT
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PROVIDES A CLNICAL METHOD FOR EVALUATING THE INFANT IMMEDIATELY AFTER BIRTH.
ALLOWS FOR A RAPID APPRAISAL OF AN INFANT IN DETERMINING THE NEED FOR RESUSCITATION |
APGAR SCORE
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APGAR SCORE IS ROUTINELY DONE AT
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1 AND 5 MINUTES
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APGAR SCORE DONE IN 1 MINUTE PREDICTS
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THE NEONATAL SURVIVAL
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APGAR SCORE DONE IN 5 MINUTES PREDICTS
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FUTURE NEUROLOGIC DAMAGE
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5 FACTORS ARE EVALUATED IN APGAR
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A-PPEARANCE/COLOR
P-ULSE/HR G-RIMACE/REFLEX IRRITABILITY A-CTIVITY/MUSCLE TONE R-ESPIRTORY EFFORT |
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APGAR SCORE OF 0-3 INDICATES
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RESUSCITATION
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APGAR SCORE OF 4-6 INDICATES
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SUPPORT-STIMULATE, WARM ADMINISTER 02
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APGAR SCORE OF 7-10 INDICATES
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MONITOR- ROUTINE CARE
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A BRIGHT FIBEROPTIC LIGHT IS PLACED AGAINST THE INFANTS CHEST IN A DARKENED ROOM.
NORMALLY A LIGHTED HALO IS SEEN AROUND THE POINT OF CONTACT |
TRANSILLUMINATION
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TRANSILLUMINATION WILL CAUSE THE ENTIRE HEMOTHORAX TO LIGHT UP DUE TO
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A PNEUMOTHORAX OR
PNEUMOMEDIASTINUM |
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TRANSILLUMINATION IS RECOMMENDED WHEN
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A PNEUMOTHORAX IS SUSPECTED
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INFANTS LOSE BODY HEAT VERY QUICKLY AND MAY NEED TO BE PLACED IN A WARM ENVIRONMENT TO MAINTAIN ADEQUATE BODY TEMPERATURE
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TEMP OF INFANT
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NORMAL TEMPERATURE FOR AN INFANT
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36.5 C
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Normal transillumination
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a lighted "halo" is seen around the point of contact
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What is the new ballard score used for?
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Estimates gestational age in very low birth weight infants
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What is the normal score?
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Normal score of 40 corresponds to 40 weeks
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A blood gas drawn from the right radial artery(pre-ductal) indicates a PaO2 of 90 mmhg, and a blood gas drawn from the umbilical artery(post-ductal)indicates a PaO2 of 60 mmHg. What does the difference in the PaO2 indicate?
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R-L shunting occurs across the ductus arteriosus.
*PaO2 differences greater than 15 mmHg indicates R-L shunting accross the ductus arteriosus. |
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What does L/S stand for?
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Lecithin/Sphingomyelin
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What is L/S ratio used as?
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Lung maturity information
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What does a 2:1 ratio or higher indicate?
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Good Lung maturity
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What does a ratio of less than 1:1 indicate?
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anything less than 2:1 is a high risk
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What is the most reliable indicator of pulmonary maturity even with diabetes?
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PG-Phosphatidylglycerol
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