Patient Assessment

Front 1

What are pack years?

Back 1

# of packs/day X # of years smoked

Front 2

What do you recommend for tobacco use?

Back 2

Nicotine replacement

Front 3

What is normal urine output?

Back 3

40 mL/hr

Front 4

What is CVP?

Back 4

Central venous pressure

Front 5

What is normal CVP?

Back 5

2-6 mm Hg

Front 6

What can decreased CVP indicate?

Back 6

Hypovolemia, recommend fluids

Front 7

What can increased CVP indicate?

Back 7

Hypervolemia, recommend diuretics

Front 8

Lethargic, somnolence, sleepy

Back 8

Consider sleep apnea or excessive O2 in COPD

Front 9

Stuporous, confused

Back 9

Responds inappropriately, drug OD, intoxication

Front 10

Semicomatose

Back 10

Responds only to painful stimuli

Front 11

Obtunded

Back 11

Drowsy state, may have decreased gag/ cough

Front 12

Coma

Back 12

Does not respond to painful stimuli

Front 13

Orthopnea

Back 13

Difficulty breathing except in upright position, CHF

Front 14

General malaise

Back 14

Run down, nausea, weakness, fatigue, headache. Think electrolyte imbalance

Front 15

Dyspnea Grade I

Back 15

After unusual exertion

Front 16

Dyspnea Grade II

Back 16

Breathless after going up hills or stairs

Front 17

Dyspnea Grade III

Back 17

Walking normal speed

Front 18

Dyspnea Grade IV

Back 18

Slowly walking short distances

Front 19

Dyspnea Grade V

Back 19

Rest, shaving, dressing, etc

Front 20

Venous distention (JVD)

Back 20

Occurs with CHF, seen during exhalation in pts with obstructive lung disease

Front 21

Asymmetrical movement indicates?

Back 21

Post lung resection/post-pneumonectomy, atelectasis, pneumothorax, flail chest, ett in R or L mainstem bronchi

Front 22

What causes retractions?

Back 22

Severe airway obstruction or respiratory distress

Front 23

Dry, non-productive cough

Back 23

May indicate tumor in the lungs

Front 24

Productive cough

Back 24

Indicate infection or chronic lung disease

Front 25

4 types of difficult airway

Back 25

Short receding mandible, enlarged tongue, bull neck, limited range of motion

Front 26

Change in heart rate of 20 or more

Back 26

Stop therapy, notify nurse/dr, and record event

Front 27

Paradoxical pulse/pulsus paradoxus

Back 27

Pulse/blood pressure varies with respiration. May indicate severe air trapping (status asthma, tension pneumothorax, cardiac tamponade)

Front 28

Trachea pulled to abnormal side

Back 28

Atelectasis, fibrosis, pneumonectomy, diaphragmatic paralysis

Front 29

Trachea pushed to normal side

Back 29

Pleural effusion, pneumothorax, neck or thyroid tumors, mediastinal mass

Front 30

Resonant

Back 30

Normal air-filled lung. Hollow sound

Front 31

Flat

Back 31

Heard over sternum, muscle, atelectasis

Front 32

Dull

Back 32

Heard over fluid-filled organs like heart or liver. Pleural effusion or pneumonia

Front 33

Tympanic

Back 33

Heard over air-filled stomach. Drum like and indicates increased volume when heard over lungs

Front 34

Hyperresonant

Back 34

Booming sound heard over pneumothorax or emphysema

Front 35

Diaphragmatic excursion

Back 35

Percussing at peak inspiration and peak exhalation

Front 36

Normal diaphragmatic excursion

Back 36

3 to 5 cm

Front 37

Normal breath sounds

Back 37

Vesicular

Front 38

Bronchial breath sounds

Back 38

Normal over trachea or bronchi, over lung indicates lung consolidation

Front 39

Abnormal breath sounds

Back 39

Adventitious

Front 40

Coarse crackles

Back 40

Large airway secretions, suction pt or advise to cough

Front 41

Medium crackles

Back 41

Middle airway secretions, move to big airway (bronchial hygiene)

Front 42

Fine crackles

Back 42

Alveoli, fluid. Associated with CHF/pulmonary edema

Front 43

What to do with fine crackles?

Back 43

O2, positive pressure therapy, positive inotropic agents, diuretics