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78 Cards in this Set

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Erythema
Redness of the skin. Maybe due to inflammation or infection
Cyanosis
Blue-gray discoloration of skin and mucous membranes.
Caused by increased amount of reduced hemoglobin. 5gms% of reduced hemoglobin
Chest Configuration
Normal
A-P diameter is less than transverse diameter
A-P diameter increases with age with COPD, barrel Chest
Spinal deformities
Pectus Carinatum
Sternal protusion
Spinal deformities
Pectus Excavatum
Sternal depression
Spinal deformities
Kyphosis
A-P Curvature
Spinal deformities
Scolisis
lateral curvature
Spinal deformities
Kyphoscoliosis
both lateral and A-P curvature
Barrel Chest
A result of air trapping in the lungs for long periods of time
Increase in A-P diameter
General Appearance
Age, Height, Weight, Sex, Nourishment
Peripheral Edema
Presence of excessive fluid in the tissue (pitting edema)
Primarily in arms and ankles
CHFand Renal Failure Rated a +1 +2 +3 etc
Clubbing of the finger and toes
Abnormal enlargement of distal phalanges Usually associated with advanced chronic pulmonarey disease
Venous distention
Occurs with congestive heart failur Seen with patients with obsturctive lung disease.
Capillary Refill
Indication of peripheral circulation.
Skin Color
Normal, pink, tan, brown, black.
Skin Color
Abnormal decrease in color.
Ashen, pale due to anemia or acute blood loss.
Skin Color
Jaundice; Increase in bilirubin in blood and tissue. Occurs in liver diseases and hemolytic states
Movement of the Chest/diaphragm
Normal;Sequence of lung expansion, Abdominal protrusion, Lateral costal expansion, Upper chest expansion Inspiratory muscles. Diaphragm and External Intercostals Expiration is passive
Unequal Movement
Paradoxical Breathing
Abdomen retracted during inspiration, usually indicative of fatique of the diaphragm.
Use of Accessory Muscles of Inspiration
Indicative of increased work of breathing
Scalenes
Pectoralis major and minor
Trapezius
Sternocleido mastoid
Use of Accessory Muscles of Expiration
Indicative of increased work of breathing. Used for forced expiration. Muscles of back, thorax, or abdomen. Used to pull thorax down during paradoxical breathing
Eupnea
Normal breathing pattern
Tachypnea
Abnormal rapid rate of breathing. >20 bpm
Hypermetabolic and hypoxic states
Bradypnea
Abnormal slow rate of breathing <12bpm
Brain Injury
Drug overdose
Apnea
No breathing for > 10 or more seconds
Cardiac Arrest
Obstructive anatomic blockage
Hyperpnea
Deep, rapid, labored respiration
Exercise, pain,fever, hypoxemia
Cheyne-Stokes
Irregular type of breathing
Breaths increase and decrease in depth and rate with periods of apnea.
Siseases of CNS, CHF
Biots
Irregular breathing with long periods of apnea. Increased intracranial pressure
Kussmal's
Deep and fast, sighing respirations Diabetic ketoacidosis
Apneusis
Prolonged inspiration. Brain damage
Retractions
Visible sinking in of the soft tissues of the chest between and around the ribs
Occurs with increased inspiratory effort.
Nasal Flaring
Dilation of the alar nasal on inspiration An early sign of an increase in ventilatory demands and work of breathing;especially in infants
Breathing Pattern Associated with Restrictive Processes
Rapid and shallow pattern
Breathing Pattern Associated with Obstructive Processes
Slow, deep breaths with long expiration
Palpation
Touching the chest wall to evaluate underlying lung structure and function
Assymmetrical Chest Movement
Assessment of symmetry of chest expansion.
thumbs should move equally during inspiration.
Bilateral reduction'neuromuscular disease, COPD
Unilateral reduction;lovar consolidation,atelectasis, pleural effusin and pneumothorax.
Tactile Fremitus
Vibrations produced by vocal cords during phnation are transmitted down the tracheobronchial tree and through the alveoli to the chest wall Patient says99 assess chsst wall with palm or ulnar aspect of hand
Incresed fremitus
Results forem tranmission of the vibration through a more solid medium. Pneumonia , lung turmor, atelectasis
Decreased fremitus
Results with ofesity, overly muscular patients and when the pleural space is filled with air of fluid ( blocks transmission from bronchus pneumothorax pleural effusion mucus plug
Diffuse fremitus
COPD Muscular or obese chest wall
Rhonchial fremitus
Passage of air through airways containing thick secretions Associated with course, low-pitched sound that is audible without a stethoscope May clear with productive cough
Subcutaneous emphysema
when air leaks from the lung into the subcutaneous tissue, fine beads of air will produce a crackiling sound and sensation when palpated
Shift of Trachea Away from affected side
Pneumothorax and pleural effusion
Shift of Trachea toward affected side
atelectasis and consolidation
Percussion
Art of tapping on a surface in an effort to evaluate the underlying structureProduces a sound and vibration Place middle finger firmly in chest,parallel to ribs'tip of middle finger of other hand strikes the finger near base of terminal phalanx
Compare sides of chest
Normal Resonance
Normal is called normal resonance Heard easily, low in pitch
Compare sides of chest
Increased Resonance
Lower in pitch and louder in intensity (tympanic) Hyperinflated lungs. Pneumothorax
Compare sides of chest
Dull Note
Sull, flat sound (opposite of resonance) is a high pitched short duration, and not loud Increased density such as consolidation of tissue from pneumonia, atelectasis, pleural fluid
Diaphragmatic Excursion
Can be assessed by percussion
Ascultation
Listening for sounds, Pitch, intensity, distinctive characteristics, and duration of inspiration vs expiration
Bronchial
Heard over trachea loud, tubular, high-pitched, expiratory component equal to inspiratory component
Bronchovesicular
Heard around sternum and between scapula not as loud as bronchial, slightly lower in pitch, equal E and I
Vesicular
heard over lung fields
heard over lung fields lungs sounds heard over the chest are primarily generated by turbulent flow in the larger aiways, this sound transmitted through lung and chest wall Filtered bronchial sounds muffled because filtered by normal lung tissue soft, muffled, lower in pitch and intensity, heard primarily during inspiration
Harsh
Abnormal bronchial sounds may be heard over lung perophery when the lung tissue increases in density as ocurs in atelectasis and pneumonia (filtering effect lost) Increased intensity
Diminished
Intensity reduced when breath is shallow or slow
transmission reduced when air or fluid is in the pleural space obesity hyperinflated lungs obstructed airways
Wheezes
High pitched continuous abnormal sounds May also be used for low pitched continuous sounds (Ronchi)Generated by the vibration of the wallof a compressed airway as air passes through at high velocity Reduction in airway due to bronchospasm, mucosal edema foreign objects. Caused by asthma, CHF bronchitis. the tighter the compression the higher the pitch
Rhonchi (low pitched wheeze)
Low pitched continuous sounds are usually associated with mucous in the airway. Rapid airflow through obstructed airway caused by excess sputum, bronchospasm Caused by bronchitis asthma
Crackles
Siscontinuous lung sounds Also called rales
Coarse Crackles
Produced by movement of excessive secretions or fluid in the airways as air passes through;Heard during expiration and inspiration. Many clear with coughing Caused by Bronchitis Respiratory Infections
Fine Crackles
Produced when collasped airways pop open during inspiration. Peripheral airway openion heard during end inspiration. Atelectasis fibrosis pneumonia pulmonary edema all related to a decrease in lung volumes.Proximal bronchi opening heard during early inspiration. Larger airways may close during expiration when there is an increase in bronchial compliance COPD
Pulse Oximetry
Used to measure the amount of oxygen bound to hemoglobin in the blood
Low blood pressure,nail polish and cold affect reading
Normal is>/92%
CODP patients88-92%
Disfunctional Hemoglobin or carboxyhemoglobin may give inaccurate results
Body Temperature
Measurement of the balance between heat loss and heat produced by the body (muscle movement, digestion of food)
Conditions that increase body temperature
Exercise, Digestion of food,Increased environmental temperature, Illness, Infection, excitement anxiety
Conditions that decrease body temperature
Sleep, Fasting, exposure to cold, depression decreased muscle acitivity, illness mouth breathing
Gas Exchange Units
Terminal Brochole,Pulmonary arteriole,respiratory brochole, alveolar ducts,alveolar sacs, alveoli,alveolar capilary
Depth of Respiration
Normal depth is noexaggerated and effortless
Hypoventilation is shallow with minimal chest movement
Hypernea is with greater volum/depth
Agonal
End of life /take a deep breath and exhale and then nothing
Arteries
Capillaries
Veins
Deliver blood to tissues
Actual exchange of gases, nutrients and waste products
Reture deoxegenated blood and wasteproducts back to heart
Factors that affect heart rate
Age,time of day,gender(woman higher)body build, exercise, stress and emotions, body temperture(chemical release, infection) blood volume drugs
Pulse Volume
pulse strength or amplitude reflects the stroke volume of the heart and the peripheral vascular resistance
Ranges from absent to bounding Reported on a 3 to 4 point scale
Palpating a pulse
Place the pad of your first, second or third finger on the site of the radial pulse
Pulse sites
temperal,carcoid,femoral,dorsalic,posterior tibal,popliteal,radial,brachial
Korotkoff Sounds
Blood flow through a obstructed artery creates vibrations and sounds between the systole and diastole
Occulude the artery
Blood pressure cuff
Isolation Precautions
Contact
Private room if possible, gloves, wash hands with antimicrobial agent after glove removal , gown when entering ,removing gown before leaving. limit transport and dedicate single patient to equipement
Droplet Precautions
Private room if possible, Mask unpon entering room and limit transport of patient
Airborne Precautions
Private room with Hepa filter,(negative pressure) Tuberculosis wear an respiratorN95, when entering room,Measles, Chiclen pox no entry if suceptible or wear respiratorN95.patient wear surgical mask if must move
Pediatric RSV Precautions
Private room , Wash hands unpon leaving, Mask and goggles or face shield, gloves when entering, Limit patient transport,Dedicate single care equipment to patient, charts remain outside, clipboards inside room