Advanced Patient Assessment After Midterm Day 6

Front 1

wilkins chapter 10 page 207 to 215

Back 1

Egans chapter 18, 381 to 388

Workbook Chapter 18 page 141 to 146

Front 2

summary of normal values for electrocardiogram interpretation and common alterations

Back 2

Rate 60 to 100 /min

Front 3

SInus bradycardia

Back 3

Meets all the criters for NSR but is too slow

:Rate: less than 60 bpm

:Rhythm: regular

:P waves normal and is followed by a QRS

:PR interval 0.12 to 0.2 seconds

Front 4

SInus Tachycardia

Back 4

Meets all criteria for NSR but is too fast

:Rate 100 to 150 bpm

Rhythm regular

P waves normal but increased

Front 5

SInus Tachycardia

Back 5

Meets all the criteria for NSR but is too fast

:Pr interval: 0.12 to 0.2 second

:QRS less than 0.12 seconds

Front 6

SInus dysrhythmia

Back 6

Meets all the criteria for normal sinus rhythm but is irregular

:Rate 60 to 100 beats per minu, may also be bradycardia

:Rhythm: irregular

:P waves: normal and followed by a QRS complex

:PR interval 0.12 to 0.2 second in length

:QRS: less than 0.12 second in width

Front 7

Atrial FLutter

Back 7

Distinct rapid swtooth pattern between normal WRS

:Rate: atrial rates 180 to 400; ventricular rate is slower

:Rhythm: regular

:P waves, sawtooth and uniform

Front 8

Atrial FLutter

Back 8

Distinct rapid sawtooth pattern between normal WRS

:PRI: not measurable

:QRS less than 0.12 second

Front 9

Atrial fib

Back 9

Characterized by chaotic baseline between WRSs

:Rate: variable (count WRSs in 6 second strip)

:Rhythm: irregularly irregular

:P waves: fibrillatory waves that all vary

Front 10

Atrial fibrillation

Back 10

Characterized by chaotic baseline between WRSs

:PRI not measurable

:QRS is less than 0.12 seconds

Front 11

Premature ventricular contractions

Back 11

Underlying rhythms is interrupted by wide QRS (greater than 0.12 seconds) not preceded by a P wave and has an inverted T

:Rate: that of the underlying rhythm

:Rhythm: regular rhythm is interrupted by PVC

:P waves: not associated with the PVC

Front 12

Premature ventricular contractions

Back 12

Underlying rhythm is interrupted by wide QRS so greater than 0.12 sec, and is not preceded by a P wave, and has an inverted T

:PR interval not measurable

:QRS is greater than 0.12 sec, premature, abnormal configuration,

Front 13

Ventricular Tachycardia

Back 13

Wide QRS occuring rapidly without P waves

:Rate of 140 to 300 bpm

:Rhythm is regular

:P waves not associated with QRS complexes

Front 14

VVentricular tachycardia

Back 14

Wide QRS occuring rapidly without P waves

:PR interval: not measurable

:QRS: abnormal and greater tthan 0.12 second in width

Front 15

Ventricular fib

Back 15

Chaotic rhythm, characterized by wavy irregular pattern

:Rate: none

:Rhythm, irregular, chaotic waves

:P waves: none

:PRI, non

:QRS: none or sporadic low amplitutde

Front 16

Asystole

Back 16

Characterized by a straight or almost flat line

Rate: none

:Rhythm non

:P waves non

:PRI non

;QRS none

Front 17

AV Heart block

Back 17

General term: problems conducting impulses from the atrial to the ventricules

Blocks can occur at the AV node, bundle of His or the bundle branches

Complete heart block may be associated with hypotension

Milkder forms of heart block often cause no symptoms

Front 18

First degree AV block

Back 18

Looks like NSR but a prolonged PR interval (greater than 0.2 seconds)

:Rate: underlying rhythm rate

:Rhythm: regular

:P waves: normal, each preceding a QRS complex

Front 19

Radiograph views

Back 19

Standard views

:Anteroposterior (film behind your back, camera in front)

:Posterior anterior view

Special views

:Lateral decubitus

:Apical lordotic

:Oblique (side of lungs)

:expiratory

Front 20

Anterior Posterior view

Back 20

Indications for AP portable films

:Evaluate the lung status

:evaluate lines and tubers

:See results of invasive therapeutic maneuvers

:Portable chest film

Film cassette placed behind patients back

X ray beam moves from front to back

:anterior to posterior) 4 feet from beams origin

:More magnification artifact that PA Chest X ray

Front 21

Evaluation of the chest radiograph

Back 21

Recognition of anatomic landmarks

Review clinical finding before viewing CXR

Placing the chest film

:Patient facing clinician

:cardiac shadow more prominent

Front 22

Xray

Back 22

Penetration inversely proportional to density of structure

Normal lung density tissue has low density

:Cavities, blebs darkers

Consolidation increases density

:Pneumonia, tumer, collapse (white patch)

Greatest density in the chest: bones

Systemic review of all structures

:A through Z

Front 23

Determine quality of the film

Back 23

Visualize vertebral bodies through cardiac shadow

:If easily seen, overexposed, recognize rotation of the patient

SPnous processes to medial ends of clavicles

Degree of patients inspiratory effort

:10 posterior ribs on PA film

Front 24

Silhouette Sign and air bronchogram

Back 24

Silhouette sign

:infiltrate that obliterates heart border or

:diaphragm must be located in anterior segments of the lung

Air bronchogram

:visible bronchi when surrounded by consolidated alveoli

:Confirms intrapulmonary disease

Front 25

Clinical and radiographic findings in lung disease

Back 25

Atelectasis

Hyperinflation

Interstitial lung disease

Front 26

Atelectasis

Back 26

Compressive atelectasis

:pleural effusion, pneumothorax, hemomthorax

:If severe, mediastinal shift

Obstructive atelectasis

:Tumor, aspirated foreign body, mucus plugging

Posteroperative atelectasis

:Microatelectasis

CXR: lung volume loss, mediastinal shift

Front 27

Emphysema

Back 27

Anatomic alterations of the lungs

Permanent enlarbement of alveoli

Results in dereased surface area for optimum gas exchange

Causes ventilation in excess of perfusion which is deadspace

Wasted ventilation

Distal airways, weakended in the process, then collapse during expiration

trapped gas is a result in the alveoli

This leads to increased alveolar deadspace increase Vd alv

Increase PaCO2

Alveolar ventilation and PaCO2 are inversely related

Front 28

Emphysema

Back 28

Alpha 1 antitrypsin deficiency

Alpha 1 is secreted by the liver

When white blood cells are destroyed in the lungs the alpha 1 is released that destroys elastic tissue

Front 29

CXR COPD

Back 29

Translucent (dark lung fields)

Density of the lungs decreases because of the air trapping

Decrease in the lung recoiling

Flattened diaphragms

Long narrow heart

Front 30

Pneumothorax

Back 30

Tall, thin young males

COPD with bullous dissease

Trauma

:Broken ribs

:Puncture wound

:latrogenic

Air enters pleural space

Pleura separate

Affected lung collapses

Front 31

Tension pneumothorax is a medical emergency

Back 31

Needs immidiate relief via tube thoracostomy

Front 32

Pleural diagnostic evaluation

Back 32

Size of pleural effusion

:To see on chest film

:200 cc

Radography

Thoracentesis

Thoracoscopy

:Video assisted thoracic surgery

Thoracotomy

Front 33

Thoracentesis

Back 33

Insertion of needle into pleural space

:Use of local anesthetic

:sample for cell counts, cultures, chemistries, cytology and pH

Catheter placed

:If theres a lot of fluid to be drained

:Lung re expansion needed

Needle placed just superior to a rib

3 major risks

:intercostal artery laceration, infection, pneumothorax

Front 34

Thoracoscopy

Back 34

Video assisted thoracic surgery

Local anesthesia and conscoius sedation

Thoracoscope placed through intercostal incision

:Visualization of lung surfaces

:drainage of pleural fluid

:Biopsy under direct visualization

Front 35

Chylothorax

Back 35

Chyle in pleural space

:Milky appearance

:leakage of thoracic duct

Ruptures into pleural space

Front 36

Hemothorax

Back 36

Blood in pleural space(usually occures cause of trauma)

Life threatening