ACCS Respiratory correctly answered 2022

ACCS Respiratory correctly answered 2022Normal Urine Output 40 mL/hr (approx. 1 Liter/day) Decreased CVP (2 mmHg) Hypovolemia Increased CVP (6 mmHg) Hypervolemia Glasgow Coma Scale (GCS) Eye-opening response Spontaneous opening- 4 To verbal stimuli- 3 To pain- 2 None- 1 Most appropriate verbal response Oriented- 5 Confused- 4 Inappropriate words- 3 Incoherent- 2 None- 1 Most intergrated motor response (arm) Obeys commands- 6 Localizes pain- 5 Withdraws from pain- 4 Flexion to pain- 3 Extension to pain- 2 None- 1 Orthopnea ability to breathe only in an upright position (CHF, Heart problem) General malaise Run down feeling, nausea, weakness, fatigue, headache (electrolyte imbalance) Dyspnea Grade 1- occurs after unusual exertion Grade 2- breathless after going up hills or stairs Grade 3- while walking at normal speed Grade 4- slowly walking a short distance Grade 5- at rest, shaving, dressing, etc. vasovagal syncope Common dizziness and fainting, caused by loss of peripheral venous tone orthostatic hypotension Excessive drop in BP when assuming the standing position Carotid sinus syncope Associated with hypertension carotid sinus - more common in elderly patients Cough (tussive) syncope Transient loss of consciousness following severe coughing FUO fever of unknown origin heart rate 60-100 bpm Respiratory rate 12-20 breaths per minute Temperature Norm. Oral- 97.0-99.5 F (36.5-37.5 C) Rectal- 98.7-100.5 F (37.1-38.1 C) Ear- 98.7-100.5 F (37.1-38.1C) PERRLA pupils- equal, round, reactive to light and accommodation Miosis constricted pupils (pinpoint) Ptosis Drooping of the upper eyelid Diplopia Blurred or double vision Nystagmus involuntary, rapid, rhythmic movement of the eyeball Peripheral edema Presence of excess fluid in the tissue. Caused by CHF, pulmonary hypertension, venous insufficiency and renal failure. Rated +1,+2,+3,+4; higher numbers indicate more severs swelling. May be described as "pitting edema" ascites abnormal accumulation of fluid in the abdomen, generally caused by liver failure Clubbing of fingers Caused by chronic hypoxemia, suggestive of pulmonary disease Eupnea normal respiratory rate, depth and rhythm Tachypnea increased respiratory rate (over 20 breaths per minute) Bradypnea decreased respiratory rate (less than 12 per minute) variable depth and irregular rhythm Apnea not breathing Hyperpnea increased respiratory rate, increased depth, regular rhythm (caused by metabolic disorder, CNS disorder) Cheyne Stokes gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 seconds, with periods of apnea lasting up to 60 seconds. Biot's increased respiratory rate and depth with irregular periods of apnea. Each breath has the same depth. Kussmaul's Increased respiratory rate (usually over 20 breaths/min.), increased depth, irregular rhythm, breathing sounds labored. Apneustic prolonged gasping inspiration followed by extremely short, insufficient expiration. Macroglossia Enlarged tongue Cachectic Muscle wasting Normal Pulse 60-100 bpm Tachycardia 100 bpm, indicated hypoxemia, anxiety, stress Bradycardia 60 bpm, indicates heart failure, shock, code/emergency Heart rate change more than 20 bpm Considered an adverse reaction, stop therapy, notify nurse/doctor Pulse varies with respiration May indicate air trapping (status asthmaticus or cardiac tamponade) Tracheal Deviation, Toward Pulmonary atelectasis Pulmonary fibrosis pneumonectomy Diaphragmatic paralysis Tracheal Deviation, Away Massive pleural effusion Tension pneumothorax Neck or thyroid tumors Large mediastinal mass Coarse Rales (rhonchi) large airway secretions, patient needs suctioning Medium Rales Middle airway secretions, patients needs chest physical therapy Fines Rales (moist crepitant rales) alveoli, fluid, patient has CHF/ pulmonary edema, patient needs IPPB, heart drugs, diuretics and oxygen Wheeze bronchospasm, patient needs a bronchodilator, unilareral wheeze indicative of a foreign body obstruction Stridor (Monophonic inspiratory sound, crowing) Supraglottic swelling Subglottic swelling (post extubation) Foreign body aspiration (solid or fluid) Treatment- topical decongestant (racemic epinephrine) for swelling and edema Suctioning and/or bronchoscopy for secretions and foreign body aspiration Intubation for marked/severe stridor Heart Sounds: First Sound (S1) is created by normal closure of the mitral valve and tricuspid valves at the beginning of ventricular contraction Heart Sounds: Second Sound (S2) is normal and occurs when systole ends, the ventricles relax and the pulmonic and aortic valves close. Heart Sounds: Third Sound (S3) in an adult, the presence of an S3 sound, is abnormal and may suggest CHF Heart Sounds: Fourth Sound (S4) the presence of a fourth sound, S4, is indicative of a cardiac abnormality such as myocardial infarction of cardiomegaly Adult Blood Pressure Normal 120/80 mmHg Acceptable: 90/60 - 140/90 Increased Blood Pressure (Hypertension) indicates cardiac stress, hypoxemia Decreased Blood Pressure (Hypotension) indicates poor perfusion, hypovolemia, CHF Work of Breathing Calculation (WOB) Change in pressure X change in volume Normal WOB 0.5 - 0.7 J/L (0.05 - 0.07 kg-m/L)