CRT/RRT (NBRC) FULL REVIEW EXAM STUDY GUIDE GRADED A 2024

Ascites - accumulation of fluid in the abdomen caused by LIVER FAILURE Venous distention - -occurs with CHF -seen with obstructive patients (seen in exhalation phase) Capillary refill - -indication of peripheral circulation -Normal < 3 seconds Jaundice skin color - -increase in bilirubin. -mostly in face and trunk Bradypnea (oligopnea) - -decreased respiratory rate (<12bpm) variable depth and irregular rhythm Hyperpnea - -increased rate, depth, with regular rhythm Cheyne-Stokes - -gradually increasing then decreasing rate and depth in a cycle lasting from 30 - 180 secs, with apnea up to 60 secs -increased ICP, meningitis, overdose Biots - -increased rate and depth with irregular periods of apnea -CNS problem, head/brain injury Kussmaul's - -increased rate, depth, irregular rhythm, breathing sounds labored -Raspy voice Apneustic - prolonged gasping inspiration followed by extremely short, insufficient expiration -respiratory center problems, trauma, tumor cachectic - muscle atrophy/loss of muscle tone retractions - -chest moves inward during inspiratory efforts instead of outward -blocked airway in adults = INTUBATE -RDS in infants Character of cough - -dry, non-productive cough may indicate tumor in the lungs or asthma -productive cough may indicate infection evidence of difficult airway - -short receding mandible (chin) -enlarged tongue (macroglossia) -bull neck -limited neck range-of-motion pulsus paradoxus - -pulse/blood pressure varies with respiration. may indicate severe air trapping (status asthmaticus or cardiac tamponade) tactile fremitus - -vibrations felt by hand on chest wall -vocal fremitus: voice vibrations on the chest wall -pleural rub fremitus: grating sensation due to roughened pleural spaces -Rhonchial fremitus(palpable rhonchi): secretions in airways Crepitus - -bubbles of air under skin that can be palpated and indicates subcutaneous emphysema Resonant percussion - -hollow sound -normal lungs Flat percussion - -heard over sternum, muscles, or areas of atelectasis Dull percussion - -heard over fluid-filled organs such as heart or liver (thudding) -pleural effusion or pneumonia Tympanic percussion - -heard over air-filled stomach. -drum-like sound and when heard over lung = increased volume Hyperresonant - -found where pneumothorax or emphysema is present. -booming sound vesicular breath sounds - normal sounds in lungs bronchial breath sounds - -normal sounds over airways. -breath sounds over lungs indicate LUNG CONSOLIDATION Egophony - -patient instructed to say E and sounds like A. -lung consolidation Bronchophony / whisphered pectoriloquy - -increased intensity or transmission of the spoken voice and indicate CONSOLIDATION or PNEUMONIA -increase in spoken voice = consolidation -decrease in spoken voice = obstructon, pneumo, emphysema Rales - -crackles -secretions/fluid Coarse rales - -rhonchi -LARGE airway secretions -needs suctioning medium rales - -middle airway secretions -needs CPT Fine rales - -fluid in alveoli -CHF, pulmonary edema -IPPB, heart drugs, diuretics and O2 Wheeze - -due to bronchospasm -bronchodilator Tx -unilateral wheeze indicative of a foreign body obstruction stridor - -upper airway obstruction -supraglottic swelling (epiglottitis) (thumb sign) -subglottic swelling (croup, postextubation) (steeple sign) -foreign body aspiration -Racemic epinephrine -intubation if MARKED stridor -Lateral neck Xray for confirmation Pleural friction rub - -coarse grating or crunching sound -visceral and parietal pleura rubbing together -associated with TB, pneumonia, pulmonary infarction, cancer -steroids and antibiotics Heart Sound S₁ - -closure of the mitral and tricuspid valves at the beginning of ventricular contraction Heart Sound S₂ - -closure of pulmonic and aortic valves -occurs when systole ends; ventricles relax Heart Sound S₃ - -abnormal and may suggest CHF Heart Sound S₄ - -abnormal and indicative of cardiac abnormality such as myocardial infarction or cardiomegaly Heart murmurs - -sounds caused by turbulent blood flow -heart valve defects or congenital heart abnormalities -can occur when blood is pushed through an abnormal opening (ASD, PDA)