FULL REVIEW CRT/RRT (NBRC)
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Bronchoscopy & Chest Tubes Weakn... ch 2 positioning chest clinical indica... Pulmonary M1
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Terms in this set (322)
Ascites accumulation of fluid in the abdomen caused by LIVER FAILURE
-occurs with CHF
Venous distention
-seen with obstructive patients (seen in exhalation phase)
-indication of peripheral circulation
Capillary refill
-Normal < 3 seconds
-increase in bilirubin.
Jaundice skin color
-mostly in face and trunk
Bradypnea (oligopnea) -decreased respiratory rate (<12bpm) variable depth and irregular rhythm
Hyperpnea -increased rate, depth, with regular rhythm
-gradually increasing then decreasing rate and depth in a cycle lasting from
30 - 180 secs, with apnea up to 60 secs
Cheyne-Stokes
-increased ICP, meningitis, overdose
-increased rate and depth with irregular periods of apnea
Biots
-CNS problem, head/brain injury
-increased rate, depth, irregular rhythm, breathing sounds labored
Kussmaul's
-Raspy voice
prolonged gasping inspiration followed by extremely short, insufficient
expiration
Apneustic
-respiratory center problems, trauma, tumor
cachectic muscle atrophy/loss of muscle tone
-chest moves inward during inspiratory efforts instead of outward
retractions -blocked airway in adults = INTUBATE
-RDS in infants
-dry, non-productive cough may indicate tumor in the lungs or asthma
Character of cough
-productive cough may indicate infection
, -short receding mandible (chin)
-enlarged tongue (macroglossia)
evidence of difficult airway
-bull neck
-limited neck range-of-motion
-pulse/blood pressure varies with respiration. may indicate severe air
pulsus paradoxus
trapping (status asthmaticus or cardiac tamponade)
-vibrations felt by hand on chest wall
-vocal fremitus: voice vibrations on the chest wall
tactile fremitus
-pleural rub fremitus: grating sensation due to roughened pleural spaces
-Rhonchial fremitus(palpable rhonchi): secretions in airways
-bubbles of air under skin that can be palpated and indicates subcutaneous
Crepitus
emphysema
-hollow sound
Resonant percussion
-normal lungs
Flat percussion -heard over sternum, muscles, or areas of atelectasis
-heard over fluid-filled organs such as heart or liver (thudding)
Dull percussion
-pleural effusion or pneumonia
-heard over air-filled stomach.
Tympanic percussion
-drum-like sound and when heard over lung = increased volume
-found where pneumothorax or emphysema is present.
Hyperresonant
-booming sound
vesicular breath sounds normal sounds in lungs
-normal sounds over airways.
bronchial breath sounds
-breath sounds over lungs indicate LUNG CONSOLIDATION
-patient instructed to say E and sounds like A.
Egophony
-lung consolidation
-increased intensity or transmission of the spoken voice and indicate
CONSOLIDATION or PNEUMONIA
Bronchophony / whisphered pectoriloquy
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
-crackles
Rales
-secretions/fluid
-rhonchi
Coarse rales -LARGE airway secretions
-needs suctioning
-middle airway secretions
medium rales
-needs CPT
-fluid in alveoli
Fine rales -CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
-due to bronchospasm
Wheeze -bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
, -upper airway obstruction
-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
stridor -foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
-coarse grating or crunching sound
-visceral and parietal pleura rubbing together
Pleural friction rub
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
-closure of the mitral and tricuspid valves at the beginning of ventricular
Heart Sound S₁
contraction
-closure of pulmonic and aortic valves
Heart Sound S₂
-occurs when systole ends; ventricles relax
Heart Sound S₃ -abnormal and may suggest CHF
-abnormal and indicative of cardiac abnormality such as myocardial
Heart Sound S₄
infarction or cardiomegaly
-sounds caused by turbulent blood flow
Heart murmurs -heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
-sounds made in an artery or vein when blood flow becomes turbulent or
Bruits flows at an abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
-systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
Blood pressure
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
-angle made by the outer curve of the diaphragm and the chest wall
Costophrenic Angle
-obliterated by pleural effusions and pneumonia
-dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
Diaphragm
-right hemidiaphragm is level of 6th anterior rib and slightly higher than
the left
-right lung: 55% and appear larger than left lung
-patient lying on affected side
Lateral decubitus CXR
-detecting small pleural effusions
-taken when patient is at end-exhalation
End expiratory film
-detecting small pneumothorax/foreign body aspiration (FBA)
-tip should be positioned below the vocal chords and no closer than 2 cm
or 1 inch above the carina.
-approx same level of the aortic knob/arch
Position of ET/Tracheostomy tube
-observation and auscultation will quickly determine adequate ventilation
before CXR is taken
-cuff should not extend over the end of the ET or tracheostomy tube