ACCS Patient Assessment
Normal Urine output
40-80 ml/hr (appx 1.0-2.0 L/day)
Sensible water loss
urine vomiting
Insensible water loss
Lungs and skin
If intake exceeds output, could result in?
Wt gain
Electrolyte imbalance
INcreased hemodynamic pressures
Decreased Lung complaince
Pt CVP is < 2mmHg, what are the indications?
hypovolemia (tx with fluid challenge)
if Pt CVP is greater than 6 mmHg
can indicate hypervolemia (tx with diuretics)
If patient opens eyes with pain, inappropriate words and withdraws from pain with arms, what is their
GCS score
EYE open (3) Inappropriate words (3); withdraws with pain (4) then 10
Inability to cooperate may be due to?
Lang difficulties
Influence of meds
Hearing loss
Fear, apprehension, depression etc
IF patient can only breath comfortable in the upright position, they would have what?
CHF, heart problems
Orthopnea
Pt feeling run down, weakness, fatiqued, with HA and electrolytes are imbalance, pt is considered?
general malaise
Grade 1 dyspnea is defined
dyspnea occurs after unusual exertion
Grade II dyspnea is considered
breathless after going up hills or stairs
Grade III dyspnea
SOB while walking at normal speed
Grade IV dyspnea defined
dyspnea with slowly walking short distances
Grade V dyspnea
dyspnea, at rest, shaving or dressing, tying shooes
What are the 8 characteristics of pain
PQRST Hx
What is Vasovagal syncope:
common dizziness and fainting, caused by loss of peripheral venous tone
What type of syncope is more common and elderly?
Carotid sinus syncope
,Tussive syncope
transient loss of consciousness following severe coughgin
Hemiparesis
abnormal posturing could indicate brain injury
Decorticate
arms flexed, hands clinched, legs extended
Pinpoint pupils
miosis
Drooping of upper lids
ptosis
Peripheral edema can be caused by what conditions?
CHF (heart failure)
pulmonary hypertension
Venous insufficiency
Renal failure
Ascities:
accumulation of fluid in the abdomen
Ascities generally caused by what?
Liver failure
JVD is seen in what type of patients?
CHF
Obstructive lung disease
Cyanosis is caused by hypoxia from increased amount of reduced Hb. At what level of Hb would cause
cyanosis?
5g
What under lying pathology would cause unequal (asymmetrical)movement of the chest?
Atelectasis
Pneumothorax
Flail chest
INtubated in right mainstem (usually)
Cause for hyperpnea
metabolic disorders or CNS problems
What is Cheyne-stokes
gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 seconds with periods
of apnea up to 60 seconds
Causes for patients that have Cheyne-stokes?
ICP eleveated
Meningitis
Drug OD
Increased RR and depth with irregular periods of apnea each breath same depth
BIOT's
Caused of Biot's type of breathing pattern?
CNS problems
Kussmaul's breathing pattern
deep and fast breathing; often associated with metabolic acidosis
Causes of Kussmaul's breathing pattern
Hypoxemia
Acidosis
Renal Failure
, DKA
Paradoxical pulse/pulsus paradoxus may indicate what in patients?
Severe air trapping (status asthmaticus or cardiac tamponde)
What conditions would pull lung to abnormal side; towards the pathology
Pulmonary atelectasis
Fiborsis
Pneumonectomy
Diaphragmatic paralysis
Conditions that cause lung shift away from pathology?
Massive Pleural effusion
Tension Pneumothorax
Neck or thyroid tumors
Large mediastinal mass
WHat is Rhonical fremitus
secretions heard felt in the airways
Diaphragmatic excursion during a deep breath is apprx _____________________cm
5-7 cm
Normal breaths sounds are called
vesicular
Breath sounds over the lung periphery that are bronchial, would indicate what?
Lung consolidation
Egophony
instructed pt to say "E" and it sounds like A
Positive Epgphony would indicate
consolidation of the lung tissue and PNA like condition
Bronchophony, whispered pectoriloquy are indicated of what?
consolidation and PNA
Crackles
secretion/fluid
COarse rales (rhonchi)
large airway secreionts
Pt has Coarse rales, pt should recieve
suctioning
Medium rales associated with middle airway secretions. Pt should receive what therapy?
CPT
FINE rales (moist crepitant rales) indicates
fluid in alveoli
Pt has CHF or pulmonary edema
Pt needs PPV, HEART DRUGS, DIURECTICS and O2
Unilateral wheezing indicative of what
FBO
Stridor
Monophonic inspiratory sound , crowing
What is the cause of Stridor
Upper airway obstruction
SUPRAGLOTTIC swelling
SUBGLOTTIC swelling (post extubation)
FBO
What are specific treatments for STRIDOR?
Normal Urine output
40-80 ml/hr (appx 1.0-2.0 L/day)
Sensible water loss
urine vomiting
Insensible water loss
Lungs and skin
If intake exceeds output, could result in?
Wt gain
Electrolyte imbalance
INcreased hemodynamic pressures
Decreased Lung complaince
Pt CVP is < 2mmHg, what are the indications?
hypovolemia (tx with fluid challenge)
if Pt CVP is greater than 6 mmHg
can indicate hypervolemia (tx with diuretics)
If patient opens eyes with pain, inappropriate words and withdraws from pain with arms, what is their
GCS score
EYE open (3) Inappropriate words (3); withdraws with pain (4) then 10
Inability to cooperate may be due to?
Lang difficulties
Influence of meds
Hearing loss
Fear, apprehension, depression etc
IF patient can only breath comfortable in the upright position, they would have what?
CHF, heart problems
Orthopnea
Pt feeling run down, weakness, fatiqued, with HA and electrolytes are imbalance, pt is considered?
general malaise
Grade 1 dyspnea is defined
dyspnea occurs after unusual exertion
Grade II dyspnea is considered
breathless after going up hills or stairs
Grade III dyspnea
SOB while walking at normal speed
Grade IV dyspnea defined
dyspnea with slowly walking short distances
Grade V dyspnea
dyspnea, at rest, shaving or dressing, tying shooes
What are the 8 characteristics of pain
PQRST Hx
What is Vasovagal syncope:
common dizziness and fainting, caused by loss of peripheral venous tone
What type of syncope is more common and elderly?
Carotid sinus syncope
,Tussive syncope
transient loss of consciousness following severe coughgin
Hemiparesis
abnormal posturing could indicate brain injury
Decorticate
arms flexed, hands clinched, legs extended
Pinpoint pupils
miosis
Drooping of upper lids
ptosis
Peripheral edema can be caused by what conditions?
CHF (heart failure)
pulmonary hypertension
Venous insufficiency
Renal failure
Ascities:
accumulation of fluid in the abdomen
Ascities generally caused by what?
Liver failure
JVD is seen in what type of patients?
CHF
Obstructive lung disease
Cyanosis is caused by hypoxia from increased amount of reduced Hb. At what level of Hb would cause
cyanosis?
5g
What under lying pathology would cause unequal (asymmetrical)movement of the chest?
Atelectasis
Pneumothorax
Flail chest
INtubated in right mainstem (usually)
Cause for hyperpnea
metabolic disorders or CNS problems
What is Cheyne-stokes
gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 seconds with periods
of apnea up to 60 seconds
Causes for patients that have Cheyne-stokes?
ICP eleveated
Meningitis
Drug OD
Increased RR and depth with irregular periods of apnea each breath same depth
BIOT's
Caused of Biot's type of breathing pattern?
CNS problems
Kussmaul's breathing pattern
deep and fast breathing; often associated with metabolic acidosis
Causes of Kussmaul's breathing pattern
Hypoxemia
Acidosis
Renal Failure
, DKA
Paradoxical pulse/pulsus paradoxus may indicate what in patients?
Severe air trapping (status asthmaticus or cardiac tamponde)
What conditions would pull lung to abnormal side; towards the pathology
Pulmonary atelectasis
Fiborsis
Pneumonectomy
Diaphragmatic paralysis
Conditions that cause lung shift away from pathology?
Massive Pleural effusion
Tension Pneumothorax
Neck or thyroid tumors
Large mediastinal mass
WHat is Rhonical fremitus
secretions heard felt in the airways
Diaphragmatic excursion during a deep breath is apprx _____________________cm
5-7 cm
Normal breaths sounds are called
vesicular
Breath sounds over the lung periphery that are bronchial, would indicate what?
Lung consolidation
Egophony
instructed pt to say "E" and it sounds like A
Positive Epgphony would indicate
consolidation of the lung tissue and PNA like condition
Bronchophony, whispered pectoriloquy are indicated of what?
consolidation and PNA
Crackles
secretion/fluid
COarse rales (rhonchi)
large airway secreionts
Pt has Coarse rales, pt should recieve
suctioning
Medium rales associated with middle airway secretions. Pt should receive what therapy?
CPT
FINE rales (moist crepitant rales) indicates
fluid in alveoli
Pt has CHF or pulmonary edema
Pt needs PPV, HEART DRUGS, DIURECTICS and O2
Unilateral wheezing indicative of what
FBO
Stridor
Monophonic inspiratory sound , crowing
What is the cause of Stridor
Upper airway obstruction
SUPRAGLOTTIC swelling
SUBGLOTTIC swelling (post extubation)
FBO
What are specific treatments for STRIDOR?
