Respiratory (RRT) 2023 with complete solution

Ventilation moving air in and out the lung Oxygention getting oxygen into the blood circulation moving the blood thru the body perfusion getting blood and oxygen into the tissue ventilation respiratory rate, TV, Chest movement, breath sound, Paco2, etc Oxygenation heart rate, color, sensorium, PaO2, first drug in ER Circulation pulse, heart rate, and strength, cardiac output Perfusion blood pressure, sensorium, temp. urine output, hemodynamic, strong pulse indicate hypoxia, weak pulse is heart failure decrease central venous pressure (CVP) <2 mm hg indicate hypovolemia increase central venous pressure >6 mm hg indicate hypervolemia S/S Lethargic, somnolent(sleepy, drowsy), sleepy COPD O2 overdose or sleep apnea s/s stuporous(lack of critical mental function and LOC), confused drug overdose, intoxication, respond inappropriately Obtunded ( greatly reduced LOC) drowsy state, may have decreased cough or gag reflex. anger, combative, irritable electrolyte imbalance Euphoria (intense feeling of well being, happiness and excitement drug overdose S/S anxiety, nervousness asthmatic, respiratory distress, hypoximia Activities of daily living scale based on 6 criteria bathing with sponge, shower eating dressing toilet use transferring urine and bowel continence (self control) katz ADL score for 6 full functional Katz ADL score for 4 moderate and need some assistance Katz ADL score for 2 or less severe impairment Orthopnea difficulty breathing except in the upright position (heart problem, CHF) General malaise run down feeling, nausea, weakness, fatigue, headache (electrolyte imbalance) Peripheral edema appear where arm and ankles. if both choice in it chose ankle best answer Peripheral edema cause by what CHF and renal failure Ascites accumulation of fluid in the abd generally caused by liver failure What cause by clubbing finger chronic hypoxemia (low O2 in blood) suggestive of pulmonary disease. venous distention cause congestive heart failure What cause diaphoresis profuse/heavy sweating, cause by cause failure, fever, infection, anxiety, nervousness, tuberculosis(night sweat) abnormal decrease in color skin cause by skin color ashen(ash), pallor (pale) cause by anemia or acute blood loss what cause jaundice(yellow color) increase in bilirubin in blood and tissue appear mostly face and trunk what cause cyanosis hypoxia on tissue increase amount of reduced hemoglobin 5 g of reduce hemoglobin Pectus carinatum anterior protrusion of the sternum Pectus excavatum depression of part or all the sternum Kyphosis convex curvature of the spine (lean forward) Scoliosis lateral curvature of the spine (lean side to side) Kyphoscoliosis combination of both and causes a severe restrictive impairment Barrel chest air trapping in lung for long period of time cause by COPD and increases in A-P diameter Eupnea breathing pattern normal respiratory rate, depth and rhythm; 12-20 breaths/min Tachypnea increase rate >20 b/m cause hypoxia, fever, pain, CNS problem bradypnea (oligopnea) decrease rate 12b/m < variable depth and irregular rhythm cause by sleep normal, drug, alcohol Hyperpnea increase respiratory rate, increased depth, regular rhythm cause by metabolic disorder/CNS disorder cheyne-stokes gradually increasing then decreasing rate and depth in a cycle lasting from 30-180 sec and apnea last up 60 sec cause increase ICP, meningitis, drug overdose Biot increased respiratory rate and depth with irregular period of apnea. each breath has same depth cause CNS problem Kussmaul increased respiratory rate over 20 b/m, increased depth, irregular rhythm, breathing sound labor cause by metabolic acidosis, renal failure, diabetic ketoacidosis Apneustic prolonged gasping inspiration followed by extremely short, insufficient expiration cause by respiratory center, trauma or tumor. atrophy muscle wasting is loss of muscle tone and occur in paralysis Retraction chest move inward during inspiratory sign of obstructed airway and respiratory distress in infants Nasal flaring nostril flaring during inspiration sign of respiratory distress in infants Dry or non-productive cough may indicate tumor in lungs Productive cough may indicate infection evidence of difficult airway short receding mandible enlarge tongue(macroglossia) bull neck limited range of motion of the neck increased how much heart rate is an adverse reaction, stop therapy, notify nurse & doctor 20 beat/min paradoxical pulse (decrease systolic pressure) indicate severe air trapping (status asthmaticus or cardiac tamponade) Tracheal deviation pull to abnormal side toward pathology Pulmonary atelectasis, Pulmonary fibrosis, pneumonectomy and diaphragmatic paralysis. (FAPP) tracheal deviation Pushed to normal side away from pathology. Massive pleural effusion, tension pneumothorax, neck or thyroid tumor, and large mediastinal mass (MTTM) lung sound Resonant normal air filled lung , hollow sound Lung sound Flat heard over sternum, muscle or areas of atelectasis Lung sound Dull fluid filled organ such as heart or liver. Pleural effusion or pneumonia will give thudding sound Lung sound tympanic heard over air-filled stomach. drum like sound and when heard over the lungs indicates increased volume Hyperresonant lung where pneumothorax or emphysema is present, booming sound Diaphragmatic excursion to determine patient has pneumonia and pneumothorax Normal diaphragmatic excursion 3-5cm and if less than 3-5 cm is pneumonia and pneumothorax. vesicular normal breath sound Egophony patient instructed to say "E" and it sound like "A" this indicate consolidation lung tissue with pneumonia Bronchophony and whisper pectoriloquy increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso or transmission of spoken voice indicate consolidation and pneumonia. Decrease spoken voice indicate obstructed bronchi, pneumothorax, emphysema adventitious abnormal breath sound Rales (crackles) secretion/ fluid coarse rales (rhonchi) large airway secretion need suction medium rales middle airway secretion need chest PT Fine rale (moist crepitant rales) alveoli, fluid. PT has CHF/pulmonary edema. PT need IPPB, heart drug, diuretic and O2 Unilateral wheeze indicate foreign body obstruction Pleural friction rub caused pleurisy, TB, pneumonia, pulmonary infarction, cancer and TX steroid and antibiotic Rales (crackle) rales to the tales usually happen on alveoli fluid overload and discontinuous sound Rhonchi (wheezing) Rhonchi or Bronchi in the bronchi happen inflammation large airway and continue sound when auscultation. Presence of S3 sound in heart indicate CHF Presence of S4 sound in heart indicate myocardial infarction or cardiomegaly(enlarge heart) normal adult blood pressure 120/80 mmhg acceptable range 90/60 to 140/90 hypertension indicate cardiac stress -hypoxemia hypotension indicate poor perfusion-hypovolemia, CHF how much % of right lung volume larger than the left lung 55% if major bronchi narrowed indicate bronchogenic carcinoma (cancer) increase A-P diameter indicate COPD, Barrel chest and hyperinflation costophrenic angles obliterated( invisible) indicate pleural effusion flattened with diaphragm indicate COPD Left and right hemidiaphragms (lower of the lung) shift downward indicate pneumothorax soft tissue when hyperlucency( all dark in image )seen surrounding soft tissue indicate subcutaneous emphysema under the skin as a air trapping lateral decubitus position (right of left affect side) indicate detect small pleural effusion (fluid build around lung) End expiratory film indicate detect small pneumothorax tip of the ET tube should position where aortic knob or aortic arch, 2cm or 1 inch carina nasogastric tube or feeding tube position how far in stomach 2-5 cm below diaphragm pacemaker should positioned where right ventricle central venous catheter place where right or left subclavian or jugular vein rest in vena cava or right atrium of the heart CROUP What another name and how it appear on X-ray laryngotracheobronchitis, pencil point sign, picket fence sign or steeple sign (viral in infant and young children) Epiglottitis how it appear on X-ray life-threatening inflammation consider as emergency caused by bacteria infection, thumb sign. Infiltrate ( one side look normal & other look funny) on Radiology. atelectasis (I do not know but look funny), any ill-defined radiodensity solid white area. Consolidation (I still do not know but something funny) on Radiology. solid white area; pneumonia (inside lung)/pleural effusion(outside lung) Radiolucent on radiology air, dark pattern is normal for lungs Radiodense/opacity fluid, solid, white pattern, bone, something solid, heart shadow. hyperlucency extra pulmonary air; COPD, asthma attack, pneumothorax, unilateral one side hyperlucency vascular markings lymphatics, vessel, lung tissue usually have marking, cause by increased with CHF, absent with pneumothorax diffuse spread throughout over the place did not know what it is , cause atelectasis/pneumonia fluffy infiltrates or butterfly/batwing pattern diffuse whiteness or infliltrate in shape of butterfly cause by pulmonary edema patchy infiltrates or platelike inffiltrates scattered densities, thin-layered densities or little bit there & here cause by atelectasis Ground glass appearance, honeycomb pattern, diffuse bilateral radiopacity reticulogranular, reticulonodular cause by ARDS/IRDS Air bronchogram, Peripheral wedge shaped infiltrate small airway with fluid & big air way stickout, wedge shaped V shape . air bronchogram pneumonia, wedge shape is pulmonary embolus Concave superior interface/border, basilar infiltrates with meniscus (curve) pleural effusion on V/Q scan indicated normal ventilation scan but abnormal perfusion scan cause pulmonary emboli Pulmonary angiography diagnose for pulmonary embolism and intermediate or indeterminate V/Q scan normal value for ICP 5-10 mm hg how much ICP recommend for tx ICP > 20 mmhg and hyperventilated PaCO2 25-30 torr what cause of ICP Intracranial tumor, abscesses, meningitis, cerebral edema and subdural hematoma. formula for cerebral perfusion pressure CPP= MAP-ICP normal value 70-90 mmhg and must least 70 mmhg what nitric oxide concentration use for monitor asthma patient response to anti-inflammatory (corticosteroid) tx and decrease in airway inflammation. what cause high RBC polycythemia occur chronic tissue hypoxemia (COPD) What cause low RBC anemia occur blood loss, hemorrhage normal value RBC 4-6 mil/mm normal value of hemoglobin 12-16 gm/100 ml blood normal count WBC 5000-10,000 per mm increase WBC (leukocytosis) and decrease WBC (leukopenia) increase bacterial infection and decrease is viral what WBC fight tuberculosis monocytes 3% WBC What is major WBC Neutrophil, band immature cell 4% WBC increased with bacterial infections, seg mature cell 60% WBC decreased with bacterial infection Potassium K (muscle function and cardiac muscle) range 3.5-4.5, Hypokalemia cause by metabolic alkalosis, excessive excretion, renal loss, vomit, flattened T wave on EKG. The first electrolytes check first. Hyperkalemia K high K, kidney failure, spike T wave (metabolic acidosis) Sodium (Na) major extracellular control by kidney normal 135-145 meq/L; Na is retained in exchange for K hyponatremia low Na fluid loss from: diuretic, vomit, diarrhea, fluid gain from CHF, IV therapy hypernatremia dehydration Chloride (CI) major extracellular anion range 80-100 mEq/L, closely associated with sodium = Potassium hypochloremia low CI (metabolic alkalosis) hyperchloremia high CI (metabolic acidosis) Creatinine excreted by kidney, normal 0.7-1.3 mg/dl test the kidney function if creatinine and blood urea nitrogen both choice pick creatinine mospt important. Blood urea nitrogen (BUN) evaluate kidney function normal 8-25 mg/dl, increased BUN= kidney failure mucoid (white /gray) sputum chronic bronchitis green sputum stagnant sputum, gram negative bacteria (bronchiectasis, pseudomonas) brown/dark old blood pink frothy pulmonary edema Sensitivity ID what antibiotic will kill the bacteria Gram stain ID whether it is gram positive or gram negative Acid fast stain ID mycobacterium tuberculosis Purpose for coagulation studies clotting time normal up to 6 mins -evaluation of preop patient for bleeding risk -evaluate bleeding S/S -Diagnose disseminated intravascular coagulation -monitor anticoagulant therapy Platelet count decrease cause aid blood coagulation, normal value 150,000-400,000/mm3 decrease cause by bone marrow function Activated Partial Thromboplastin Time(APTT) measure length of time require plasma form a fibrin clot. normal value 24-32 sec if >100sec cause spont bleeding. use to monitor heparin therapy Prothrombin Time (PT) same as APTT used to monitoring warfarin (Coumadin) therapy. normal value 12-15 sec > 30sec spont bleeding Thrombin time (TT) normal 7-12 sec Urinalysis test measure what specific gravity, ph, glucose, ketones, blood bilirubin and sedimentation. estimate heart rate between R waves 300 divide # of large boxes 1500 divide # of small boxes two R wave between 3 and % larges boxes then normal 60-100. two R wave closer than 3 large/15 small squares then > 100 tachycardia. Two R waves are wider 5 large boxes/25 small squares less than 60 bradycardia. sinus tachycardia >100 TX = Oxygen sinus arrhythmia - sinus rhythm with irregular rate TX any other symptoms Sinus bradycardia -< 60 Oxygen, atropine Premature ventricular contraction-PVC Oxygen, lidocaine multifocal premature ventricular contractions - PVC. many location of PVC Oxygen, Lidocaine