Respiratory Therapy Patient Assessment Questions and answers

Respiratory Therapy Patient Assessment Questions and answers Critical Life Functions Ventilation, Oxygenation, Circulation, and Perfusion During an emergency which critical life function is your first priority? Ventilation During an emergency which critical life function is your second priority? Oxygenation During an emergency which critical life function is your third priority? Circulation During an emergency which critical life function is your fourth priority? Perfusion What is used to assess the Ventilation? respiratory rate, tidal volume, chest movement, breath sounds, PaCO2, and EtCO2 What is used to assess Oxygenation? heart rate, color, sensorium, PaO2, and SpO2 What is used to assess Circulation? cardiac output, heart strength, and heart rate What is used to assess perfusion? blood pressure, sensorium, temperature, urine output, and hemodynamics Advance Directives set of instructions documenting what treatment a patient would want if he was unable to make medical decisions Lethargy, somnolence, sleepiness are all signs of what? sleep apnea or excessive O2 administration in a patient with COPD Obtunded drowsy state that may have decreased cough or gag reflex Activities of Daily Living (ADL's) bathing, eating, dressing, toilet use, and continence Orthopnea difficulty breathing except in the upright position and is a sign of CHF Dysphagia difficulty swallowing may cause aspiration Review respiratory care plan and making changes on what page in the book? A-8 What do we visually inspect during a respiratory assessment at the bedside? general appearance, edema, clubbing, venous distention, capillary refill, diaphoresis, skin color, chest configuration, chest movement, breathing patterns, accessory muscle use, muscle conditions, nasal flaring, cough, and evidence of a difficult airway General appearance age, height, weight, nourishment, etc. Edema presence of excessive fluid in the tissues caused by CHF and it rated as +1, +2 or +3 Clubbing of fingers caused by chronic hypoxemia and is suggestive of pulmonary disease especially COPD Venous Distension occurs with CHF and seen during exhalation in obstructive lung disease Capillary Refill indication of peripheral circulation where you blanch the hand and wait for color to return which should return within 3 seconds Diaphoresis sweating; night sweats indicate tuberculosis Ashen or Pallor abnormal skin color due to anemia or acute blood loss Jaundice increased billirubin level in blood and tissue mostly in the face and trunk Erythema redness of the skin caused by infection, inflammation, or capillary congestion Cyanosis blue or blue-gray (dusky) discoloration of skin and mucous membranes which is caused by hypoxia Chest configuration straight spine, no alterations to chest size, and a normal A-P diameter Kyphoscoliosis reduces lung volumes by restriction and causes barrel chest or increase in A-P diameter Movement of the chest/diaphram unequal or assymetrical movement may indicate underlying pathology or right main stem intubation Biot's increased respiratory rate and depth with irregular periods of apnea but same depth with each breath caused by problems in the CNS Kussmaul's increased depth, irregular rythym, labored breathing sounds, and an increased respiratory rate (usually over 20 breaths per minute) caused by metabolic acidosis, renal failure, or diabetic ketoacidosis Accessory Muscle Activity used to increase ventilation in times of stress or when there is an increase in resistance or a decrease in compliance Accessory Muscles internal intercostal, scalene, sternocleidomastoid, pectoralis major, and abdominal muscles Retractions intercostal or sternal occur when chest moves inward during inspiration instead of outward caused by severe airway obstruction or respiratory distress Nasal Flaring a sign of respiratory distress especially in infants Cough strong, moderate, or weak; productive or not; frequency; tight or moist; dry or nonproductive may indicate a tumor; productive may indicate infection or chronic lung disease Evidence of a Difficult Airway short receding mandible (micrognathia), enlarged tongue (macroglossia), bull neck, or limited range of motion of the neck Assessment by Palpation pulse, tracheal deviation, tactile fremitus, tenderness, crepitus, and chest motion symmetry Pulse a change in rate of 20 bpm is an adverse reaction so you stop therapy and notify the nurse and doctor and chart the event Paradoxical Pulse pulse varies with inspiration and may indicate severe air trapping as in status asthmaticus, tension pnuemothorax, or cardiac tamponade Tracheal Deviation palpate trachea in suprasternal notch and compare the space between the left clavicle and left border of the trachea Trachea deviates (pulls) toward pathology or the abnormal side pulmonary atelectasis, pulmonary fibrosis, pneumonectomy, or diaphragmatic paralysis Trachea deviates (pushes) away from pathology toward the normal side massive pleural effusion, tension pneumothorax, neck or thyroid tumors, or large mediastinal mass Tactile Fremitus vibrations felt on the chest wall caused by voice, pleural rub, or secretions in the airway (rhonchal fremitus) Tenderness around incisions, chest tubes, bruises, fractured bones, burns, and one should avoid touching these areas if possible Crepitus bubbles of air under the skin that can be palpated and indicate the presence of subcutaneous emphysema Chest Motion Symmetry check for asymmetrical chest expansion by placing hands on chest and evaluating the distance moved by each during inspiration Assessment of Percussion does it sound resonant, flat, dull, tympanic, or hyperresonant Resonant normal air filled lungs that gives a hollow sound Flat normally heard over the sternum, muscle, or areas of atelectasis Dull normally heard over fluid filled organs such as the heart or liver; plueral effusion or pneumonia can cause this thudding sound Tympanic normally heard over air filled stomach which sounds drum like and indicates increased volume when heard over lungs Hyperresonant booming sound heard in an area of the lung affected by a pneumothorax or emphysema