Patient Assessment Chapter 3 & 4 Study Guide

Questions:

1. What are the three phases of the cough mechanism?

2. What is the inspiratory phase?

3. What is the compression phase?

4. What is the expiratory phase?

5. What conditions make a cough ineffective?

6. What conditions cause a chronic productive cough?

7. What are some complications of a forceful cough?

8. What is sputum?

9. What is phlegm?

10. What conditions cause excessive sputum productions?

11. What is hemoptysis?

12. What is massive hemoptysis?

13. What are the most common causes of hemoptysis?

14. What could hemoptysis with a sudden onset of chest pain cause?

15. What is dyspnea?

16. What must be present for dyspnea to occur?

17. What is name of the grading system used for assessing dyspnea?

18. What conditions causes acute dyspnea in children?

19. What are common causes of chronic dyspnea in adults?

20. What is Paroxysmal Nocturnal dyspnea?

21. What is pleuritic chest pain?

22. What is nonpleutitic chest pain?



23. What disease is chest pain the cardinal symptom of?

24. What is angina?

25. What is syncope?

26. What pulmonary conditions causes syncope?

27. What factors are associated with a syncope episode?

28. What condition is associated with right heart failure?

29. What is the most common manifestation of infection in a patient with pulmonary

disorder/disease?

30. What condition causes early morning headaches?

31. What age does snoring occur in men and women?

32. What is GERD?

33. What causes lower extremity bruising and swelling?

34. What is pitting edema?

35. How do you evaluate the severity of pitting edema?

36. What are the signs and symptoms of TB?

37. What are the four vital sign measurements?

38. What are the advantages of trending vital signs?

39. What other factors are often on the vital sign sheet?

40. How often should vital signs be measured?

41. What is differential diagnosis?

42. What is the importance in comparing changes in vital signs?

43. What is monitored in a patient suspected of dehydration?

44. What do you do when your patient is in distress?

45. What are the benefits of other healthcare providers having a written description of the

RT’s assessment?

46. What is the importance of evaluating a patient’s level of consciousness?

47. What is the Glasgow coma scale used for?

48. What is a fever?

49. What are causes of hypothermia?

50. How do you treat hypothermia?

51. What are the sights for taking a patient’s temp?

52. What are the advantages of the tympanic measurement?

53. Does small volume nebulizers affect the oral temp?

54. What is tachycardia?

55. What are common causes of tachycardia?

56. What are the sights for measuring a pulse rate?

57. Where do you feel for the pulse in a hypotensive patient?

58. What other characteristics are assessed when feeling the pulse?

59. What is the normal range of respiratory rate?

60. What is abnormally high respiratory rate at any age?

61. What causes tachypnea in surgical patients?

62. How do you count the respiration rate?

63. What is pulsus paradoxus?

64. What is pulsus alternans?

65. What is breathing pattern of Kussmaul’s breathing?

66. what is diastolic blood pressure?

67. What organs are at risk for disease due to hypertension?

68. what are korotkoff sounds?

Answers

1. The inspiratory phase, The compression phase, and the expiratory phase

2. the reflex opening of the glottis and contraction of the diaphragm, thoracic, and abdominal muscles cause a deep inspiration with a concomitant increase in lung volume accompanied by an increase in the caliber and length of the bronchi

3. closure of the glottis and relaxation of the diaphragm while the expiratory muscles contract against the closed glottis can generate very high intrathoracic pressures and narrowing of the trachea and bronchi

4. opening of the glottis, explosive release of trapped intrathoracic air, and vibration of the vocal cords and mucosal lining of the posterior laryngeal wall shake secretions loose from the larynx and move undesired material out of the respiratory tract

5. weakness of either the inspiratory or expiratory muscles, inability of the glottis to open or close correctly,, obstruction, collapsibility, or alteration in shape or contours of the airways, decrease in lung recoil as occurs with emphysema, abnormal quantity or quality of mucus production

6. Bronchiectasis, chronic bronchitis, lung abscess, asthma, fungal infections, bacterial pneumonias, tuberculosis

7. torn chest muscles, rib fractures, disruption of surgical wounds, pneumothorax/pneumomediastinum, syncope/fainting, arrhythmia, esophageal rupture, and urinary incontinence

8. the substance expelled from the tracheobronchial tree, pharynx, mouth, sinuses, and nose by coughing or clearing the throat

9. secretions from the lungs and tracheobronchial tree. Secretions can include mucus cellular debris microorganisms, blood pus, and foreign particles they shouldn’t be confused with saliva

10. Normal production is 100 mL a day excessive sputum is most often caused by inflammation of mucous glands that line the tracheobronchial tree, inflammation occurs from infection, cigarette smoking, and all allergies

11. an expectoration of sputum containing blood, can be an alarming symptom that may suggest serious disease and massive hemorrhage, severe forms it is frightening

12. 400 mL in 3 hours or more than 600 mL in 24 hours seen is lung cancer, tuberculosis, bronchiectasis, and trauma. It is an emergency situation

13. historically tuberculosis and bronchiectasis now erosive bronchitis and bronchogenic carcinoma are also common

14. pulmonary embolism and infarction

15. difficulty in breathing consisting of qualitatively distinct sensations varying in intensity sensations may be mixed with anxiety

16. The work of breathing is abnormally high for the given level of exertion (common with narrowed airways asthma/ pneumonia), the ventilator capacity is reduced (common when vital capacity is abnormally low neuromuscular disease), or the drive to breath is elevated beyond normal hypoxemia/acidosis/exercise)

17. Modified Borg scale, the American Thoracic Society Shortness of Breath Scale, and Dyspnea -12 Survey/D-12

18. asthma, bronchiolitis, croup, and epiglottitis

19. COPD and chronic CHF

20. PND is the sudden onset of difficult breathing that occurs when a sleeping patient is in the recumbent position associated with coughing relieved when the patient assumes an upright position. It is associated with the condition known as CHF occurs 1-2 hours after lying down

21. inspiratory pain most common symptom of disease causing inflammation of the pleura it is sharp severe enough for patient to seek medical help within hours of onset increases with inspiration, cough , sneeze, hiccup , or laughing. Usually one side

22. Outside of the pleura

23. Heart disease

24. viselike chest pain radiating down the arms most commonly the left may spread to

shoulders, neck, jaw, or back

25. temporary loss of consciousness caused by reduced blood flow and a reduced supply of oxygen and nutrients to the brain



26.thrombosis, embolism, atherosclerotic obstruction pulmonary embolism (obstruction of blood flow from the right into the left heart), prolonged bout of coughing (tussive syncope), and

hypoxia ( low levels of oxygen in the blood ) or hypocapnia (low levels of CO2)

27. fainting

28. cor pulmonale

29. Fever

30. it is a result of a retaining of abnormally high amounts of carbon dioxide

31. 50-59 ages in men and 60-64 ages in women

32. it stands for gastroesophageal reflux disease it is symptoms produced by the abnormal reflux of gastric contents into the esophagus it occurs when the lower esophageal sphincter opens inappropriately. Heartburn and regurgitation occurs associated with laryngitis, asthma, chronic and nocturnal dry cough, chest pain and dental erosion. Associated factors are obesity cigarette smoking and pregnancy

33. Edema

34. when compression of an edematous area produces a depression that does not fill immediately

35. using a scale trace, mild, moderate, or severe look at table 3-12 page 49

36. cough, fatigue, low grade temp, positive TB test and chest radiograph

37. temperature, pulse, respirations, blood pressure, and pain

38. they help optimize patient care and avoid costly medical errors

39. height and weight, level of consciousness and responsiveness (sensorium, level and type of

pain, and general impression observed by caregiver

40. it depends on the condition of the patient, the nature and severity, procedures, surgery , or treatments being performed. A baseline should be taken on admission and at least at the beginning of each shift. For patients with conditions affecting only selected organs monitoring is focused on specific vital signs heart rate and rhythm done by telemetry or by a Holter monitor. Routine vitals for stable patients are done 4-6 hours

41. comparison of multiple signs and symptoms to arrive at the patient’s diagnosis

42. to see how the patient is changing or responding to therapy over time, it tells if the measurements are high or low compared to the normal value 24 hour comparison creates a trend

43. electrolytes

44. measure vital signs immediately, consider activating the rapid response team or in an alternate care setting calling 911

45. it helps others to know how to plan care and relate to the patient’s needs

46. if they are alert conscious and oriented it means they are getting adequate cerebral oxygen also it evaluates their mental status by time, place, and person (sensorium). This also tells you the patient’s ability to participate/cooperate in treatment

47. it is an evaluation scale of LOC by objective evaluation based on behavioral response in 3 areas motor, verbal, and eye opening response

48. temperature is elevated from disease

49. seen in patients with severe head injuries that damage the hypothalamus and in people exposed to cold environmental temperatures

50. patients will be placed on mechanical ventilator the settings may need significant adjustments in the depth and rate of delivered tidal volumes as the body temperature of the patient varies above and below normal. Heated aerosol may be helpful in raising the body temmp in hypothermic patients

51. rectal for comatose, intensive care or confused patients and infants; axillary mostly for children; oral awake adults shouldn’t be used with infants; tympanic pediatric and emergency department

52. no direct contact is made, takes less than 3 seconds, fast, clean, noninvasive and avoids embarrassment and time delays associated with the classic forms of temperature measurement

53. not significantly you don’t have to wait to take temp unless they have ingested hot or coldd liquid or have been smoking then you wait 10-15 minutes

54. pulse rate exceeding 100 beats/ min in adults

55. anxiety, fear, exercise, fever, high ambient temperature, low blood pressure, anemia, reduced arterial blood oxygen levels, and certain medications like bronchodilators

56. the radial artery is most common, brachial, femoral, and carotid arteries

57. the carotid pulse in neck and femoral and pulses in the groin

58. the rhythm and strength

59. study table 4-3 page 64

60. 60 breathes/min

61. when significant fever develops or when the lungs partially collapse as a side effect of

surgery the degree of atelectasis determines the degree of tachypnea

62. watch the abdomen or chest wall move in and out with breathing

63. when the systolic pressure drops more than 10 mmHg during inhalation at rest a definite abnormality exists occurs in various circulatory and respiratory conditions like asthma and cardiac tamponade

64. an alternating succession of stroon and weak pulses and usually is not related to respiratory disease

65. fast and deep breathing often seen in uncontrolled diabetes

66. the force occurring when the heart is relaxed the bottom number

67. the heart vascular and renal

68. the sounds produced by the arterial pulse waves when blood flow in the artery resumes