Kettering TMC workbook (patient assessment) |2026/2027 Update | Verified Questions & Answers | 100% Pass Guarantee | A+ Grade

Kettering TMC workbook (patient assessment) |2026/2027 Update | Verified Questions & Answers | 100% Pass Guarantee | A+ Grade Q: List 4 critical life functions Answer Ventilation Oxygenation Circulation Perfusion Q: What life function is first priority? Answer Ventilation Q: What assessments would determine how well a patient is ventilating? Answer -RR -Vt -Chest Movement -Breath Sounds -PaCo2 -EtCO2 Q: How would the therapist determine if a patient has a problem with oxygenation? Answer -HR -Color -Sensorium -PaO2/SpO2 Q: What information would help the therapist determine if a patient's circulation is adequate? Answer -HR and Strength -CO Q: What changes may indicate if a patient doesn't have adequate perfusion? Answer -HR -BP -Sensorium -Temperature -Urine Output Q: Signs are objective information - things you can see and measure Answer -color -pulse -edema -vital signs Q: symptoms are subjective information - things patient tells you Answer -dyspnea -pain level -nausea -muscle weakness Q: 5 items that are important to review in a patients medical record Answer 1. Allergies 2. Signs/Symptoms 3. History 4. Advanced directives 5. HPI Q: advanced directive Answer set of instructions documenting what Tx a patient wants if they were unable to make medical decisions Q: what are 4 types of advanced directives Answer 1. living will - Tx patient wants if became terminally ill; doesn't appoint someone else to make medical decisions 2. DNI order - do not intubate (can ventilate) 3. DNR order - do not resuscitate 4. durable power of attorney - health care proxy; only in affect when patient can't make healthcare decisions Q: A properly written order for respiratory care should include what 4 factors? Answer 1. type of treatment 2. frequency 3. medication/dosage 4. physician signature Q: The respiratory therapist has just finished administering an aerosol treatment with albuterol to a child with asthma. What should be included in documentation of the treatment? Answer date, time, reactions, etc. respiratory notes Q: What is the normal value for urine output Answer 40mL/hour (approx. 1 liter/day) Q: What findings might indicate a patients fluid intake has exceeded his urine output? Answer weight gain electrolyte imbalance increased hemodynamic pressures decreased lung compliance Q: Changes in what value can indicate hypovolemia? Answer CVP - less than 2 need fluid (IV) therapy Q: Describe medication reconciliation Answer ensuring patients medication list is accurate and up to date as possible. Must be done within first 24 hours of admission Q: Semicomatose Answer responds to only painful stimuli Q: lethargic/somnolent Answer sleepy consider sleep apnea, excessive O2 therapy with COPD patients Q: Obtunded Answer drowsy decreased cough/gag reflex risk of aspiration Q: when assessing a patients orientation to time place and person, what are some of the factors that could affect the patients ability to cooperate? Answer language difficulties influence of medication hearing loss fear/apprehension depression Q: define activities of daily living Answer basic tasks of everyday life Q: 6 criteria for ADL are based on Answer bathing eating dressing toileting transferring urine/bowel continence Q: ADL are evaluated using the - system Answer katz Q: orthopnea Answer Answer difficulty breathing lying down think CHF Q: general malaise feeling unwell electrolyte imbalance dyspnea Answer short of breath dysphagia Answer trouble swallowing what are 4 factors to consider when conducting a patient interview Answer ask open ended questions use simple language use pictures or diagrams identify patients with major problems Eupnea Answer normal breathing tachypnea Answer fast RR conditions: fever, hypoxia, pain, CNS problems bradypnea slow RR conditions: sleep (normal), drugs, alcohol, metabolic alkalosis Gradually increase then decreasing rate and depth in a cycle lasting from 30-180 seconds fast slow period of apnea condition: increased IC pressure, brainstem injury, drug overdose cheyne stokes increased respiratory rate and depth with irregular periods of apnea. Each breath has the same depth fast irregular w/ apnea Cause: CNS problem biots breathing gasping, labored breathing, also called air hunger condition: hypoxemia, metabolic acidosis, renal failure, diabetic ketoacidosis Kussmaul breathing hypertrophy increased [muscle] size think COPD atrophy decreased [muscle] size think paralysis tList 4 changes to a patient's upper airway that complicates airway patency #1 tracheal shift deviation List 4 changes to a patient's upper airway that complicates airway patency #2 bull neck List 4 changes to a patient's upper airway that complicates airway patency #3 large tongue (macroglossia) List 4 changes to a patient's upper airway that complicates airway patency #4 short mandible class 1 mallampati Class - soft palate, uvula, fauces, pillars visible class 2 mallampati class - soft palate, uvula, fauces visible class 3 mallampati class - soft palate, base of uvula visible class 4 mallampati class - hard palate only visible mallampati class - and - are considered difficult airways and require the use of a fiberoptic bronchoscope or a video assist device* class 3 and 4 normal range for HR 60-100 indications for tachycardia hypoxemia anxiety stress - need o2 therapy indications for bradycardia heart failure shock code/emergency - atropine adverse reaction/when to stop tx HR change of 20 bpm indications of paradoxical pulses/pulsus paradoxus sever air trapping, Pneumo, status asthmaticus, cardiac tamponade (pulse/BP varies with respiration) pulled toward affected side atelectasis pneumonectomy diaphragmatic paralysis pushed away from affected side pleural effusion tension pneumothorax tumor (neck or thyroid) mediastinal mass vibrations felt on chest wall by hand Increased in consolidation and pulmonary edema decreased in COPD, pneumothorax, and pleural effusion tactile fremitus skind tender around incisions, chest tubes, bruises, burns, or fractures tenderness bubbles of air under skin crepitus (subcutaneous emphysema) different than therapeutic chest percussion (chest PT) diagnostic chest percussion normal air filled lungs (hollow sound) resonant (less air) normally heard over sternum areas of atelectasis flat (less air) normally heard over fluid filled organs (heart, liver) Pleural effusion/pneumonia (thud) dull (extra air) normally heard over air-filled stomach drum like sound indicating increased volume when heard over lungs tympanic (extra air) booming sound that can be heard on an area of lung were either a pneumothorax or emphysema is present hyperresonant normal breath sounds vesicular abnormal breath sounds adventitious patient instructed to say E and sounds like A (or 99) indicates consolidation of the lung tissue as with a pneumonia like condition egophony what breath sounds would be expected in a patient with pulmonary edema fine crackles (moist crepitant rales) large airway secretions rhonchi that clears with cough suction or have patient cough coarse crackles middle airway secretions bronchial hygiene medium crackles moist crepitant rales alveoli/fluid associated with CHF and pulmonary edema o2, IPPB, diuretics, and positive inotropic agents (strengthens the heart) fine crackles bronchospasm unilateral wheeze = obstruction bronchodilator or bronchoscopy wheeze upper airway obstruction supraglottic swelling (epiglottitis) subglottic swelling (croup and post extubation) racemic epi (mild to moderate), suctioning/bronch, intubation (marked or severe) stridor noisy during inhalation low pitch snoring (vibrations for secretions bc tissues relax) stertor coarse, raspy, crunching sound inflamed surface of visceral and parietal pleura rubbing pleurisy, TB, pneumonia, cancer, pulmonary infarction *steriods (inflammation) or antibiotics (infection) pleural friction rub normal closure of mitral and tricuspid valves lub S1 normal sound occurring when systole ends, ventricles relax and pulmonic and aortic valves close dub S2 abnormal heart sound heart failure S3 abnormal heart sounds hypertension/aortic stenosis S4 abnormal heart sounds turbulent blood flow/heart valve defects murmur abnormal heart sounds made in an artery/vein when blood flow becomes turbulent or flows at abnormal speed/carotid artery Bruit what affect would cardiac stress have on blood pressure? hypertension hypoxemia what affect would hypoperfusion have on blood pressure (poor perfusion)? hypotension hypovolemia (chf) normal Bp 120/80 Normal systolic range 90-140 normal diastolic range 60-90 both hemidiaphragms are rounded right hemidiaphragm is slightly higher right hemidiaphragm is at 6th anterior rib trachea is midline bilateral radiolucent lungs sharp costophrenic angles normal cxr will show intervertebral disc space through the shadow of the mediastinum proper exposure/penetration image doesn't allow visualization of the intervertebral disc through the heart shadow under penetrated images will show black lung parenchyma without blood vessels over penetrated what condition causes blunting of costophrenic angles? pleural effusion in what pathology is the diaphragm flattened? COPD what pathology causes crowding of the ribs? atelectasis what pathology causes straight or horizontal ribs? air trapping posterior to anterior cxr PA anterior to posterior cxr AP lying on affected side detects small pleural effusion (liquid moves) if doesn't move then it's pneumonia lateral decubitus end of exhalation detects small pneumothorax can measure diaphoretic excursion end expiratory image below vocal chords 2-6 cm above the carina at level of aortic knob or arch position of ETT what is the FIRST way to determine adequate ventilation following intubation? inspection and auscultation (followed by CXR) in pleural space surrounding the lung chest tube positioned in the stomach 2-6 cm below diaphragm NG or feeding tube right lower lung field pulmonary artery catheter positioned in the right ventricle pacemaker subclavian/jugular vein should rest in superior vena cava/right atrium of the heart (4th intercostal space and right of sternum) central venous catheter steeple sign picket fence pencil point hourglass croup (laryngotracheobronchitis) thumb sign epiglottitis (supraglottic narrowing) what type of radiographs are helpful in locating areas of air trapping? inspiratory/expiratory radiographs aspirated FB (food) are - and cant be see on X-rays radiolucent dark pattern = air normal lungs radiolucency white = solid/fluid (thick) bones or organs radiodense (radiopacity) any ill defined radiodensity atelectasis infiltrates solid white area pneumonia or pleural effusion consolidation extra pulmonary air COPD pneumo asthma attack hyperlucency lymphatics, vessels, lung tissue increased with CHF absent with pneumothorax vascular markings spread throughout atelectasis/pneumonia diffuse fluid/solid consolidation opaque xray terminology fluffy infiltrates butterfly pattern batwing pattern pulmonary edema xray description diffuse whiteness infiltrates in shape of a butterfly pulmonary edema treatment diuretics (decrease fluid) digitalis digoxin (both strengthen heart) pulmonary edema xray terminology & description patchy infiltrates scattered density thin layered density atelectasis treatment lung expansion PEEP IPPB CPAP atelectasis xray terminology and description ground glass (reticulogranular) honeycomb (reticulonodular) diffuse bilateral radiopacity ARDS (IRDS) treatment O2 CPAP PEEP Low Vt/PIP ARDS (IRDS) Xray terminology and description blunting of costophrenic angles fluid level on affected side mediastinal shift to unaffected side pleural effusion treatment chest tube thoracentesis antibiotics steroids pleural effusion Xray terminology and description air bronchograms increased density from consolidation and atelectasis pneumonia treatment antibiotics (bacterial) antivirals (viral) pneumonia xray description and terminology peripheral wedge shaped infiltrate may be normal pulmonary embolus treatment heparin (clot formation) streptokinase (clot buster) pulmonary embolus xray terminology and description cavity formation upper lobes Tb treatment antitubercular agents acid fast stain TB xray through a specific plane of the body part to be examined (narrow slices of an organ) CT scan (computed tomography) pathologies for which a - - is indicated: -parenchymal, mediastinal, and pleural masses CT scan special CT scan used to diagnose PE spiral CT with contrast dye no radiation determines precise positions of tumors, etc MRI ventilation scan - inhale xenon gas and obstruction will prevent gas from filling that area perfusion scan - albumin (iodine) injected in peripheral vein then scanned with a device v/q scan normal ventilation without perfusion pulmonary embolism indications for - -esophageal malignancy -dysphagia -GERD barium swallow test a - - procedure is used to diagnose and detect diseases earlier than MRI and CT PET scan useful in determining cancer, brain disorders, and heart disease PET Scan indications for - identifies obstructing lesions (tumors) by outlining the airways bronchography (bronchograms) 2 hazards of - - allergic reaction - impairment of ventilation bronchography indicated to assess activity of the brain: brain tumors traumatic brain injuries loss of brain function evaluation of sleep disorders eeg indicated to diagnose PE -suspicion of PE pulmonary angiogram noninvasive method for monitoring cardiac performance. Used to assess heart function, left ventricular volume, and ejection fraction echo also indicated for -myocardial disease -valvular disease/dysfunction -abnormal heart sounds echo normal range for ICP 5-10 mmHg treatment is recommended when ICP increases above what level? 20 mmHg Nitric oxide concentration in patients exhaled breath monitors patients response to anti-inflammatory (corticosteroids) monitors patients with asthma copd cystic fibrosis exhaled nitric oxide (niox) a decrease in FEno levels suggest a decrease in airway inflammation used to evaluate: -abstinence in cigarette smokers -obstructive sleep apnea exhaled carbon monoxide heavy smokers 20 ppm light smokers 7-10 ppm measures all major ingredients of the blood cbc contains hemoglobin necessary for o2 transport 4-6 million (approx 5) too low = anemia too high = polycythemia rbc carries o2 12-16 (approx 15) x3 method hemoglobin percent of rbc in original blood volume 40-50% (approx 45%) x3 method hematocrit changes with response to infection 5,000-10,000 too low = viral infection too high = bacterial infection wbc most abundant wbc neutrophils immature WBC increased with bacterial infections bands mature WBC decrease with bacterial infections segs what pathology would show an increase in eosinophils? allergic reactions K+ Na+ Cl- Hco3-(co2 content) normal metabolism associated with fluid levels muscle function and kidney function electrolytes muscle weakness soreness nausea lethargy dizziness general malaise or drowsy electrolyte imbalance Sodium hyponatremia hypernatremia Na+ 135-145 potassium low= metabolic alkalosis K+ 3.5-4.5 chloride Cl- 90-100 bicarb Co2 content metabolic alkalosis = low potassium hco3- 22-26 most specific way to evaluate kidney function creatinine 1 another way to evaluate kidney function BUN 8-25 an increase in BUN would indicate? kidney failure sputum description mucoid (white/gray) chronic bronchitis sputum description yellow WBC (eosinophils) bacterial infection sputum description green stagnant sputum gram - bronchiectasis (pseudomonas) sputum description brown old blood (lung infection) sputum description bright red hemoptysis (bleeding tumor, TB) sputum description pink frothy pulmonary edema what information is obtained from a culture and sensitivity? bacteria present (+ or -) what information is obtained from a gram stain? identifies pos or neg series of tests that evaluate the clotting mechanisms of the body coag studies analysis of the number, size, and shape of platelets 150,000-400,00 decreased levels indicate bone marrow function or sepsis platelet count (150,000-400,000) measures length of time required for plasma to form fibrin clot monitors heparin therapy 24-32 seconds ptt (24-32) monitors warfarin(Coumadin) therapy 12-15 seconds pt (12-15) protein found in myocardial cells indicator for damage of heart muscle (MI) for tx 0.1 risk of death troponin secreted by cardiac muscles when heart failure develops or worsens 100 = CHF 300 = mild CHF 900= severe diuretics positive inotropic agents (dig.) BNP a Mantoux test is the most reliable test for detecting (aka tuberculin skin test or PPD) tb sensitivity (exposure not infection) electrical impulse is created by the SA node (pacemaker of the heart) wave of depolarization moves through the atria causing contraction P wave the impulse is received by AV node where it is delayed P-R interval stimulus is then sent through the bundle of HIS and left&right bundle branches to purkinje fibers. this produces ventricular deplorization and contraction QRS complex measures the net direction of all the electricity through the heart during contraction the axis of ekg what is the direction of the normal axis? down and to the left axis will shift toward - and increase electrical activity hypertrophy axis will shift away from - and no electrical activity infarction bronchial breath sounds are normal when heard over - trachea bronchial breath sounds are abnormal when heard over the - consolidation lungs object placed on the skin to conduct electric current from the body to a monitoring/measuring device electrode displays movement of electricity from the electrode to another lead what is the best lead lead 2 lead that goes on 4th intercostal space on right side of sternum V1 lead that goes on 4th intercostal space on left side of sternum v2 lead that goes on between v2 and v4 on left side v3 lead that goes on 5th intercostal space left mid clavicular line v4 lead that goes on between v4 and v6 on the left side v5 lead that goes on intercostal space on left mid axillary line v6 p wave normal rate doesn't march out treat other symptoms SA p wave normal rate HR 100 treat with o2 ST p wave normal rate HR 60 treat with atropine and O2 SB saw tooth pattern digoxin/beta blockers/calcium channel blockers a flutter no visible p waves treat with digoxin, calcium channel blockers/anticoags a fib could be multifocal oxygen lidocaine and consider other causes PVC HR 100 cardiovert if pulse present (stable vt) defib if pulseless/cpr/epi/amiodarone vt completely irregular ventricular rhythm defib/cpr/epi/amiodarone v fib confirm in 2 leads first CPR/epi asystole decreased blood flow to tissue depressed/inverted T waves ischemia acute damage to tissue elevated ST segment Stemi injury necrosis/death of tissue significant Q wave infarction normal etco2 range (capnography) 3-5% an increase in PetCO2 indicates what? a decrease in ventilation (ventilatory failure) a decrease in PetCO2 indicates what? hyperventilation or deadspace disease (PE) to increase the heart rate treat w/ chronotropic agent (atropine) excessive fluids treated w/ diuretics (furesomide) Increased BP treated w/ vasodilators or ACE inhibitors nitroprusside hyrdralazine milrinone vasodilators (high BP) lisinopril perindopril captopril enalapril ramipril ACE inhibitors (high BP) to decrease the HR treat w/ b blockers or b antagonists atenelol propranolol labetalol b blockers or b antagonists (lower hr) loss of fluid treated with fluid or blood low BP treated with vasoconstrictors epinephrine phenylephrine dopamine dobutamine vasoconstrictors (low bp) pressure transducer should be same level as the tip of the catheter if transducer is above the catheter the readings will be lower if transducer is below the catheter the readings will be higher PAP right side of the heart/atrium/valves - cor pulmonale - lungs 25/8 (mean 14) PCWP (pwp) left side of the heart/atrium/valves - think CHF 4-12 mmhg (mean 8) CVP fluids - also monitors right heart (will increase if right heart failure) 2-6 mmhg (mean 4) MAP 93 mmhg If PAP is rising - the trouble is in the lungs anyone with lung disease has - - nitric/flolan pulmonary hypertension if right heart failure only the - will go up, the rest go down cvp Proximal catheter port measures cvp distal port with balloon deflated measures pap distal port with balloon inflated measures pcwp the presence of a double spike is normal for the arterial pressure waveform and occurs when the pulmonic or aortic valve closes dicrotic notch if while monitoring the PAP and unable to see distinct high and low values, check to see if the - - balloon is deflated occurs when the monitor doesn't show the dicrotic notch and the catheter is somehow obstructed pressure dampening a blood clot(most common), bubble in the catheter or transducer dome, or kinking of the tube may cause an - obstruction if a - - occurs: -aspirate -flush the catheter -rotate the catheter blood clot increased CVP normal or decreased PAP normal or decreased PCWP normal Qt (cardiac output) right heart failure (cor pulmonale, tricuspid valve stenosis) increased CVP Increased PAP normal or decreased PCWP normal Qt (cardiac output) lung disorders (PE, pulmonary hypertension, air embolism) normal CVP Increased PAP Increased PCWP decreased Qt left heart failure (mitral valve stenosis, chf) increased CVP Increased PAP Increased PCWP Increased Qt hypervolemia decreased CVP decreased PAP decreased PCWP decreased Qt hypovolemia difference between systolic and diastolic pressure systolic - diastolic = pulse pressure pulse pressure MAP formula bc the heart spends twice as much time in diastole than in systole 2x diastolic + systolic/3 measures the output of the left ventricle to the systemic arterial circulation cardiac output (Qt) fick equation Qt=Vo2/C(a-v)o2(10) stroke volume equation Qt= HRxSV Qt normal value 4-8 Cardiac index (body surface area = BSA) CI= Qt/BSA cardiac index normal value (half of Qt) 2.5-4 the pressure gradient across the systemic circulation divided by cardiac output SVR SVR formula svr=(MAP-CVP)/QT SVR normal value 20 mmhg SVR is - with systemic hypertension and/or vasoconstriction increased the pressure gradient across the pulmonary circulation divided by Qt PVR PVR formula pvr=(MPAP-PCWP)/QT PVR normal value 2.5 mmHg to convert mmHg to dynes multiply by 80 PVR is - with hypoxia, pulmonary hypertension, and lung disease increased