FINAL REVIEW CRT/RRT (NBRC)
QUESTIONS AND ANSWERS.
Laryngectomy & Laryngectomy tubes -
\-pt will breath through a laryngectomy tube initially
-pt cannot be orally or nasally intubated
-tube will be removed after 3-6 weeks then pt will have a permanent stoma
-tubes do NOT have an inflatable cuff
Ascites -
\accumulation of fluid in the abdomen caused by LIVER FAILURE
Venous distention -
\-occurs with CHF
-seen with obstructive patients (seen in exhalation phase)
Capillary refill -
\-indication of peripheral circulation
-Normal < 3 seconds
Jaundice skin color -
\-increase in bilirubin.
-mostly in face and trunk
Bradypnea (oligopnea) -
\-decreased respiratory rate (<12bpm) variable depth and irregular rhythm
Hyperpnea -
\-increased rate, depth, with regular rhythm
Cheyne-Stokes -
\-gradually increasing then decreasing rate and depth in a cycle lasting from 30 - 180
secs, with apnea up to 60 secs
-increased ICP, meningitis, overdose
Biots -
\-increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's -
,\-increased rate, depth, irregular rhythm, breathing sounds labored
-Raspy voice
Apneustic -
\prolonged gasping inspiration followed by extremely short, insufficient expiration
-respiratory center problems, trauma, tumor
cachectic -
\muscle atrophy/loss of muscle tone
retractions -
\-chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
Character of cough -
\-dry, non-productive cough may indicate tumor in the lungs or asthma
-productive cough may indicate infection
evidence of difficult airway -
\-short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
pulsus paradoxus -
\-pulse/blood pressure varies with respiration. may indicate severe air trapping (status
asthmaticus or cardiac tamponade)
tactile fremitus -
\-vibrations felt by hand on chest wall
-vocal fremitus: voice vibrations on the chest wall
-pleural rub fremitus: grating sensation due to roughened pleural spaces
-Rhonchial fremitus(palpable rhonchi): secretions in airways
Crepitus -
\-bubbles of air under skin that can be palpated and indicates subcutaneous
emphysema
Resonant percussion -
\-hollow sound
-normal lungs
Flat percussion -
\-heard over sternum, muscles, or areas of atelectasis
,Dull percussion -
\-heard over fluid-filled organs such as heart or liver (thudding)
-pleural effusion or pneumonia
Tympanic percussion -
\-heard over air-filled stomach.
-drum-like sound and when heard over lung = increased volume
Hyperresonant -
\-found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds -
\normal sounds in lungs
bronchial breath sounds -
\-normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony -
\-patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy -
\-increased intensity or transmission of the spoken voice and indicate
CONSOLIDATION or PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales -
\-crackles
-secretions/fluid
Coarse rales -
\-rhonchi
-LARGE airway secretions
-needs suctioning
medium rales -
\-middle airway secretions
-needs CPT
Fine rales -
\-fluid in alveoli
-CHF, pulmonary edema
, -IPPB, heart drugs, diuretics and O2
Wheeze -
\-due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor -
\-upper airway obstruction
-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub -
\-coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ -
\-closure of the mitral and tricuspid valves at the beginning of ventricular contraction
Heart Sound S₂ -
\-closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ -
\-abnormal and may suggest CHF
Heart Sound S₄ -
\-abnormal and indicative of cardiac abnormality such as myocardial infarction or
cardiomegaly
Heart murmurs -
\-sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits -
\-sounds made in an artery or vein when blood flow becomes turbulent or flows at an
abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
QUESTIONS AND ANSWERS.
Laryngectomy & Laryngectomy tubes -
\-pt will breath through a laryngectomy tube initially
-pt cannot be orally or nasally intubated
-tube will be removed after 3-6 weeks then pt will have a permanent stoma
-tubes do NOT have an inflatable cuff
Ascites -
\accumulation of fluid in the abdomen caused by LIVER FAILURE
Venous distention -
\-occurs with CHF
-seen with obstructive patients (seen in exhalation phase)
Capillary refill -
\-indication of peripheral circulation
-Normal < 3 seconds
Jaundice skin color -
\-increase in bilirubin.
-mostly in face and trunk
Bradypnea (oligopnea) -
\-decreased respiratory rate (<12bpm) variable depth and irregular rhythm
Hyperpnea -
\-increased rate, depth, with regular rhythm
Cheyne-Stokes -
\-gradually increasing then decreasing rate and depth in a cycle lasting from 30 - 180
secs, with apnea up to 60 secs
-increased ICP, meningitis, overdose
Biots -
\-increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's -
,\-increased rate, depth, irregular rhythm, breathing sounds labored
-Raspy voice
Apneustic -
\prolonged gasping inspiration followed by extremely short, insufficient expiration
-respiratory center problems, trauma, tumor
cachectic -
\muscle atrophy/loss of muscle tone
retractions -
\-chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
Character of cough -
\-dry, non-productive cough may indicate tumor in the lungs or asthma
-productive cough may indicate infection
evidence of difficult airway -
\-short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
pulsus paradoxus -
\-pulse/blood pressure varies with respiration. may indicate severe air trapping (status
asthmaticus or cardiac tamponade)
tactile fremitus -
\-vibrations felt by hand on chest wall
-vocal fremitus: voice vibrations on the chest wall
-pleural rub fremitus: grating sensation due to roughened pleural spaces
-Rhonchial fremitus(palpable rhonchi): secretions in airways
Crepitus -
\-bubbles of air under skin that can be palpated and indicates subcutaneous
emphysema
Resonant percussion -
\-hollow sound
-normal lungs
Flat percussion -
\-heard over sternum, muscles, or areas of atelectasis
,Dull percussion -
\-heard over fluid-filled organs such as heart or liver (thudding)
-pleural effusion or pneumonia
Tympanic percussion -
\-heard over air-filled stomach.
-drum-like sound and when heard over lung = increased volume
Hyperresonant -
\-found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds -
\normal sounds in lungs
bronchial breath sounds -
\-normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony -
\-patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy -
\-increased intensity or transmission of the spoken voice and indicate
CONSOLIDATION or PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales -
\-crackles
-secretions/fluid
Coarse rales -
\-rhonchi
-LARGE airway secretions
-needs suctioning
medium rales -
\-middle airway secretions
-needs CPT
Fine rales -
\-fluid in alveoli
-CHF, pulmonary edema
, -IPPB, heart drugs, diuretics and O2
Wheeze -
\-due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor -
\-upper airway obstruction
-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub -
\-coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ -
\-closure of the mitral and tricuspid valves at the beginning of ventricular contraction
Heart Sound S₂ -
\-closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ -
\-abnormal and may suggest CHF
Heart Sound S₄ -
\-abnormal and indicative of cardiac abnormality such as myocardial infarction or
cardiomegaly
Heart murmurs -
\-sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits -
\-sounds made in an artery or vein when blood flow becomes turbulent or flows at an
abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
