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RT patient assessment
RT patient assessment
117
Physics
Undergraduate 1
11/16/2011

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Term
Vital signs are used to
Definition
general status, baseline, Monitor response, Observe trends, further action
Term
Four classic Vital Signs
Definition
Temperature, Pulse, Respirations, Blood pressure
Term
Additional observations,
Definition
Height, weight, LOC, level and type of pain, general appearance, Pulse oximetry
Term
Baseline measurement,
Definition
On admission, At beginning of each shift, Before procedure, Any time patient’s condition changes
Term
Normal Vital Signs for a patient depend on:,
Definition
Age, Disease , Treatment
Term
Change in patient’s condition,
Definition
Comparing changes in Vital Signs, signs and symptoms, Establishing differential diagnosis by distinguishing between diseases of similar character by comparing their signs and symptoms
Term
Key to expert assessment:,
Definition
Constant awareness of change, Look, Listen, Touch, Reassess and analyze, Trend, trend, trend… by recording observations in the patient record (chart) for comparison
Term
Hypoxemia General clinical presentation
Definition
Impaired coordination or cooperation, Cool extremities, Diaphoresis (profuse sweating)
Term
Hypoxemia Sensorium (level of consciousness)
Definition
Decreased mental function, Impaired judgment, confusion, Loss of consciousness, Decreased pain perception
Term
Hypoxemia Respiration
Definition
Increased rate and depth of breathing, Difficulty breathing, use of accessory muscles
Term
Hypoxemia Heart rate
Definition
Tachycardia , Arrhythmia (irregular heart rate), especially during sleep
Term
Hypoxemia Blood pressure
Definition
Increased blood pressure initially
Term
Height and Weight,
Definition
Routinely measured , Scales must be age appropriate and regularly calibrated
Term
If hospitalized = admission weight,
Definition
Document in kilograms (1 kg = 2.2 lb), every 24 to 48 hours, Fluctuations in weight may mean dehydration/fluid overload, Follow intake/output (I&O)
Term
General Clinical Impression,
Definition
levels of distress and severity of illness, personality, hygiene, culture, and reaction to illness, May dictate order of care, physical examination
Term
Cardiopulmonary distress suggested by:,
Definition
Labored, rapid, irregular, or shallow breathing, Coughing, choking, wheezing, chest pain, cyanosis
Term
Anxiety may be suggested by:,
Definition
Restlessness, fidgeting, tense look, difficulty communicating
Term
Pain may be suggested by:,
Definition
Drawn features, moaning, shallow breathing, guarding, refusal to take deep breath
Term
Head-to-toe inspection
Definition
Hearing, smelling, seeing, touching, perception
Term
Ectomorphic:
Definition
Slight development, body linear and delicate with sparse muscular development
Term
Endomorphic:
Definition
Soft, roundness throughout the body; large trunk and thighs with tapering extremities
Term
Mesomorphic:
Definition
Preponderance of muscle, bone, and connective tissue, with heavy hard physique of rectangular outline (between endomorphic and ectomorphic)
Term
Sthenic:
Definition
Average height; well-developed musculature, wide shoulders, flat abdomen; oval face
Term
Hypersthenic:
Definition
Short, stocky, may be obese; shorter, broader chest; thicker abdominal wall; rectangular-shaped face
Term
Hyposthenic:
Definition
Tall, willowy, musculature poorly developed; long, flat chest; abdomen may sag; long neck; triangular face
Term
Asthenic:
Definition
Exaggeration of hyposthenic body type
Term
Cachectic:
Definition
Profound and marked malnutrition; wasting; ill health
Term
Debilitated:
Definition
Weak, feeble, lack of strength (with weakness and loss of energy)
Term
Failure to thrive:
Definition
Physical and developmental delay or retardation in infants and children; seen in children with illness but more often in children with psychosocial or maternal deprivation
Term
Pain Level and Type,
Definition
“Fifth vital sign”, Pain level scale 1-10 to quantify subjective measure, facial expressions and verbal description, Find linked symptoms, alleviating/aggravating factors, Patients with chronic lung disease often complain of shortness of breath when experiencing pain
Term
Level of Consciousness,
Definition
Measure cerebral oxygenation, Evaluation of time, place, and person (“Oriented × 3”), Deterioration from restlessness to coma, Status of sensorium directs treatment plan, Glasgow Coma Scale
Term
Temperature,
Definition
Normal: 98.6°F (37°C), range (97°-99.5°F), variations (1°-2°F) , Lowest in morning; highest late afternoon, Normal increase from exercise, ovulation, pregnancy, Balance of heat production and loss, Dissipation through sweating, peripheral vasodilation, hyperventilation
Term
Fever is
Definition
Elevation of temperature, From normal activities (exercise) = hyperthermia, From disease (infection) = fever
Term
Newborns, AIDS, Transplant recipients on anti-rejection drugs may not be able to generate….
Definition
…fever despite infection
Term
Ratio of fever temperature increase per degree Celsius to O2 and CO2 production
Definition
IO2 consumption and CO2 production increase 10% for each 1° C elevation in body temperature , Patients with limited respiratory function may develop respiratory failure in response to fever
Term
Hypothermia ,
Definition
Body temperature below normal, Head injury, cold exposure, Reduced O2 consumption and CO2 production, Slow and shallow breathing
Term
Rectal temperature
Definition
body core temperature, Rectal in comatose patients, Axillary: safe and accurate in infants and small children, 1°F lower than oral, 2°F lower than rectal
Term
Pulse,
Definition
Evaluate rate, rhythm, and strength, Normal rate: 60-100 beats/min adult, The younger the patient, the faster the rate, Arrhythmia = irregular rhythm
Term
Tachycardia =
Definition
>100 beats/min, Anxiety, hypoxemia, exercise, fever, anemia
Term
Bradycardia =
Definition
<60 beats/min, Diseased heart, athletes, medication side effects
Term
Measurement of Pulse Rate,
Definition
Radial and brachial artery are most common sites, Central pulses (Carotid, femoral) if hypotension present
Term
Bigeminy is
Definition
a rhythm coupled in pairs
Term
Volume of the pulse can be described as
Definition
Bounding, Full, Normal, Weak, Thready, Absent
Term
Pulse deficit = auscultated – palpated ,
Definition
A difference in count between heartbeat and peripheral pulse. Pulse is not reaching the periphery. This can occur in irregular heart rhythms, atrial fibrillation, and with pacemakers
Term
What is Pulsus paradoxus
Definition
A pulse whose Strength decreases with inspiration
Term
Alternans =
Definition
Alternating strong and weak pulses
Term
Apnea
Definition
Absence of spontaneous ventilation
Term
Eupnea
Definition
Normal rate and depth of breathing
Term
Bradypnea
Definition
Less than normal rate of breathing
Term
Tachypnea
Definition
Rapid rate of breathing
Term
Hypopnea
Definition
Decreased depth of breathing
Term
Hyperpnea
Definition
Increased depth of breathing with or without an increased rate
Term
Sighing respiration
Definition
Normal rate and depth of breathing with periodic deep and audible breaths
Term
Intermittent breathing
Definition
Irregular breathing with periods of apnea
Term
Blood Pressure
Definition
Force exerted against arterial walls, Systolic: peak force during ventricular contraction, Diastolic: force during ventricular relaxation
Term
Pulse pressure Equation = ,
Definition
P systolic – P diastolic
Term
Pulse pressure normal
Definition
Normal: 35-40 mm Hg, <30 mm Hg: poor peripheral perfusion
Term
Blood Pressure normal & normal range
Definition
Normal: 120/80 mm Hg, Systolic normal range 140-90, Diastolic normal range 90-60
Term
Hypertension BP range: ,
Definition
>140/90 mm Hg
Term
Hypotension BP range:,
Definition
<90/60
Term
Measurement of Blood Pressure,
Definition
Length of the bladder should cover: , 80% distance around arm in an adult, 100% distance around arm in a child, Too wide a bladder: underestimate pressure, Too narrow/short: overestimate pressure
Term
Auscultatory Blood Pressure Measurement,
Definition
Korotkoff sounds: blood flow in arteries resumes, 1st sound = systolic pressure, Disappearance of sounds = diastolic pressure
Term
Effects of the Respiratory Cycle on BP,
Definition
Systolic pressure decreases (2-4 mm Hg) with inspiration, If it drops >10 mm Hg: pulsus paradoxus, Asthma, cardiac tamponade are common causes, Pulsus paradoxus in asthma signifies more severe case
Term
Interviewing Purposes
Definition
To establish a rapport with patient, To obtain essential diagnostic information, To monitor changes in the patient’s symptoms
Term
Common questions to ask for each symptom
Definition
When did it start?, How severe is it?, Where on the body is it?, What seems to make it better or worse?, Has it occurred before?
Term
Dyspnea
Definition
Occurs when work of breathing is too high and/or when drive to breathe is elevated, Degree evaluated by asking level of exertion at which it occurs.
Term
Orthopnea:
Definition
dyspnea in the reclining position; associated with CHF
Term
Platypnea:
Definition
dyspnea when moved to the upright position
Term
Cough occurs when
Definition
cough receptors in airways are stimulated by inflammation, mucus, foreign material, or noxious gases
Term
Weak cough often due to
Definition
high Raw, poor lung recoil, weak muscles
Term
Patients with airways disease often have
Definition
loose, productive cough
Term
Sputum production
Definition
Mucus from lower airways but expectorated through mouth is called “sputum.”, Change in sputum color, viscosity, or quantity may mean infection
Term
Sputum that has pus cells in it is said to be
Definition
purulent
Term
Sputum that is foul smelling is
Definition
fetid
Term
Hemoptysis
Definition
Coughing up blood or bloody sputum from the airways, Most often occurs in patients with a history of lung disease, Common causes include bronchitis, lung cancer, tuberculosis, trauma, and pulmonary embolism
Term
Vomiting blood from the gastrointestinal tract is known as
Definition
hematemesis
Term
Chest pain types (2)
Definition
Pleuritic chest pain is located laterally or posteriorly, sharp in nature, increases with deep breathing, Nonpleuritic chest pain is located in center of chest and may radiate to shoulder or arm; often caused by coronary artery disease; then called angina
Term
Fever
Definition
Defined as an elevation of body temperature due to disease, Most often due to viral infection; also seen with pneumonia, tuberculosis, and some cancers
Term
Fever with a cough suggests
Definition
respiratory infection
Term
Fever increases the body’s need for
Definition
oxygen
Term
Pedal edema
Definition
Swelling of the ankles is most often due to heart failure., Patients with chronic hypoxemic lung disease usually develop right heart failure (cor pulmonale) due to pulmonary hypertension, Pedal edema may indicate the need for oxygen therapy.
Term
Physical Examination
Definition
Level of consciousness and orientation to time, place, and person , Vital Signs = RR, HR, BT, BP
Term
Nasal flaring is often seen in
Definition
Infants with respiratory distress and an increase in the WOB
Term
Pursed-lip breathing is seen in patients with
Definition
COPD who have obstruction of the small airways
Term
The trachea may shift left or right with
Definition
upper lobe abnormalities or mediastinal tumors
Term
Jugular venous distention is seen in patients with
Definition
CHF and cor pulmonale
Term
Enlarged lymph nodes in the neck may occur with
Definition
Infection or malignancy
Term
A barrel chest is seen with
Definition
emphysema, indicates poor lung recoil
Term
Pectus carinatum =
Definition
abnormal protrusion of the sternum
Term
Pectus excavatum =
Definition
abnormal depression of the sternum
Term
Kyphoscoliosis =
Definition
abnormal curvature of the spine; often causes severe restrictive lung disease
Term
Rapid/shallow breathing is consistent with
Definition
Restrictive lung diseases
Term
A prolonged expiratory time is consistent with
Definition
Obstructive lung disease
Term
Upper airway obstruction often causes a
Definition
prolonged inspiratory time
Term
Deep and fast breathing is consistent with
Definition
Kussmaul breathing (ketoacidosis)
Term
Tactile (or vocal) Fremitus is a
Definition
vibration felt on the patient's chest during low frequency vocalization
Term
Tactile fremitus is increased with
Definition
pneumonia and atelectasis
Term
Tactile fremitus is reduced with
Definition
emphysema, pneumothorax, and pleural effusion
Term
A unilateral reduction in chest expansion is consistent with
Definition
pneumonia or pneumothorax
Term
Chest Percussion
Definition
Resonance of the chest is evaluated with percussion, place middle finger of one hand firmly against patient's chest, With end of the opposite middle finger, strike first finger, Categorize what you hear as normal, dull, or hyperresonant
Term
Lung sounds come in two varieties:
Definition
breath sounds and adventitious lung sounds
Term
ALS =
Definition
the abnormal sounds superimposed on the breath sounds (crackles and wheezes)
Term
Decreased resonance =
Definition
pneumonia or pleural effusion
Term
Increased resonance =
Definition
emphysema or pneumothorax
Term
Tracheal breath sounds:
Definition
heard directly over the trachea and created by turbulent flow; loud and high-pitched
Term
Increased breath sounds are often called
Definition
“bronchial” breath sounds
Term
Bronchovesicular breath sounds =
Definition
heard around the sternum; softer and slightly lower in pitch
Term
Vesicular breath sounds =
Definition
heard over lung parenchyma; represent attenuated turbulent flow sounds from the larger airways; very soft and low-pitched
Term
Breath sounds reduced with
Definition
shallow breathing and when attenuation is increased (when the lung is hyperinflated as in emphysema)
Term
Breath sounds Increased when
Definition
attenuation is reduced and the turbulent flow sounds pass through the lung faster (pneumonia)
Term
ALS
Definition
Come in two varieties: continuous “wheezes” and discontinuous “crackles”, A continuous ALS heard over the upper airway is called “stridor.”
Term
Wheezes are consistent with
Definition
airways obstruction; monophonic wheezing indicates one airway is affected, and polyphonic wheezing indicates many airways are involved
Term
Fine crackles are produced by
Definition
the sudden opening of small airways in the lung with deep breathing; they are heard with pulmonary fibrosis and atelectasis
Term
Abdominal Exam
Definition
abdomen is inspected and palpated for distention and tenderness
Term
enlarged liver (hepatomegaly) is consistent with
Definition
cor pulmonale
Term
Abdominal paradox is present when
Definition
abdomen sinks inward during inspiration; this is sign of diaphragm fatigue
Term
Examination of the Extremities
Definition
Digital clubbing is not common but seen in large variety of chronic conditions: congenital heart disease, bronchiectasis, various cancers, interstitial lung diseases
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