assessments
What would be a positive finding if you were assessing for bronchophony during auscultation? What would the pathology be?
Have the patient repeat "99" and if there is a distinct transmission --> pulmonary consolidation
What might rales/crackles mean during auscultation?
Edema, pneumonia, CHF
Early inspiration: emphysema, bronchitis or bronchiectasis
Late inspiration: CHF or pulmonary fibrosis
Expiration: fluid in larger airways
What are some precautions to postural drainage? What are some relative contraindications?
Pulmonary edema, hemoptysis, massive obesity, large pleural effusion, massive ascites
Increased CIP, hemodynamically unstable, recent spinal fusion, recent head trauma, diaphragmatic hernia, recent eye surgery
What is a normal nasal cannula used for? How much oxygen can it deliver? How much does a green nasal cannula deliver?
Normal: delivers 1-6Lpm- low flow
Green: delivers 6-15Lpm- high flow
MOST COMMON
What is the criteria for stopping exercise when monitoring blood pressure and SPO2?
If there is an increase/decrease in DBP> 10 mmHg with activity
If Spo2 <88%
What would be a positive test if assessing whispered pectoriloquy? What would the pathology be?
The patient whispers "1234", if we can hear it clearly through auscultation thats a positive test
May indicate lung collapse
What would wheezes/rhonchi mean during auscultation?
Asthma, bronchial obstruction
When would you use pursed lip breathing, paced breathing, stacked breathing and diaphragmatic breathing?
Pursed lip: allows the patient to take control over respiratory rate
Paced breathing: for patients who are breathing really fast/shallow, can be used during walking or stair climbing
Stacked breathing: for patients who can take deep breaths, helps get all the air in they need to huff or cough effectively
Diaphragmatic breathing: helps decrease use of accessory muscles for breathing and strengthens the diaphragm muscle
What is a Venturi mask used for? How much O2 can it deliver? Who is it most useful for?
It is a high flow O2 device
Can deliver up to 15 Lpm
Useful for patients with COPD- you can change the flow meters
If someone had orthostatic hypotension what would we see their blood pressure do?
They would have a drop in SBP more than 20 mmHg
What would a positive test be during assessment of Egophony? What pathology might it indicate?
"E" sounds like an "A" during auscultation
May indicate pneumonia
What is an abnormal result when testing for fremitus?
The patient repeats "99" and if there is an increased in vibrations in the chest wall during palpation it is a positive test
What is a PEP/flutter device used for?
Gives resistance to expiration, can also assist in secretion clearance
Why would a non-rebreather mask be used over a green nasal cannula? How much O2 can it deliver?
If the patient has nasal irritation, can also be used to deliver inhalant medication
Low flow device- delivers 5-10 Lpm
What do platelets do in the body? What is the normal amount?
Helps with blood clotting
Normal: 100-400
If you heard a loud hyper resonating sound during mediate percussion, what pathology would this indicate?
Emphysema
Could also be assessing for pneumonia or atelectasis
How long should you have a patient in a postural drainage position? What will you have them do during this?
15-20 minutes if they can tolerate it
Have them breath deeply and huff/cough throughout
What are trunk rotation exercises beneficial for in helping strengthen the pulmonary muscles?
Helps during expiratory phase to decrease residual volumes
What is the difference between a partial and full non rebreather mask? How much O2 can they deliver? When are these used?
Partial: has one way valve- can deliver 10-15 Lpm
Full: has 2 one way valves- can deliver up to 25 Lpm
Used in severely hypoxic patients for emergent situations
What would low levels of hematocrit mean? What are the normal values for males/females?
May indicate anemia
Males: 41-50
Females: 36-44
What is the cut off point on the Borg/RPE scale for patients with pumonary and cardiac dysfunctions?
Borg- 13
Modified borg- 5
If we wanted to do postural drainage for a patient's right lower lung lobe what position would we put them in?
Patient will be laying on their stomach at a slight incline with their head lower than their feet, they will be laying more on their left side
What are the stages of a cough?
Irritation --> inspiration --> compression (glottis closes) --> expulsion
What is an important thing to remember to do before putting on a partial/full non-rebreather mask?
Inflate the bag prior to use
What does hemoglobin do in the body? What are the normal values for men and women?
Males: 13-18
Females: 12-16