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CMN 568 - Test Review with guiding questions
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CMN 568 - Test Review with guiding questions
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CMN 568 - Test Review with guidingquestions
Physical examination - ANS - Inspection
- Palpation
- Percussion
- Auscultation
Observe pattern of breathing - ANS - RR (12-14rr/min)
- Rhythm (regular with a sigh every 90 breaths or so)
- Depth of breathing / tidal volume (5ml/kg)
- Relative time spent on inspiration and expiration (ratio 2:3)
Inspect for extrapulmonary signs of pulmonary disease - ANS Use what you find to perform
more detailed exam
Palpate - ANS - Trachea at suprasternal notch
- Posterior chest wall (gauge fremitus / transmission through lungs of vibrations of spoken
words)
- Anterior chest wall (assess cardiac impulse)
Percussion - ANS Identifies dull areas or hyperresonant areas
Auscultation - ANS Lung sounds
Pulmonary Function Tests - ANS Measures airflow rates, lung volumes, ability of lung to
transfer gas across alveoli-capillary membrane
What would indicate to FNP that patient needs PFT? - ANS - Assess type/extent of lung
dysfunction
- Dx of causes of dyspnea and cough
- Detect early evidence of lung dysfunction
- Follow-up response to therapy
- Pre- op assessment
- Disability eval
Patient presents with acute asthma exacerbation with mild resp. distress. You want to perform a
PFT to see how well gas exchange is occurring. Is this correct management for the patient? -
ANS - No
- PFTs are contraindicated in acute severe asthma, resp. distress, angina aggravated by testing,
pneumothorax, ongoing hemoptysis, active TB
, How do you measure your patients PFTs to establish if they are normal or not? - ANS -
They are measured against predicted values derived from large studies of healthy subject
- Vary with age, gender, height, weight, ethnicity
Tachypnea - ANS Increased resp rate and decreased TV
Irregular rhythm - ANS - Rapid, shallow breathing
- Restrictive lung disease (precursor to resp failure)
Kussmaul resp - ANS - Rapid large volume breathing leads to intense stimulation of resp
center
- R/T metabolic acidosis
Cheyne-Stokes resp - ANS - Rhythmic
- Waxing/waning of rate and TV
- Regular periods of apnea
- Seen in end-stage LV failure, neurologic dx, sleeping at high altitude
Extrapulmonary signs of intrinsic pulmonary disease - ANS - Digital clubbing
- Cyanosis
- Increased CVP
- BLE edema
Digital clubbing - ANS - Lung abscess
- Empyema
- Bronchiectasis
- CF
- Idiopathic pulmonary fibrosis
- AV malformations
- Late presentation of concomitant lung cx
Cyanosis - ANS - Blue or bluish-gray discoloration of skin & mm due to amounts of
unsaturated HgB
in capillary blood
Anemia - ANS May prevent cyanosis from appearing
Polycythemia - ANS Cyanosis in mild hypoxemia
Cyanosis not reliable indicator of hypoxemia - ANS Get arterial PO2 or HgB saturation
measured
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