FULL REVIEW CRT/RRT (NBRC)100%
ACCURATE
Ascites - ANSWER accumulation of fluid in the abdomen caused by LIVER FAILURE
Venous distention - ANSWER -occurs with CHF
-seen with obstructive patients (seen in exhalation phase)
Capillary refill - ANSWER -indication of peripheral circulation
-Normal < 3 seconds
Jaundice skin color - ANSWER -increase in bilirubin.
-mostly in face and trunk
Bradypnea (oligopnea) - ANSWER -decreased respiratory rate (<12bpm) variable depth
and irregular rhythm
Hyperpnea - ANSWER -increased rate, depth, with regular rhythm
Cheyne-Stokes - ANSWER -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 - ANSWER -increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's - ANSWER -increased rate, depth, irregular rhythm, breathing sounds
labored
-Raspy voice
Apneustic - ANSWER prolonged gasping inspiration followed by extremely short,
insufficient expiration
-respiratory center problems, trauma, tumor
cachectic - ANSWER muscle atrophy/loss of muscle tone
retractions - ANSWER -chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
,Character of cough - ANSWER -dry, non-productive cough may indicate tumor in the
lungs or asthma
-productive cough may indicate infection
evidence of difficult airway - ANSWER -short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
pulsus paradoxus - ANSWER -pulse/blood pressure varies with respiration. may
indicate severe air trapping (status asthmaticus or cardiac tamponade)
tactile fremitus - ANSWER -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 - ANSWER -bubbles of air under skin that can be palpated and indicates
subcutaneous emphysema
Resonant percussion - ANSWER -hollow sound
-normal lungs
Flat percussion - ANSWER -heard over sternum, muscles, or areas of atelectasis
Dull percussion - ANSWER -heard over fluid-filled organs such as heart or liver
(thudding)
-pleural effusion or pneumonia
Tympanic percussion - ANSWER -heard over air-filled stomach.
-drum-like sound and when heard over lung = increased volume
Hyperresonant - ANSWER -found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds - ANSWER normal sounds in lungs
bronchial breath sounds - ANSWER -normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony - ANSWER -patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy - ANSWER -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 - ANSWER -crackles
-secretions/fluid
Coarse rales - ANSWER -rhonchi
-LARGE airway secretions
-needs suctioning
medium rales - ANSWER -middle airway secretions
-needs CPT
Fine rales - ANSWER -fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANSWER -due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANSWER -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 - ANSWER -coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANSWER -closure of the mitral and tricuspid valves at the beginning
of ventricular contraction
Heart Sound S₂ - ANSWER -closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANSWER -abnormal and may suggest CHF
Heart Sound S₄ - ANSWER -abnormal and indicative of cardiac abnormality such as
myocardial infarction or cardiomegaly
Heart murmurs - ANSWER -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 - ANSWER -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)
Blood pressure - ANSWER -systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANSWER -angle made by the outer curve of the diaphragm and
the chest wall
-obliterated by pleural effusions and pneumonia
Diaphragm - ANSWER -dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANSWER -patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANSWER -taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANSWER -tip should be positioned below the vocal
chords and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before CXR is
taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANSWER -pacemaker should be positioned in the right
ventricle
-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein and
should rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANSWER -viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
ACCURATE
Ascites - ANSWER accumulation of fluid in the abdomen caused by LIVER FAILURE
Venous distention - ANSWER -occurs with CHF
-seen with obstructive patients (seen in exhalation phase)
Capillary refill - ANSWER -indication of peripheral circulation
-Normal < 3 seconds
Jaundice skin color - ANSWER -increase in bilirubin.
-mostly in face and trunk
Bradypnea (oligopnea) - ANSWER -decreased respiratory rate (<12bpm) variable depth
and irregular rhythm
Hyperpnea - ANSWER -increased rate, depth, with regular rhythm
Cheyne-Stokes - ANSWER -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 - ANSWER -increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's - ANSWER -increased rate, depth, irregular rhythm, breathing sounds
labored
-Raspy voice
Apneustic - ANSWER prolonged gasping inspiration followed by extremely short,
insufficient expiration
-respiratory center problems, trauma, tumor
cachectic - ANSWER muscle atrophy/loss of muscle tone
retractions - ANSWER -chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
,Character of cough - ANSWER -dry, non-productive cough may indicate tumor in the
lungs or asthma
-productive cough may indicate infection
evidence of difficult airway - ANSWER -short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
pulsus paradoxus - ANSWER -pulse/blood pressure varies with respiration. may
indicate severe air trapping (status asthmaticus or cardiac tamponade)
tactile fremitus - ANSWER -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 - ANSWER -bubbles of air under skin that can be palpated and indicates
subcutaneous emphysema
Resonant percussion - ANSWER -hollow sound
-normal lungs
Flat percussion - ANSWER -heard over sternum, muscles, or areas of atelectasis
Dull percussion - ANSWER -heard over fluid-filled organs such as heart or liver
(thudding)
-pleural effusion or pneumonia
Tympanic percussion - ANSWER -heard over air-filled stomach.
-drum-like sound and when heard over lung = increased volume
Hyperresonant - ANSWER -found where pneumothorax or emphysema is present.
-booming sound
vesicular breath sounds - ANSWER normal sounds in lungs
bronchial breath sounds - ANSWER -normal sounds over airways.
-breath sounds over lungs indicate LUNG CONSOLIDATION
Egophony - ANSWER -patient instructed to say E and sounds like A.
-lung consolidation
Bronchophony / whisphered pectoriloquy - ANSWER -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 - ANSWER -crackles
-secretions/fluid
Coarse rales - ANSWER -rhonchi
-LARGE airway secretions
-needs suctioning
medium rales - ANSWER -middle airway secretions
-needs CPT
Fine rales - ANSWER -fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANSWER -due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANSWER -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 - ANSWER -coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANSWER -closure of the mitral and tricuspid valves at the beginning
of ventricular contraction
Heart Sound S₂ - ANSWER -closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANSWER -abnormal and may suggest CHF
Heart Sound S₄ - ANSWER -abnormal and indicative of cardiac abnormality such as
myocardial infarction or cardiomegaly
Heart murmurs - ANSWER -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 - ANSWER -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)
Blood pressure - ANSWER -systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANSWER -angle made by the outer curve of the diaphragm and
the chest wall
-obliterated by pleural effusions and pneumonia
Diaphragm - ANSWER -dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANSWER -patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANSWER -taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANSWER -tip should be positioned below the vocal
chords and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before CXR is
taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANSWER -pacemaker should be positioned in the right
ventricle
-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein and
should rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANSWER -viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
