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Y1 Respiratory > Clinical Skills > Flashcards

Clinical Skills Flashcards

1
Q

Target SaO2 for most people

A

94-98%

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2
Q

What clues might exist there is a respiratory complaint?

A

peak flows, inhalers, IV drips

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3
Q

Where can tar staining also be seen?

A

around the hair line - yellowing in fringe area

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4
Q

Signs of finger clubbing (5)

A 
Change in nail bed angle
Nail bed feels boggy
Sharper angle with cuticle
Distal ends of fingers may appear enlarged or bulging
Nail curves downward
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5
Q

When asthma is considered severe, the PEFR is…

A

33-50%

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6
Q

What must you do before assembling and giving nebuliser?

A

the drug

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7
Q

polycythemic patients become cyanosed at ______ SaO2 because there is an increase in the level of the RBCs in the blood

A

higher

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8
Q

How can JVP be assessed if not visible using conventional method?

A

pressing in the RUQ to circulated more blood from liver

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9
Q

What should you ask the patient to do when auscultating?

A

breath deeply but at a rate normal for them, ask them to take deep breaths when they feel the stethoscope move

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10
Q

You take the average of PEFR - true or false?

A

False

Take the best of all three as given

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11
Q

FiO2 of Reservoir mask

A

60-80%

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12
Q

the nasal cannula prevents rebreathing of expired CO2?

A

true

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13
Q

Example of low pitched sound

A

bowel sounds

heart murmurs

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14
Q

When might a spacer be useful

A

when the patient technique is not great

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15
Q

When examining the posterior aspect of the chest for percussion and auscultation, what is best for the patient?

A

ask them to swing their legs round and sit over the side of the bed

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16
Q

Normal Pulse

A

60-100bpm

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17
Q

What does oedema in the legs potentially indicate?

A

DVT

Pulmonary hypertension/R. Ventricular failure

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18
Q

Second step when visiting patient

A

introduce self, check you have the right patient and confirm details, explain plan and gain consent

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23
Q

What does palpation involve?

A

feeling for the trachea in the neck - should be in the middle of the notch above the sternum
chest expansion

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24
Q

Normal SaO2 range for healthy individuals

A

94-100%

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25
Q

Where should you percuss and ascultate?

A

anteriorly, posteriorly and laterally

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26
Q

How loud are bronchovesicular breath sounds?

A

intermediate

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27
Q

When asthma is considered moderate, the PEFR is….

A

50-75%

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28
Q

When asthma is considered life-threatening, the PEFR is

A

<33%

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30
Q

Abnormal breath sounds are…

A

bronchial

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31
Q

How loud are bronchial breath sounds?

A

loud

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32
Q

Patients should bite down around the mouthpiece of their inhaler - true or false?

A

false

they should form seal with their lips and have the inhaler between their teeth

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33
Q

Moving on from hand exam what do you check?

A

pulse, resp rate, skin

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34
Q

bronchial breath sounds are

A

harsher than vesicular sounds

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35
Q

Example of high pitched sound

A

breath sounds

normal heart sounds

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35
Q

palmar erythema

A

redness of the thenar and hypothenar eminence

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37
Q

Location to palpate trachea

A

supra-sternal notch

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39
Q

What side of the bed should you approach the patient

A

The patients right

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40
Q

When asthma is considered mild, the PEFR is…

A

> 75%

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41
Q

Diaphragm of the stethoscope is best for hearing _______ pitched sounds

A

high

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41
Q

How might you assess your patients ability to take part?

A

breathing ability, use of accessory muscles, NEWS, ability to speak in full sentences

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42
Q

vesicular breath sounds normally have a shorter expiration than inspiration - true or false?

A

true

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43
Q

Target SaO2 for people who are at risk of Type II respiratory failure

A

88-92%

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45
Q

How do you perform percussion?

A

left finger lying parallel to the ribs and in between the ribs - tap using middle right finger
need to press firmly into the chest

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46
Q

Tracheal breath sounds are?

A

very loud

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47
Q

What can give inaccurate results in SaO2 measurements? (4)

A

nail polish, strong ambient light, severe anemia, CO poisoning

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50
Q

Less common causes of finger clubbing (6)

A 
coeliac 
cirrhosis of liver
dysentery
graves disease
overactive thyroid
other cancers
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51
Q

Peripheral cyanosis can occur in isolation from central cyanosis - true or false?

A

true

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52
Q

situations where bronchial breath sounds might be heard?

A

collapse
consolidation
fibrosis

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53
Q

The reservoir mask can reach 100% oxygen delivery if used with high flow rates - true or false?

A

false

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54
Q

Type I Respiratory Failure

A

Low level of O2 without an increase in CO2

Pneumonia, ARDS

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56
Q

What should the patient do before taking the inhaler?

A

big breath out

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57
Q

Fine wrist tremor is indicative of…

A

b-agonist use such as salbutamol

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58
Q

Where must you inspect?

A

the axilla

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59
Q

common causes of cyanosis (3, 3;2)

A 
lung diseases - COPD, pneumonia, pulmonary embolis
cardiac diseases - R-> L cardiac shunt
abnormal haemoglobin 
    methaemoglobinaemia
    suflhaemoglobinaemia
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60
Q

How long should a patient extend their hands to indicate a tremor?

A

at least 10 seconds

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61
Q

Oxygen must be prescribed - true/false?

A

true

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62
Q

When might the trachea not be in the expected position?

A

where there is upper lobe pathology i.e. fibrosis, collapse or occasionally tension pneumothorax

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63
Q

How do you place your hands to check for chest expansion?

A

fingers splayed bringing chest towards midline. Have thumbs around the midline but allow them to move - look for equal movement of both thumbs

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64
Q

In anemic patients the SaO2 is higher before cyanosis occurs - true or false?

A

false

the SaO2 is lower because there is decreased levels of haemoglobin and thus longer before 5g/dL deoxyhaemoglobin

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67
Q

Tar staining is indicative of….

A

heavy smokers

69
Q

Where would you hear stridor?

A

Inspiration

70
Q

Pathologies associated with assymetry in chest expansion

A

Collapse
Consolidation
Pleural Effusion
Fibrosis

71
Q

When asking patient to do peak flow, what should be checked?

A

whether the patient has done it before, what their previous best score is, whether the pointer is at 0

72
Q

Signs that may indicate DVT?

A

calf hot, red with greater girth than the other leg

72
Q

Instructions for PEFR to patient

A 
Ask if they have done it before
If so, what is their best score
Take a deep breath in (as much as possible)
Seal lips around the tube
Blow out as hard and fast as they can
Repeat twice more
BEST of three
73
Q

Steps in taking the inhaler

A 
breath out
tight seal around inhaler
start to breath in and release medication
continue breath in slowly
hold breath for 10s
74
Q

What sort of pulse might be felt in a patient who has used b2-agonists?

A

tachycardic which may be thready

75
Q

Where should you start your percussion?

A

apex around the clavicle

76
Q

Normal respiratory rate

A

12-18 breaths a minute

77
Q

Indications of FiO2

A

Type II resp. failure and need for exact FiO2

78
Q

Where might a pneumoectomy take place?

A

from behind in the lung

79
Q

What sort of pulse and characteristics might be seen in a patient with CO2 retention?

A

bounding pulse and patient may appear drowsy

80
Q

Simple Face Mask

A

5-10L/min

81
Q

How should the patient be when listening to inspiration and expiration?

A

have their mouth open

82
Q

Lymph nodes in the face and neck (8)

A 
submental
submandibular
anterior and posterior triangle
pre and post auricle
occipital
supraclavicular
83
Q

How should the patient be positioned if possible for PEFR?

A

standing

84
Q

Where would you hear a wheeze in the respiratory cycle?

A

expiration

85
Q

Flapping wrist tremor is indicative of…

A

CO2 retention

86
Q

What does redness in the face and hands indicate in a respiratory setting?

A

CO2 retention

87
Q

cyanosis is a ________ __________ of the skin due to __________ blood which typically occurs when the amount of deoxyhaemoglobin is (>)5g/dL and SaO2 is

A

bluish discolouration, deoxygenated blood, >, 85

87
Q

What is sulfhaemoglobinaemia?

A

abnormal haemoglobin secondary to drugs i.e. sulfonamides

89
Q

Indications of Simple Face Mask

A

Short term, low oxygen requirements

90
Q

Why should you not worry about giving a COPD patient a reservoir mask in an acute situation?

A

not all COPD patients retain CO2 and hypoxia will kill before hypercapnia

91
Q

How does a spacer such as an aerochamber help?

A

slows down rate of breathing in

can be used to have 2 or 3 normal breaths rather than one big breath

94
Q

Why is it more difficult to examine chest expansion anteriorly on a female?

A

due to chest tissue - also applies to percussion

95
Q

Indications for Reservoir mask

A

critical illness

96
Q

Bell of the stethoscope is best for hearing _______ pitched sounds

A

low

96
Q

What should the patient do when examining the supraclavicular lymph nodes?

A

tilt their head towards side being examined

97
Q

How much fluid must be leaked before oedema becomes noticeable?

A

500ml

98
Q

How do you assess JVP?

A

patient should be lying at 45 degree angle on bed and move their head to opposite side. Should be visible just superior to clavicle

98
Q

FiO2 with simple face mask

A

variable

99
Q

Nebulising canninster must remain….

A

upright

102
Q

Ipratropium

A

medication that opens medium to large airways

104
Q

liquid i.e. pleural effusion, sounds _______ on percussion

A

stony dull

106
Q

How loud are vesicular sounds?

A

soft

107
Q

4 aspects of chest examination

A

inspection
palpation
percussion
auscultation

108
Q

Common causes of peripheral cyanosis in isolation

A

Reynauds phenomenom
Beta blockers
Reduced cardiac output due to HF or hypovolaemia
Venous obstruction i.e. DVT or obstruction to SVC

109
Q

What do electric nebulisers use?

A

air

110
Q

How can oedema be assessed?

A

an imprint may be left if pressed for 5secs - be gentle, as may be painful

111
Q

Abnormal percussion over pneumothorax is…

A

hyper-resonant

112
Q

Venturi Mask

A

Controlled oxygen delivery with exact percentage FiO2 delivered as stated on device

113
Q

Upper lobe pathologies leading to tracheal dislocation

A

fibrosis
collapse
tension pneumothorax

114
Q

How do you prepare a resevoir mask?

A

allow the bag to fill with air by pressing on the valve, empty the bag and allow to go again

115
Q

plethora

A

redness in the cheeks

115
Q

FiO2

A

Fraction of Inspired Oxygen

115
Q

When giving any form of treatment or performing any test, you should…

A

ask permission

check for questions

116
Q

Signs in general resp. exam in hands (5)

A 
Finger Clubbing
Cyanosis
Palmer Erythema
Tar Staining
Tremor
116
Q

Peak Flow is a good clinical assessment of…

A

Asthma

117
Q

What should be removed before assessing SaO2?

A

nail polish

117
Q

Type II Respiratory Failure

A

Causes a change in O2 and CO2 levels as a result of poor alveolar ventilation due to conditions such as COPD, ankylosing spondylitis

117
Q

Indications of Nasal Cannula

A

Low oxygen requirements

Patient able to speak and eat freely

117
Q

Typical nebulising drugs?

A

salbutamol

ipratropium

119
Q

Where else might cyanosis be seen in the face?

A

under the tongue

119
Q

oxygen cannot be prescribed retrospectively - true or false?

A

false - in emergency situations oxygen may be prescribed retrospectively

120
Q

Normal breath sounds are…

A

vesicular

122
Q

What may be noticeable on the skin and why?

A

thin or easily bruised skin

steroid use

123
Q

Oxygen prescription should contain the following details (6)

A 
patient name
DOB
Unique ID
Drug Name (oxygen)
Route of administration (inhaled)
the target
123
Q

Where should a Peak flow meter tube be discarded?

A

Orange bin

124
Q

What might a grey and breathless patient have?

A

anemia - they cannot get enough oxygen as not enough blood to carry oxygen

125
Q

polycythemia

A

have increased levels of RBCs and a raised haematocrit of >55%
decrease in relative plasma volume or increase in RBC

127
Q

solid material sounds ______ on percussion

A

dull

128
Q

What should be checked in the face/neck? (5)

A 
cyanosis
plethora
pallor of conjunctiva
pursed lip breathing
lymph nodes
128
Q

Appropriate nebulising flow rate

A

6-8L/min

128
Q

After checking PEFR what should you do? (3)

A

tell patient what you have found, check for questions, wash hands

128
Q

How should you check for chest expansion?

A

grip both hands firmly around the lower rib cage with thumbs in the middle of the chest. Ask patient to breath in and out.
Ask the patient to take a large deep breath

128
Q

Lung consolidation is when….

A

lung tissue is filled with liquid

129
Q

Reduced breath sounds are common when?

A

there is damage to alveoli

130
Q

Why might there be asymmetry in chest expansion?

A

collapse, consolidation, pleural effusion, fibrosis

131
Q

Most common causes of finger clubbing (4, 3:3)

A 
Lung Cancer
Congenital Heart Defects
Chronic Lung Infections
    Bronchieotasis
    cystic fibrosis
    lung abscesses
Infectious endocarditis
131
Q

What is methaemoglobinaemia?

A

abnormal haemoglobin due to genetic disorder or secondary to drugs i.e. quinones, sulfonamides

132
Q

From what side is a physical examination done?

A

patients right hand side

132
Q

Bronchial breath sounds have a shorter expiration than inspiration - true or false?

A

false they have longer expiratory sounds

133
Q

When is PEFR normally lower?

A

in the morning

133
Q

air filled tissue sounds _____ on percurssion i.e. pneumothorax

A

hyper-resonant

133
Q

A good fit of nebuliser is important to…

A

ensure the drugs do not irritate the patients eyes

134
Q

First thing to do when visiting a patient

A

WASH YOUR HANDS

ya wee dirty

134
Q

FiO2 achieved with nasal cannula

A

24-50% (variable because of room air and pattern of breathing)

135
Q

Inspection involves

A

looking around patient area
looking for chest shape and movement
looking for prominent veins
scars from chest drains or surgery

136
Q

Nasal Cannula

A

2-5L/min - preferably not more than 4

136
Q

Reservoir Mask

A

Used in critical illness - 15L/min

136
Q

Ascultation is usually done with the bell - true or false?

A

false

usually with diaphragm

138
Q

PEFR is a measurement of

A

how hard and fast a patient can exhale after a maximal inspiration

Y1 Respiratory (20 decks)

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