DOCSLIB.ORG

VIRAL CROUP ALGORITHM: Outpatient/ED Management

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
VIRAL CROUP ALGORITHM: Outpatient/ED Management CLINICAL PATHWAY VIRAL CROUP ALGORITHM: Outpatient/ED Management Inclusion Criteria Severity Assessment • Previously healthy • Age 6 months to 6 years Exclusion Criteria • Symptoms suggestive of an alternative diagnosis • Known upper airway abnormality Mild Severity Moderate Severe/Life-Threatening • Hypotonia or neuromuscular • Stridor only with activity/ • Inspiratory stridor at rest, • Biphasic stridor or absent due disorder agitation Biphasic with agitation to poor respiratory effort • Suprasternal retractions only • Intercostal AND suprasternal • Severe retractions • Normoxia, no tachypnea, no retractions (intercostal, nasal flaring) tachycardia • Normal saturation on room air, • Hypoxemia or cyanosis, • Normal mental status mild tachypnea, mild marked tachycardia or • Able to talk or feed tachycardia bradycardia • Agitated OR tired, low tone • Abnormal, confused, drowsy • Difficulty in talking / feeding • Unable to talk or feed ! Give Racemic Epinephrine Give Racemic Epinephrine Give Dexamethasone and and Consider other (if not previously given) Give Dexamethasone Give Dexamethasone diagnoses in children (if not previously given) (if not previously given) who appear toxic, have poor response to racemic ephinephrine, Initiate resuscitation and have high fever, or have Immediate Severity continue racemic every 20 a rapid decompensation Assessment minutes Admit to ICU Improved? ! Signs of Impeding Respiratory Failure No Yes • Poor respiratory effort • Stridor may be present or Observation for 3 hours with Consider repeat racepinephrine decreased • minimum Q1 hour assessment • Can be given Q2 hours Listless or decreased LOC • Cyanosis / Hypoxia Remains mild severity Admit Criteria Criteria for Transport • Patient with continued stridor at rest AND any symptoms listed in Patients being evaluated in an Discharge Criteria Worsens to moderate/severe the severity assessment above outpatient clinic or facility outside severity • Minimal stridor at rest(stridor • Patients receiving multiple CHCO/NOC who meet admission with activity to be expected) doses of racepinephrine criteria should be referred to the • Minimal retractions • Patients not otherwise CHCO ED. • Able to talk or feed without meeting discharge criteria difficulty Consider repeat racepinephrine • Consider ICU admission for poor Consider transporting by • 3 hours since racepinephrine response to racepinephrine or ambulance. toxic appearance Discharge Instructions Transport to Inpatient Return for increased work of breathing Management Page 1 of 12 CLINICAL PATHWAY ALGORITHM: Inpatient Management Not Routinely Recommended (No evidence supporting the use of) Inclusion Criteria Viral PCR •Previously healthy Radiographs Severity Assessment • Age 6 months to 6 years Repeat Dexamethasone Exclusion Criteria Cool Mist • Symptoms suggestive of an alternative diagnosis • Known upper airway abnormality • Hypotonia or neuromuscular Moderate Severe/Life-Threatening disorder • Inspiratory stridor at rest, • Mild Severity Biphasic stridor or absent due • Patient in PICU • Stridor only with activity/ Biphasic with agitation to poor respiratory effort agitation • Intercostal AND suprasternal • Severe retractions • Suprasternal retractions only retractions (intercostal, nasal flaring) • Normoxia, no tachypnea, no • Normal saturation on room air, • Hypoxemia or cyanosis, tachycardia mild tachypnea, mild marked tachycardia or • Normal mental status tachycardia bradycardia ! • Able to talk or feed • Agitated OR tired, low tone • Abnormal, confused, drowsy • Difficulty in talking / feeding • Unable to talk or feed Consider other diagnoses in children Give Racemic Epinephrine who appear toxic, Call code and continue have poor response Give Dexamethasone racemic every 20 minutes to racemic ephinephrine, Give Dexamethasone (if not previously given) have high fever, or have (if not previously given) a rapid decompensation Immediate Severity Assessment ! Signs of Impeding Respiratory Failure Observe Improved? • Poor respiratory effort • Stridor may be present or decreased • Listless or decreased LOC • Cyanosis / Hypoxia Evaluate criteria for No racemic epinephrine Yes Observation Observation Can give racemic ! Complete severity assessment Q4 hr Assess severity Q1 hr x 2 using epinephrine every 1 hour if until patient meets discharge criteria severity assessment MD at bedside and RRT Hypoxia is called uncommon Meets discharge criteria • Consider alternative diagnosis in Croup (see page 5 for differential • Discharge Criteria If patient worsens, consider diagnosis and Indicates severe disease, repeat racepinephrine recommendations) alternate diagnosis or lower • • Can be given Q2 hrs Minimal stridor at rest(stridor • Consider blood gas respiratory tract disease with activity to be expected) • Consider ICU transfer • Minimal retractions • Consider ENT consult • Able to talk or feed without Recommendations difficulty 1. Consider ENT consultation for direct laryngoscopy in • 3 hours since racepinephrine ≥3 doses racemic epinephrine patients with 2 or more episodes of croup AND one of the following: - history of intubation - age less than 36 months - prolonged severe disease requiring Discharge Instructions Consider further workup, inpatient management Return for increased work of and/or RRT evaluation 2. Consider evaluation for GERD and initiation of anti- breathing (see page 5 for differential reflux medications in patients with prolonged or diagnosis) recurrent coup 3. Consider evaluation and treatment for allergies Page 2 of 12 CLINICAL PATHWAY TABLE OF CONTENTS Algorithm: Outpatient/ED Management Algorithm: Inpatient Management Target Population Prevention Outpatient Telephone Triage Clinical Management Laboratory Studies | Imaging Therapeutics Disposition Follow-Up | Discharge Instructions Education Etiology of Croup References Clinical Improvement Team TARGET POPULATION Inclusion Criteria • First or repeat episode • Age 6 months to 6 years • Principle diagnoses: croup (laryngotracheitis) Exclusion Criteria • Suspicion of bacterial tracheitis, epiglottitis, upper-airway abscess (peritonsillar or retropharyngeal), or other serious bacterial infection • Severe or life-threatening disease requiring PICU admission • Chronic lung disease (bronchopulmonary dysplasia, cystic fibrosis, pulmonary artery hypertension) • Known upper airway abnormalities (for example: laryngomalacia, tracheomalacia, subglottic stenosis) • Recent airway instrumentation • Foreign body aspiration or ingestion • Neuromuscular disorder or hypotonia • Allergic reaction • Angioedema • Active varicella or tuberculosis (TB) • Congenital or acquired heart disease Page 3 of 12 CLINICAL PATHWAY PREVENTION • Droplet precautions for all care settings • Good hand washing • Protect high risk patients from exposure • Eliminate exposure to smoke OUTPATIENT TELEPHONE TRIAGE Stridor Has, but not now Has now • Trouble breathing • Struggling for breath • Croupy cough • Lip or face blue during • Passed out/stopped • Fever cough breathing • Post-tussive emesis • Retractions • Lips or face bluish • Had croup before that • Croup started after bee needed decadron sting, new medicine, • Under 1 year of age allergic food • Drooling/trouble swallowing See in office within 24 See in office or ED Call 911 hours now • Activate EMS (911): Severe difficulty breathing (struggling for breath, grunting noises with each breath, unable to speak or cry), blue lips or reduced level of consciousness. • ED visit (immediate): Underlying heart or lung disease, breathing heard across room, poor fluid intake, temperature greater than 105 F, excessive drooling, inability to lie flat without distress o Age less than 12 months, respiratory rate (RR) greater than 60, unable to sleep o Age greater than 12 months, RR greater than 40, difficulty breathing, not interactive • Office visit same day: Worsening cough, some difficulty breathing, poor fluid intake, chronic or underlying illness • Phone contact with primary care provider (PCP): barking cough, acting normally, good fluid intake CLINICAL MANAGEMENT Obtain History and perform physical exam Evaluate hydration status Distinguish croup from a more extensive or progressive process Evaluate patient using Croup severity assessment History: • Obtain past medical history \ birth (hospitalization, intubation/mechanical ventilation), sick contacts • Check immunization status: Haemophilus influenza type b (HIB), pneumococcal, tetanus. Important when considering epiglottitis or diphtherial croup • Obtain all pertinent patient history, including onset and duration of symptoms including croup prodrome (rhinorrhea, sore throat, low grade fever, cough) and timing of evidence of upper airway obstruction (hoarse voice, barking cough, audible stridor) and subglottic involvement (aphonia) Page 4 of 12 CLINICAL PATHWAY • Inquire regarding history of congenital or acquired heart disease, congenital or acquired subglottic stenosis, tracheomalacia, tracheal webs, choanal narrowing or atresia, micrognathia, macroglossia • Check current medications and time and dose of last antipyretic and recent steroid use. Clinical Symptoms of Croup: • Symptoms increase at night and improve during day o Hoarse voice o Barking cough (often described as a “barking seal”) o Stridor (variable, usually inspiratory) • Respiratory distress (variable): o Retractions (suprasternal, intercostal) o Tachypnea o Tachycardia Clinical Progress of Croup: Day 1 to 3 Rhinorrhea Day 3 to 7 Onset symptoms of upper airway inflammation Sore throat Hoarseness Low grade fever
Load more

Recommended publications
  • ABCDE Approach
    The ABCDE and SAMPLE History Approach Basic Emergency Care Course Objectives • List the hazards that must be considered when approaching an ill or injured person • List the elements to approaching an ill or injured person safely • List the components of the systematic ABCDE approach to emergency patients • Assess an airway • Explain when to use airway devices • Explain when advanced airway management is needed • Assess breathing • Explain when to assist breathing • Assess fluid status (circulation) • Provide appropriate fluid resuscitation • Describe the critical ABCDE actions • List the elements of a SAMPLE history • Perform a relevant SAMPLE history. Essential skills • Assessing ABCDE • Needle-decompression for tension • Cervical spine immobilization pneumothorax • • Full spine immobilization Three-sided dressing for chest wound • • Head-tilt and chin-life/jaw thrust Intravenous (IV) line placement • • Airway suctioning IV fluid resuscitation • • Management of choking Direct pressure/ deep wound packing for haemorrhage control • Recovery position • Tourniquet for haemorrhage control • Nasopharyngeal (NPA) and oropharyngeal • airway (OPA) placement Pelvic binding • • Bag-valve-mask ventilation Wound management • • Skin pinch test Fracture immobilization • • AVPU (alert, voice, pain, unresponsive) Snake bite management assessment • Glucose administration Why the ABCDE approach? • Approach every patient in a systematic way • Recognize life-threatening conditions early • DO most critical interventions first - fix problems before moving on
    [Show full text]
  • Emergency Nursing Program Foreword
    RESOURCE MANUAL NSW HEALTH 2011 Transition to Practice Emergency Nursing Program Foreword The role of emergency nurses requires a broad level of skill and ability to meet the care needs of patients and their families. The Transition to Emergency Nursing Program is designed to support registered nurses new to the practice of emergency nursing. The Emergency Department is a fast-moving environment within which nurses can find themselves faced with a variety of challenges across a day. This program will assist them as they develop their knowledge and skills to meet these often changing care needs within the emergency setting. The program also supports a more consistent approach to transition to emergency nursing and it is anticipated will become the standard for initial entry to practice as an emergency nurse across NSW. This Resource Manual is the core document for the program and is complemented by both the Participant Workbook and the Facilitator’s Manual. Within the Emergency Department participants will be supported by staff to meet the relevant learning objectives during the 3-6 months over which this program extends. The development of the Transition to Emergency Nursing Program has been a lengthy process which reflects the commitment of emergency nurses to their area of practice and I acknowledge and thank them for their enthusiasm and work in enabling the Program to be developed. I am sure that it will have a positive impact for those nurses new to emergency nursing and to the care of patients. 1 Adjunct Professor Debra Thoms Chief Nursing and Midwifery Officer NSW Health NSW Department of Health 73 Miller Street NORTH SYDNEY NSW 2060 Tel.
    [Show full text]
  • Inhalation of “Borax”
    Journal of Paediatrics and Neonatal Disorders Volume 4 | Issue 1 ISSN: 2456-5482 Case Report Open Access Inhalation of “Borax” and Risk of Severe Stridor Obaid O* Department of Pediatrics, MOH, Makkah, Saudi Arabia *Corresponding author: Obaid O, Department of Pediatrics, MOH, Makkah, Saudi Arabia, Tel: 00966500606352, E-mail: [email protected] Citation: Obaid O (2019) Inhalation of “Borax” and Risk of Severe Stridor. J Paedatr Neonatal Dis 4(1): 105 Received Date: March 21, 2019 Accepted Date: June 26, 2019 Published Date: June 28, 2019 Abstract Stridor in children is not uncommon reason to visit emergency department and usually due to croup but inhalation of toxic substance may cause severe stridor which is uncommon. Keywords: Stridor; Pediatric; Sodium Burate Case Report A 9 year old Saudi girl presented to emergency department accompanied by her grandmother with history of dry cough, shortness of breath and audible wheeze for more than12 hours. She has no history of fever, foreign body ingestion and chronic cough. No history of contact with sick person and no history of lip swelling or skin rash. Her vaccination status up to date. She was a Preterm 30 weeks, admitted to Neonatal intensive care for 2 months and discharge well. In emergency room she was ill looking with biphasic stridor, kept on oxygen 10 liter/min and given one dose IM epinephrine 0.3 mg and nebulizer Racemic epinephrine, connected to Cardiorespiratory monitor and 2 IV lines was inserted started on IV Fluids and given one dose of dexamethasone. Urgent consultation to ENT was done and they recommend bronchoscopy to rule out Foreign body ingestion.
    [Show full text]
  • Management of Airway Obstruction and Stridor in Pediatric Patients
    November 2017 Management of Airway Volume 14, Number 11 Obstruction and Stridor in Authors Ashley Marchese, MD Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT Pediatric Patients Melissa L. Langhan, MD, MHS Associate Professor of Pediatrics and Emergency Medicine; Fellowship Director, Director of Education, Pediatric Emergency Abstract Medicine, Yale University School of Medicine, New Haven, CT Peer Reviewers Stridor is a result of turbulent air-flow through the trachea from Steven S. Bin, MD upper airway obstruction, and although in children it is often Associate Clinical Professor of Emergency Medicine and Pediatrics; Medical Director, Emergency Department, UCSF School of Medicine, due to croup, it can also be caused by noninfectious and/or con- Benioff Children’s Hospital, San Francisco, CA genital conditions as well as life-threatening etiologies. The his- Alexander Toledo, DO, PharmD, FAAEM, FAAP tory and physical examination guide initial management, which Chief, Section of Pediatric Emergency Medicine; Director, Pediatric Emergency Department, Arizona Children’s Center at Maricopa includes reduction of airway inflammation, treatment of bacterial Medical Center, Phoenix, AZ infection, and, less often, imaging, emergent airway stabilization, Prior to beginning this activity, see “Physician CME Information” or surgical management. This issue discusses the most common on the back page. as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department. Editor-in-Chief
    [Show full text]
  • Supraglottoplasty Home Care Instructions Hospital Stay Most Children Stay Overnight in the Hospital for at Least One Night
    10914 Hefner Pointe Drive, Suite 200 Oklahoma City, OK 73120 Phone: 405.608.8833 Fax: 405.608.8818 Supraglottoplasty Home Care Instructions Hospital Stay Most children stay overnight in the hospital for at least one night. Bleeding There is typically very little to no bleeding associated with this procedure. Though very unlikely to happen, if your child were to spit or cough up blood you should contact your physician immediately. Diet After surgery your child will be able to eat the foods or formula that they usually do. It is important after surgery to encourage your child to drink fluids and remain hydrated. Daily fluid needs are listed below: • Age 0-2 years: 16 ounces per day • Age 2-4 years: 24 ounces per day • Age 4 and older: 32 ounces per day It is our experience that most children experience a significant improvement in eating after this procedure. However, we have found about that approximately 4% of otherwise healthy infants may experience a transient onset of coughing or choking with feeding after surgery. In our experience these symptoms resolve over 1-2 months after surgery. We have also found that infants who have other illnesses (such as syndromes, prematurity, heart trouble, or other congenital abnormalities) have a greater risk of experiencing swallowing difficulties after a supraglottoplasty (this number can be as high as 20%). In time the child usually will return to normal swallowing but there is a small risk of feeding difficulties. You will be given a prescription before you leave the hospital for an acid reducing (anti-reflux) medication that must be filled before you are discharged.
    [Show full text]
  • Stridor in the Newborn
    Stridor in the Newborn Andrew E. Bluher, MD, David H. Darrow, MD, DDS* KEYWORDS Stridor Newborn Neonate Neonatal Laryngomalacia Larynx Trachea KEY POINTS Stridor originates from laryngeal subsites (supraglottis, glottis, subglottis) or the trachea; a snoring sound originating from the pharynx is more appropriately considered stertor. Stridor is characterized by its volume, pitch, presence on inspiration or expiration, and severity with change in state (awake vs asleep) and position (prone vs supine). Laryngomalacia is the most common cause of neonatal stridor, and most cases can be managed conservatively provided the diagnosis is made with certainty. Premature babies, especially those with a history of intubation, are at risk for subglottic pathologic condition, Changes in voice associated with stridor suggest glottic pathologic condition and a need for otolaryngology referral. INTRODUCTION Families and practitioners alike may understandably be alarmed by stridor occurring in a newborn. An understanding of the presentation and differential diagnosis of neonatal stridor is vital in determining whether to manage the child with further observation in the primary care setting, specialist referral, or urgent inpatient care. In most cases, the management of neonatal stridor is outside the purview of the pediatric primary care provider. The goal of this review is not, therefore, to present an exhaustive review of causes of neonatal stridor, but rather to provide an approach to the stridulous newborn that can be used effectively in the assessment and triage of such patients. Definitions The neonatal period is defined by the World Health Organization as the first 28 days of age. For the purposes of this discussion, the newborn period includes the first 3 months of age.
    [Show full text]
  • Vitals & Assessment Bingo
    Vitals & Assessment Bingo myfreebingocards.com Safety First! Before you print all your bingo cards, please print a test page to check they come out the right size and color. Your bingo cards start on Page 3 of this PDF. If your bingo cards have words then please check the spelling carefully. If you need to make any changes go to mfbc.us/e/dtfgtk Play Once you've checked they are printing correctly, print off your bingo cards and start playing! On the next page you will find the "Bingo Caller's Card" - this is used to call the bingo and keep track of which words have been called. Your bingo cards start on Page 3. Virtual Bingo Please do not try to split this PDF into individual bingo cards to send out to players. We have tools on our site to send out links to individual bingo cards. For help go to myfreebingocards.com/virtual-bingo. Help If you're having trouble printing your bingo cards or using the bingo card generator then please go to https://myfreebingocards.com/faq where you will find solutions to most common problems. Share Pin these bingo cards on Pinterest, share on Facebook, or post this link: mfbc.us/s/dtfgtk Edit and Create To add more words or make changes to this set of bingo cards go to mfbc.us/e/dtfgtk Go to myfreebingocards.com/bingo-card-generator to create a new set of bingo cards. Legal The terms of use for these printable bingo cards can be found at myfreebingocards.com/terms.
    [Show full text]
  • Respiratory Failure
    Respiratory Failure Phuong Vo, MD,* Virginia S. Kharasch, MD† *Division of Pediatric Pulmonary and Allergy, Boston Medical Center, Boston, MA †Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA Practice Gap The primary cause of cardiopulmonary arrest in children is unrecognized respiratory failure. Clinicians must recognize respiratory failure in its early stage of presentation and know the appropriate clinical interventions. Objectives After completing this article, readers should be able to: 1. Recognize the clinical parameters of respiratory failure. 2. Describe the respiratory developmental differences between children and adults. 3. List the clinical causes of respiratory failure. 4. Review the pathophysiologic mechanisms of respiratory failure. 5. Evaluate and diagnose respiratory failure. 6. Discuss the various clinical interventions for respiratory failure. WHAT IS RESPIRATORY FAILURE? Respiratory failure is a condition in which the respiratory system fails in oxy- genation or carbon dioxide elimination or both. There are 2 types of impaired gas exchange: (1) hypoxemic respiratory failure, which is a result of lung failure, and (2) hypercapnic respiratory failure, which is a result of respiratory pump failure (Figure 1). (1)(2) In hypoxemic respiratory failure, ventilation-perfusion (V_ =Q)_ mismatch results in the decrease of PaO2) to below 60 mm Hg with normal or low PaCO2. _ = _ (1) In hypercapnic respiratory failure, V Q mismatch results in the increase of AUTHOR DISCLOSURE Drs Vo and Kharasch fi PaCO2 to above 50 mm Hg. Either hypoxemic or hypercapnic respiratory failure have disclosed no nancial relationships can be acute or chronic. Acute respiratory failure develops in minutes to hours, relevant to this article.
    [Show full text]
  • Exercise-Induced Laryngeal Obstruction
    American Thoracic Society PATIENT EDUCATION | INFORMATION SERIES Exercise-induced Laryngeal Obstruction Exercise-induced laryngeal obstruction (EILO) is a breathing problem that affects people during exercise. EILO is defined by inappropriate narrowing of the upper airway at the level of the vocal cords (glottis) and/or supraglottis (above the vocal cords). This can make it hard to get air into your lungs during exercise and cause a noisy breathing that can be frightening. EILO has also been called vocal cord dysfunction (VCD) or paradoxical vocal fold motion (PVFM). Most people with EILO only have symptoms when they Common signs and symptoms of EILO exercise, those some people may have the problem at During (or immediately after) high-intensity exercise, other times as well. (See ATS Patient Information Series with EILO you may experience: fact sheet ‘Inducible Laryngeal Obstruction/Vocal Cord ■■ Profound shortness of breath or breathlessness Dysfunction’) ■■ Noisy breathing, particularly when breathing in Where are the vocal cords and what do they do? (stridor, gasping, raspy sounds, or “wheezing”) Your vocal cords are located in your upper airway or ■■ A feeling of choking or suffocation that can be scary larynx. Your supraglottic structures (including your ■■ CLIP AND COPY AND CLIP Feeling like there is a lump in the throat arytenoid cartilages and epiglottis) are located above the ■■ Throat or chest tightness vocal cords and are part of your larynx. The larynx is often called the voice box and is deep in your throat. When These symptoms often come on suddenly during you speak, the vocal cords vibrate as you breathe out, exercise, and are typically quite noticeable or concerning to people around you as well.
    [Show full text]
  • Respiratory System
    Respiratory System Course Rationale Anatomy & To pursue a career in health care, proficiency in anatomy and physiology is Physiology vital. Unit XIII Objectives Respiratory Upon completion of this lesson, the student will be able to: System • Describe biological and chemical processes that maintain homeostasis • Analyze forces and the effects of movement, torque, tension, and Essential elasticity on the human body Question • Define and decipher terms pertaining to the respiratory system How long can • Distinguish between the major organs of the respiratory system the body be • Analyze diseases and disorders of the respiratory system without • Label a diagram of the respiratory system oxygen? Engage TEKS Perform the following in front of the class using a paper towel and a hand 130.206 (c) mirror: 1 (A)(B) • Use the paper towel to clean and dry the mirror. 2(A)(D) • Hold the mirror near, but not touching, your mouth. 3 (A)(B)(E) • Exhale onto the mirror two or three times. 5 (B)(C)(D) • Examine the surface of the mirror. 6 (B) What happens to the mirror? 8 (A)(B)(C) Why does the mirror become fogged? 9 (A)(B) 10 (A)(B)(C) Or Prior Student Of all the substances the body must have to survive, oxygen is by far the most Learning critical. Think about the following: Cardiovascular system – • Without food - live a few weeks Pulmonary • Without water - live a few days Circulation • Without oxygen - live 4 – 6 minutes Estimated time 4 - 6 hours Key Points 1. Introduction – Respiratory System A. General Functions *Teacher note: 1. Brings oxygenated air to the alveoli invite a 2.
    [Show full text]
  • Chest Exam Codes Code Description 1 1800 Tachypnea 2 1801 H
    Jan-07 Fernald Medical Monitoring Program Sort Code Physician Exam - Chest Exam Codes Code Description 1 1800 tachypnea 2 1801 hyperpnea 3 1802 hyperventilation 4 1803 bradypnea 5 1804 Cheyne-Stokes breathing 6 1805 ataxic breathing 7 1806 sighing respiration 8 1807 pursed lip breathing 9 1875 Prolong expiration 10 1808 Dyspneic or dyspnea-short of breath 11 1886 PT on 02 12 1809 chronic cough 13 14 1892 Upper Airway Tightness 15 1889 Respiratory Distress 16 1888 Orthopnea (difficulty breathing while lying down) 17 1885 Chest burning 18 1884 Clavicle deformity/Prominence 19 1882 Rib pain 20 1881 Chest tightness 21 1869 Abnormal Lung exam 22 23 1810 barrel chest 24 1811 funnel chest 25 1855 pectus excavatum 26 1835 Pigeon chest/pectus casrinatum 27 1839 chest wall discomfort/tenderness 28 1812 intercostal retraction 29 1813 tender pectoral muslces 30 1814 tender costal cartilages 31 1848 missing rib 32 1837 slightly protruding xyphoid tip, rib cage 33 1859 Prominent bone, sternum 34 35 1815 (Fatty-like)mass on chest 36 1816 kyphosis 37 1831 scoliosis 38 1872 poor posture 39 1817 increased AP diameter 40 1874 decreased AP diameter 41 pacemaker generator in place/ 1818 defibrillator 42 1819 Hickman catheter in precordium port-a-cath 43 44 1820 Faint/few breath sounds 45 1838 Using accessory muscles to breathe 46 1844 decreased breath sounds 47 1838 small lung volume 48 1821 (fine) rales 49 1822 crackling rales 50 1823 rhonchi 51 1824 wheeze 52 1825 obstructive breathing 53 1826 pleural rub 54 1827 basilar crackles 55 1828 bilateral crackles
    [Show full text]
  • Module 10: Vital Signs
    Module 10: Vital Signs Module 10: Vital Signs Minimum Number of Theory Hours: 3 Recommended Clinical Hours: 6 Statement of Purpose: The purpose of this unit is to prepare students to know how, when and why vital signs are taken and how to report and chart these procedures. Students will learn the correct procedure for measuring temperature, pulse, respirations, and blood pressure. They will learn to recognize and report normal and abnormal findings. Terminology: Temperature: Blood Pressure Pulse Respiration Pain (effects on Vital signs) 1. Afebrile 10. Aneroid manometer 22. Apical 33. Abdominal respirations 46. Acute pain 2. Axilla 11. Bell 23. Arrhythmia 34. Apnea 47. Chronic pain 3. Celsius 12. Diaphragm 24. Bounding 35. Bradypnea 4. Fahrenheit 48. Phantom pain 13. Diastolic 25. Brachial 36. Cheyne-Stokes 5. Febrile 49. Pain scales 6. Metabolism 14. Hypertension 26. Bradycardia 37. Cyanosis 7. Mucosa 15. Hypotension 27. Carotid 38. Diaphragm 8. Pyrexia 16. Orthostatic hypotension 28. Pulse deficit 39. Dyspnea 9. Tympanic 17. Pre-hypertension 29. Radial 40. Labored respiration 18. Pulse pressure 30. Rhythm 41. Orthopnea 19. Sphygmomanometer 31. Thready 42. Shallow respiration 20. Stethoscope 32. Tachycardia 43. Stertorous 21. Systolic 44. Tachypnea 45. Temperature, Pulse, Respiration (TPR) Patient, patient/resident, and client are synonymous terms Californiareferring to Community the person Colleges Chancellor’s Office Nurse Assistant Model Curriculum - Revised December 2018 Page 1 of 46 receiving care Module 10: Vital Signs Patient, resident, and client are synonymous terms referring to the person receiving care Performance Standards (Objectives): Upon completion of three (3) hours of class plus homework assignments and six (6) hours of clinical experience, the student will be able to: 1.
    [Show full text]