CEC Session 2

Question 1

Pulmonary Basic Exam

Answer 1

Subjective data: ask two questions

Inspection: anterior chest for symmetry, shape, inspiratory/ exploratory effort, trachea

• Symmetry (equal rise and fall of chest)
• Shape (anteriorposterior diameter, transverse diameter)
• Effort (unlabored)

Auscultate breath sounds (anterior- 4, posterior- 6, lateral -2)

Question 2

Pulmonary Basic Exam Subjective Questions

Answer 2

Are you experiencing any shortness of breath?
Any issues with breathing?
Any cough? Is it productive? Any sputum? what color?

Question 3

Pulmonary Focused Exam

Answer 3

Palpation: posterior chest bilaterally for tenderness, posterior chest bilaterally for thoracic expansion

Percussion: posterior chest bilaterally

Auscultation: breath sounds (anterior-6 sites, posterior- 10 sites, lateral-4 sites)

Question 4

Cardiac Basic Exam

Answer 4

Obtain subjective questions

Auscultation apical side 30-60 seconds (note s1, S2, rhythm, murmur, extra heart sounds)

Question 5

Cardiac Basic Exam Subjective Questions

Answer 5

Do you ever feel like your heart is racing?

Do you ever feel a flutter in your chest?

Question 6

Cardiac Focused Exam

Answer 6

Inspection: precordium for lifts and heaves
Palpation: precordium for thrills
Auscultation: 4 valvular areas for S1, S2, rhythm, murmur, extra heart sounds using bell and diaphragm of stethoscope (20-30 seconds)
- Aortic (2nd intercostal space, RSB)
- Pulmonic (2nd intercostal space LSB)
- Tricuspid (4th intercostal space LSB)
- Mitral (5th intercostal space left MCL)

Question 7

Third Heart Sounds (S3, Ken-tu-cky)

Answer 7

Low pitched sound, using bell

Occurs just after S2

Best heard at apex of heart

May be physical or pathological (eg: CHF)

Question 8

Fourth Heart Sound

Answer 8

S4 (Ten-nes—-see)

Low pitched sound- using bell

Just before S1

Best heard at the apex of the heart

More common to be pathological (eg: diastolic heart failure, ventricular hypertrophy, prior myocardial ischemia)