Chp 15 Clinical Evaluation and Assessement of the Cardiovascular and Pulmonary System

Question 1

Main places to palpate during a chest exam pg. 200 bxo 15-1

Answer 1

Supra sternal notch -
Sternomandibular angle- lateral is the rib 2 and ribs can be counted down from here..

Costal angle- right angles formed between the sternum and the ribs

Vertebrae prominences- C7 SP and alllows numbering very easy.

Question 2

Should you check the SCM and other respiratory msucles for movmenet during exam and if so why?

Answer 2

Yes because sometimes outward flaring of the nose. The hypertrophyed SCM or other neck muscles maybe making up for the lack of the intercostals weakness.

Question 3

What about the Jugluar venous distention tell me about this

Answer 3

The patients head is rested to 45 degrees and is lying supine and compare bilateral veins and absence of symmetry should be noted. This is usually a good indication of a poor right atrium.

Question 4

Clubbing of nails what is normal degree mark what is mild clubbing and what is advanced clubbing

Answer 4

normal nail angle is 160

mild is exactly 180 degrees

advanced clubbing is above 180 of clubbing

Question 5

Breathing patterns

Answer 5

adults 14-20 BPM (breathes per minute)
newborns 30-60 BPM

early childhood (20-40 ) BPM.

childhood- 15-20 BPM

Question 6

chest wall configurations

Answer 6

Normal barrel, kypohosis, pectus excavtum dimple in middle of chest, Pectus Carinatum

Question 7

describe how each one of these will sound Bronchial, Bronchialvescicular, vesicualr

Answer 7

Bronchial- loud, high pitched hollow quality pg. 206
distinct pause between inspiration and expiration

Bronchovesicular- mixture of bronchial and vesicular heard of main stem of Bronchi not very descriptive on where to place the stethoscope

Vesicular- soft low pitched over peripheral lung tissue. no pause between inspiration and expiration

Question 8

Where do you place stethoscope to hear these sounds Aorta, Pulomanry valve, Tricuspid valve, mitral valve

Answer 8

Aorta- Second intercostal space right sternal border

Pulmonic- second intercostal space at left sternal border

Tricuspid fourth and fifth ICS Left sternal border

Mitral: cardiac apex fifth ICS, MCL. (midclavicular line

Question 9

tell me what S1 phase means , s2 phase, S3 phase means and S4 phase means

Answer 9

s1- signifies the AV valves closing and should .10 seconds and heard over the heart apex the loudest

S2 - signifies the Ventricular valves closing and end of the Ventricular contraction

S3 and S4 if heard usually indicate a problem

S3- means that the ventricles are filling to early (diastolic) normal in childern abnormal with people over the age of 40.

S4- indicates the rapid ventricular filling that occurs after the artial contractions can be a major medical concern because oxygen rich blood is not being properly pumped throughout the entire human body. Can be an indciation of Left ventricular hypertrophy (LVH)

Question 10

Grading of Heart Murmurs grade 1, grade 2, grade 3 , 4, 5, ,6 tell me about each

Answer 10

Grade 1- Faint requires concentrated effort to hear
Grade 2- faint audible immediately
Grade 3- intermediate intensity louder than 2
Grade 4- Loud intermediate intensity associated with palable vibrations
Grade 5- Very Loud thrill present
Grade 6- Audible without stethoscope

Question 11

How evaluate the chest exspansion of the apical or lobe motion, Anteriorlateral region, and posterior region

Answer 11

Apical- Face patient and expose area apporiately
hands placed over anterior chest wall, and heel of had over fourth rib and finger tips reach toward upward traps
the thumbs lie horizontal about the level of the sternal angle and meet at the midline slightly stretching the skin
4. patient asked to inhale
5.hands should be relaxed
6. the symmetry and extent of movement is assessed

Anterolateral or middle lobe- palms places distal to the nipple line and the thumbs meet meet in the midline and fingers wrap around into posterior axilla fold. Repeat steps 4-6

Posterior lower lobe- stands behind the patient and area is exposed apporiately. hands placed flat on the posterior chest wall at the level of the tenth rib. The thumbs meet at the midline; fingers reaching toward the anterior axillary line fold.
repeat steps 4-6 and there is a visual depiction of these hand placements
on pg. 210.

Question 12

How to differ between Emphysema , chronic bronchitis, pneumonia, pulmonary embolism, pneumothorax, pleural effusion, atelectasis

Answer 12

Emphyesma- typically caused by COPD but it is basically the breakdown of lung tissue. decreased tactile fremitus, increased resonance decreased lung sounds, increased A-P dimesions use of accessory muscles

Chronic Bronchitis- Inflammation of the bronchioles- possible cyanosis or appperance lack of O2 palpation often normal. percussion often normal and early crackles

Pneumonia - inflammation of the Avelovi due to virus or bacteria or community exposure to someone else that has it. Possible cyanosis- increases tactile fremitius. splinted on affected side percussion is dull. late crackles.

Pulmonary Embolism- via DVT “we knows” :). sudden onset of dyspnea chest pain, palpation normal. percussion and ausculation normal

Pneumothorax- abnormal collection of fluid from within the perual space that seperates the lung from the actual chest wall. rapid onset, absent fremitus hyperresonat absent breathe sounds

Pleural effusion- fluid that gathers between the pariteal and the viscreal pleura and weights down lungs and decreases proper breathing. may not be any outward clinical signs decreased fremitus. trachea shifted to the other side? dullness with percussion absent breath sounds with ausculation

Atelectasis- closure of a lung and deflation of avelovi maybe part or the whole lung. often no clincal signs, absent breath sounds, dullness with precussion. decreased fremitus trahcea shifted decreased chest wall. absent breath sounds via ausculation.