Exam 1: Respiratory and Cardiac Assessment Flashcards
Tracheal bifurcation
located below Angle of Louis or T4-T5
lung fissures
separate the different lobes of the lungs
Anterior posterior (AP) diameter of chest
Refers to the shape of the chest; AP should be less than transverse
resonance
refers to percussion tone over chest wall; low-pitched, clear, hollow sounds that predominates in health lung tissue
barrel chest
AP=T, ribs are more horizontal
seen with pulmonary disease like COPD where the ribs become fixed in inspiratory position due to air trapping
Clubbing of the nails
change in normal configuration of distal phalanx due to growth of vascular connective tissue or respiratory disease (chronic hypoxia)
Subjective data to collect for respiratory assessment
cough
SOB
chest pain w/ breath
hx of resp infections
smoking hx
environmental exposure
patient-centered care (maintenance)
stridor
inspiratory wheeze audible w/o stethoscope caused by obstruction
characteristics of sputum
white/clear - colds/bronchitis
yellow/green - bacterial infection
pink/frothy - fluid in pleural cavity
bronchial breath sounds
normal breath sounds heard over the trachea and larynx
loud and high pitched
bronchovesicular breath sounds
normal breath sounds heard over major bronchi; posterior, between scapular; anterior, around sternum in 1st and 2nd ICS
vesicular breath sounds
normal breath sounds heard over peripheral lung fields
soft and low pitched
crackles (rales)
adventitious BS crackling, popping sound
suggest secretions in periphery
usually on inspiration
rhonchi
adventitious BS sonorous bubbling sound
usually expiratory, but may be inspiratory
suggests secretions in large airways
wheeze
adventitious BS whistle-like sound
suggest narrowed airways from secretions, etc.
inspiratory or expiratory
friction rub
cracking/grating sound secondary to pleural irritation or inflammation
absent breath sounds
seen w/ pneumothorax, obstruction, mass, etc.
tripod position
leaning forward to aid recruitment of abdominal, intercostal and neck (accessory) muscles with breathing
accessory muscles
trapezius, sternocleidomastoid & scalenus muscles that enlarge (hypertrophy) with chronic respiratory disease
pursed lip breathing
prolonged expiratory phase and resistance to outflow allows alveoli to remain open longer
pneumothorax
air in pleural space
absent BS
trachea shifts from midline
uneven expansion
hyper-resonant percussion
lobar pneumonia
a serious infection in which the air sacs fill with pus and other liquid
dull percussion over area of PNA
expect rhonchi and rales
pg 443
precordium
area around the heart on the anterior chest
myocardium
muscles of the heart
endocardium
the thin, smooth membrane which lines the inside of the chambers of the heart and forms the surface of the valves
pericardium
the membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane
reduces friction
AV valves
atrioventricular valves - separate the atria from the ventricles
tricuspid & mitral
SL valves
Semilunar valves - separate the chambers of the heart from the great vessels
pulmonic & aortic
peripheral vessels
jugular veins (ext & int)
carotid artery
direction of blood through the heart
Simplified:
Vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Pulmonary arteries
LUNGS
Pulmonary veins
Left atrium
Mitral valve
Left ventricles
Aortic valve
Aorta
heart failure (pg 487?)
L-sided - volume can’t get out, so back up into lungs. Pulm HTN. Increased hydrostatic pressure in the lungs and pulmonary capillaries. (Cough, SOB, increased WOB, pulm edema)
R-sided - hepatomegaly, JVD, dependent pedal edema
Increased hydrostatic pressure in the systemic capillaries.
ventricular dilation
volume overload
Dilated cardiomyopathy (DCM) is a condition in which the left ventricle, the heart’s main pumping chamber, is enlarged (dilated). As the chamber gets bigger, its thick muscular wall stretches, becoming thinner and weaker. This affects the heart’s ability to pump enough oxygen-rich blood to the rest of the body
ventricular hypertrophy
pressure overload
thickening and stiffening of the ventricle walls (typically HTN) and leads to the heart not being able to pump blood effectively
cardiac risk factors
high cholesterol
smoking
physical inactivity
obesity
HTN
DM
age (65+) and gender (male)
heredity
apical impulse
4-5th ICS, L MCL
thrills
palpable vibration that signifies turbulent blood flow, associated with murmurs
“A Point To Memorize”
Aortic valve (2 ics (R) SB)
Pulmonic (2 ics (L) SB)
Tricuspid (4 ics (L) SB)
Mitral (5 ics (L) MCL)
not anatomic area of valve, but where heard best
S1
Heart sounds associated with closure of the mitral and tricuspid valves. Loudest at apex.
Beginning of ventricular systole
“LUB”
S2
Heart sound associated with closure of the pulmonic and aortic valve. Loudest at base.
Beginning of ventricular diastole
“DUB”
S3
Extra heart sound heard in early diastole
physiologic (young) vs pathologic (noncompliant ventricle w/fluid overload, high CO)
S4
Extra heart sound heard in late diastole
“atrial kick”
inflow of blood vibrates valves and structures of wall
physiologic (middle age adults after exercise) vs pathologic (noncompliant ventricle or valve)
Split S2
Occurs with asynchronous closure of the aortic and pulmonic valve
occurs with deep inspiration
“more to the right, less to the left”
more input to the R side of heart - less pressure intrathoracic, so more blood trapped in the lungs and less to the L side of heart, also septum bulges and L side can’t hold as much
delays pulm valve closure
aortic valve closes earlier
Bruit
Turbulent blood flow (vessels) makes a swishing sound upon auscultation
Murmur
Turbulent blood flow (heart) makes a swishing sound upon auscultation
innocent (young)
functional (pregnancy)
pathological (stenosed or loose valves)
Pericardial friction rub
caused by inflammation of the pericardium
heard best at apical
jugular vein distention
indicated R-sided heart failure
diastole
tricuspid & mitral open
pulm & aorta closed
S2
systole
tricuspid & mitral closed
pulm & aorta open
S1
pulse deficit
if there is a lag b/t the apical pulse and carotid, subtract the 2 for a value
“difference b/t hearing and feeling”
Split S1
Asynchronous closure of mitral & tricuspid valve
depolarization on the left is faster
carotid
bruit in carotid indicative of plaque and blood moving through it
Landmarks for right oblique fissure
T3 -> 5th rib mid-axillary -> 6th rib (R) MCL
Landmarks for right horizontal fissure
5th rib mid-axillary -> 4th rib (R) SB
Landmarks for left oblique fissure
T3 -> 5th mid-axillary -> 6th rib (L ) MCL
