exam 2 Flashcards
apical heart rate can be auscultated where
Erb point
what helps determine how much pressure in the right atrium
neck veins
locations where to auscultate heart sounds
aortic area, pulmonic area, Erb point, tricuspid area, mitral area
what causes variations in heart sounds
timing of heart valve closure
structure of heart valves
how quickly pressure rises in vessels
a third heart sound is a indication of
congestive heart failure, myocardial failure, valvular disease
degree of bed when looking at patient neck vessels
30-45
high pitched noise that increases with inhalation in third intercostal space on left sternal border
pericardial friction rub
what system has more pressure: arterial or venous
arterial
picks up all extra interstitial fluid
lymphatic capillaries
what disease is known to cause muscle atrophy
peripheral vascular disease
signs of arterial disease
decreased capillary refill, delayed wound healing
signs of DVT or thrombophlebitis
erythema, edema, tenderness
finding that is most suggestive of skin cancer
8-mm diameter
fluid filled lesion on skin
vesicle
turgor
speed with which skin returns into place
the sound made from air passing through narrowed bronchioles
wheezing
high pitched, soft, brief sounds on inspiration
fine crackles
low pitched, moist, lung sounds on inspiration
coarse crackles
continuous, high pitched sounds caused by narrowing of small airways
wheezing
load, coarse, low pitched grating or creaking sound
pleural friction rub
low pitched snoring or gurgling sound that may clear with coughing
rhonchi noise
high, harsh sounds with short inspiration and long expiration while ausculating trachea
bronchial breath sounds
when does wheezing occur
when air passes thru a constricted passageway
what causes crackles in breath sounds
moisture in airways
normal lung sound for most of lung for normal adult
vesicular
turbulence in blood flow
murmur
when does s4 happen
immediately before s1
what happens at start of systole
mitral and tricuspid valve need to close
what happens during P wave
depolarization of atria. atrial pressure increases, ventricular volume increases
what happens during QRS complex
depolarization of ventricles. increase in ventricular pressure
what happens during T wave
ventricular repolarization. ventricular pressure goes down
what does phonocardiograms do
shows sound of heart beat
S1
Tricuspid and mitral valve close
S1
Tricuspid and mitral valve close
S2
aortic and pulmonary valve close
split s2
heard only during inspiration. pulmonary valve was delayed in closing
split S1
mitral closes before tricuspid. this can be heard the best on apex. does not vary with respiration
usually closes after birth. if it doesn’t close, oxygenated blood mixes with deoxygenated blood
Atrial septal defect (ASD)
ventricular septal defect (VSD)
Jugular venous distention
backup of blood flow. right atria has high pressures
JVP
high pressure that reflects right atrial pressure.
would be seen on right internal jugular vein over the left, but could be both
what should bed be at to detect JVP
30-45 degrees
dyspnea
SOB
orthopnea
SOB when patient is laying down but improves when standing
paroxysmal nocturnal dyspnea
sudden SOB that wakes someone up from sleep. makes a person physically stand to breathe
what could cause chest pain
angina pectoris, CAD, MI, acute coronary syndrome
swelling on lower part of body. legs, sacrum, feet
dependant edema
swelling on lower part of body. legs, sacrum, feet
dependant edema
poor oxygenated of body
cyanosis or pallor
fatigue in cardio patients
signals heart is not adequately supplying oxygen
what could rheumatic fever cause
cardiac dysfunction
assessing carotids
one at a time. do not massage them. Patients need to be laying down
All Patients Eventually Take Meds acronym
aortic
pulmonic
ERBs point
Tricuspid
Mitral
5 areas of listening to heart
where to listen to aortic
right 2nd intercostal space
where to listen to pulmonic
left 2nd intercostal space
where to listen to ERBs point
left 3rd intercostal space
where to listen to tricuspid
lower left sternal border/4th intercostal
where to listen to mitral
left 5th intercostal
medial to midclavicular line
high rate of blood flow thru normal valves
murmer
normal blood flow thru abnormal valves
murmer
grade 1 murmer
very faint. may not be heard in all positions
grade 2 murmer
quiet, but heard immediately after placing stethoscope on chest
grade 3 murmer
moderately loud
grade 4 murmur
loud with palpable thrill (vibration)
grade 5 murmur
very loud with thrill. may be heard when stethoscope is partly off chest
grade 6 murmur
very loud with thrill. can be heard with stethoscope entirely off chest
risk factors in coronary heart disease
diabetes, hypertension, increased cholesterol, smoking, obesity, inactivity
risk factors of hypertension
alc consumption, obesity, excess sodium intake, smoking, inactivity, not enough K+
healthy fats
foods high in monounsaturated fats, polyunsaturated fats, and omega 3 fatty acids
lymphatic system
takes fluid out of capillary beds, if fails, edema occurs
should you be able to palpate lymph nodes in healthy normal adults
no
brawny edema
nonpitting
scale 1 edema
2 mm depression - pitting
scale 2 pitting edema
4 mm depression
scale 3 pitting edema
6 mm depression
scale 4 pitting edema
8 mm depression
intermittent cladication
pain in legs during activity caused by insufficient arterial blood flow
symptoms/signs of PAD
sharp pain that’s worse at night
intermittent claudication
weak pulse in extremities
cool temp
pale
hairless, dry, scaly skin
gangrene- tissue death from lack of blood
round, punched out wounds
signs/symptoms of PVD
dull,achy pain
edema
warm legs
stasis dermatitis- brownish/yellow skin
irregular shaped wounds
what causes swollen lymph nodes
infection, tumor, malignancy
0 grading for pulse
absent pulse. try doppler before writing this
1+ grading pulse
diminshed, weak pulse
2+ grading pulse
brisk, expected (normal)
3+ grading pulse
bounding pulse
when inspecting edema
measure difference, note color and texture of skin, note wounds
when assessing hair
access color, condition of shaft, if hair shafts are shiny, cleanliness, parasites, lesions
A high-pitched crowing sound from the upper airway results from tracheal or laryngeal spasm and is called what?
stridor
sound to suspect client has chronic lung disease
hyperresonance
When assessing posteriorly, where would the trachea bifurcate into its mainstem bronchi?
T4 spinous process
What replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space?
dullness
what causes jaundice
liver issues.
Too much Bilirubin.
you can tell if someone has jaundice by the sclera of the eye
what causes cyanosis
lack of oxygen or bloodflow
ecchymosis
bruising
what is erythema and what causes it
reddening of the skin
caused by increased blood flow
carotenemia
comes from a diet high in beta carotene. yellow/orangish skin
vitiligo
absence of melanin pigment
mobility
ease at which skin lifts
turgor
speed at which skin returns to place
characteristics of psoriasis
red and angry looking
on extensor surfaces
linear skin pattern
in line
geographic skin pattern
map like appearence
clustered skin lesion
several lesions that are grouped together
serpiginous lesion
wavy border
annular lesion
ring shaped
acriform lesion
arc shaped
plaque
elevated lesion. 1cm or larger
patch
larger than cm. flat, nonpalpable
macule
less than cm. flat, non palpable
wheals
localized, palpable skin edema
cyst
nodule with accessible material like pus
vesicle
clear appearance with fluid
bulla
vesicles that are a cm or larger with fluid
pustule
palpable lesion filled with pus
what causes secondary skin lesions
over treating other skin issues or continuous scratching
lichenification
chronic rubbing or scratching
keloid
over scarring
erosion
loss of superficial epidermis
fissure
skin cracks due to dry skin
spider angioma
bright red, up to 2 cm. has middle with leg like appearance. throb or pulse feeling present
spider vein
could be several inches, common in legs or anterior chest. from increased pressure in veins
cherry angioma
bright red. no pulse feeling
petechiae / purpura
blood accumulated outside blood vessel. fades to look like bruise overtime
nevus
mole
stage 1 ulcer
reddend slin
stage 2 ulcer
skin is broken. superficial
stage 3 ulcer
wound near to reaching muscle
stage 4 ulcer
wound is down to bone
characteristics of alopecia
skin looks healthy, clear borders
trichotilomania
broken hair loss is seen. from plucking or pulling
clubbing nails
rounded. means chronic hypoxia
basal cell carcinoma
basal level of epidermis
most common and rarely metastasize
squamous cell carcinoma
upper layer of epidermis
can metastasize
ulcerated and scaly looking
melanoma
arise from melanocytes in epidermis
dangerous- metastasizes easy
dark with irregular looking border
how many lobes in lung
left-2
right-3
accessory muscles breathing
can see if there is trouble with respiration
hemoptysis
bloody sputum
purulent sputum
pus in sputum
sudden onset dyspnea examples
anaphylaxis, pulmonary embolism, spontaneous pneumothorax, anxiety
progressive onset wheezes
pneumonia, bronchitis, copd, interstitial lung disease, left sided heart failure
wheezing
from airway obstruction or inflammation
pleuritic pain
very painful with inspiration, coughing, or movement
-inflammation of pluera
funnel chest
chest indents. could lead to lung or cardiac issues
barrel chested
from air trapping
pigeon chest
from cartilage displacement. effects breathing
pigeon chest
from cartilage displacement. effects breathing
pigeon chest
from cartilage displacement. effects breathing
spine issues not allowing good expansion
thoracic kyphoscoliosis
tactile fremitus
patient say 99
If vibration heard in all location, normal finding
use hand
bronchoscopy
patient say 99
Sound becomes less distinct as moving down
Use stethoscope
If same throughout- abnormal
egophony
patient say E
Use stethoscope
Normal if E is more distinct
If it sounds more like AAA then abnormal finding
whispered pectoriloquy
Whisper 99
Use stethoscope
It should sound faint, if distinct as you keep going down, abnormal
low pitch, loud sound
resonance
sound of a healthy lung
high pitch soft sound
flatness
ex-thigh
medium pitch and sound
dullness
ex-liver
very loud, low pitch
hyperresonance
loud, high pitch
tymphany
crackles
fluid in lungs
could be fine or course
friction rub
could be from pleura or pericardium
rhonchi sounds
from thick mucus
measures how fast you can push air out the lungs when you blow as hard as you can
peak flow measure
Hair follicles, sebaceous glands, and sweat glands originate from the
dermis
ABCDE melanoma
Asymmetry
border
color
diameter
evolving
The nurse should carefully inspect which part of the body in an effort to differentiate central cyanosis from peripheral cyanosis?
oral mucosa
