Exam 2 Flashcards
1
Q
Ch. 19
List the 4 anterior thoracic landmarks
A
- Suprasternal notch: hollow U-shaped depression just above the sternum, between the clavicles
- Sternum
- Manubriosternal angle: lines up with the second rib
- Costal angle: R & L costal margins form an angle (usually 90° or less) where they meet at the xiphoid process
2
Q
Ch. 19
What is the Manubriosternal Angle?
A
- angle of Louis
- in line / lines up with 2nd rib
- useful place to start counting ribs
3
Q
Ch 19
What are the 4 Posterior Thoracic Landmarks?
A
- Vertebra prominens: most prominent bony spur protruding at the base of the neck when you flex your head
- Spinous processes: align with their same numbered ribs only down to T4. after T4, the spinous processes angle downward from their vertebral body & overlie the vertebral body & rib below
- Inferior border of scapula: usually located at the 7th or 8th rib
- Twelfth rib
4
Q
Ch 19
What is unique about the spinous processes landmark?
A
- align with their same numbered ribs only down to T4
- After T4 the spinous processes angle downward from their vertebral bodies & overlie the vertebral body & rib below
5
Q
Ch 19
What are the important reference lines to keep in mind when assessing the thorax & lungs?
A
- Midsternal
- Midclavicular
- Scapular
- Vertebral
- Anterior, Posterior, & Midaxillary lines
6
Q
Ch 19
What is the mediastinum?
A
- middle section of the thoracic cavity
- contains the esophagus, trachea, heart, & great vessels
7
Q
List the lobes of the lung
Ch 19
A
- RUL, RML, RLL
- LUL & LLL
8
Q
When are accessory muscle used & where are they located?
Ch 19
A
- used when someone has difficulty breathing
Location: found in the intercostal spaces (also includes sternomastoid muscles & abdominal muscles)
9
Q
What does White or Clear Sputum indicate?
Ch 19
A
- cold
- viral infection
- bronchitis
10
Q
What does Yellow or Green Sputum indicate?
Ch 19
A
Bacterial infection
11
Q
What does Rust-Colored Sputum indicate?
Ch 19
A
- TB
- Pneumococcal pneumonia
12
Q
What does Pink, Frothy sputum indicate?
Ch 19
A
- pulmonary edema
- certain sympathomimetic medications
13
Q
What is orthopnea?
Ch 19
A
difficulty breathing when laying down
14
Q
Explain the Anteroposterior / Transverse Diameter
Ch 19
A
The transverse measurement should be twice as long as anteroposterior measurement
15
Q
What should the Anteroposterior / Transverse diameter be?
Ch 19
A
1:2
16
Q
Where should the thumbs be placed when evaluating for symmetric expasion?
Ch 19
A
place thumbs at ribs 9 or 10
17
Q
In what conditions does tactile fremitus increase & decrease?
Ch 19
A
- Increase: pneumonia
- Decrease: COPD, asthma, PE, collapsed lung (pneumothroax), emphysema
18
Q
What sounds will you hear when listening over the scapula, organs, above the shoulders, and intercostal spaces?
Ch 19
A
- Scapula: flat
- Organs: dull
- Above Shoulders & Intercostal Spaces: resonance
19
Q
What is the predominant sound heard when listening to lung sounds?
Ch 19
A
vesicular breath sounds
20
Q
What are 3 types of breath sounds to listen for during auscultation?
Ch 19
A
- Bronchial
- Broncovesicular
- Vesicular
21
Q
List types of adventitious sounds & describe them
Ch 19
A
- Crackles: discontinuous popping heard during inspiration
- Wheezes: continuous musical sound heard mainly on expansion
22
Q
Where are bronchial sounds heard anteriorly & when are they longest?
Ch 19
A
heard over the trachea & are longest on expiration
23
Q
What are Cheyne-Stokes Respirations & when are they heard?
Ch 19
A
a cycle when respirations wax & wane in a regular pattern (periods last 30 - 45 seconds with perods fo apnea alternating the cycle)
- Heard / Common With: head trauma, brain abscess, heat stroke, meningitis, & encephalitis
24
Q
What is a stridor?
Ch 19
A
high pitched inspiratory crowing sound heard due to upper airway obstruction
25
**Tactile fremitus findings would be increased when**
**a.)** The patient has a mild case of pneumonia
**b.)** The patient has an advanced case of pneumonia
**c.)** The patient has a pleural effusion
**d.)** The patient has a blocked bronchus
| Ch 19
**b.)** The patient has an advanced case of pneumonia
26
**Which of the following is a true statement regarding the findings related to percussion?**
**a.)** Percussion is a useful technique for identifying small lesions in lung tissue.
**b.)** Percussion is helpful only in identifying surface alterations of lung tissue.
**c.)** Percussion notes are not influenced by the overlying chest muscle & fat tissue.
**d.)** A dull not elicited with percussion is the expected finding.
| Ch 19
**b.)** Percussion is helpful only in identifying surface alterations of lung tissue
27
**Which of the following correctly expresses the relationship to the lobes of the lungs & their anatomic position?**
**a.)** Upper lobes -- lateral chest
**b.)** Upper lobes -- posterior chest
**c.)** Lower lobes -- posterior chest
**d.)** Lower lobes -- anterior chest
| Ch 19
**c.)** Lower Lobes -- posterior chest
28
**What organs are considered solid viscera?**
| Ch 22
* **S**pleen
* **A**drenal glands
* **L**iver
* **P**ancreas
* **O**varies
* **U**terus
* **K**idneys
29
**What organs are considered hollow viscera?**
| Ch 22
* **B**ladder
* **C**olon
* **G**allbladder
* **St**omach
* **S**mall intestine
30
**What is the difference in solid & hollow viscera?**
| Ch 22
The shape of hollow viscera can change
31
**What order do you perform an abdomen exam?**
| Ch 22
* **I**nspection
* **A**uscultation
* **P**ercussion
* **P**alpation
32
**What arteries are listened to int he abdomen & where are they heard?**
| Ch 22
* **Aorta:** midline (epigastric region)
* **Renal:** above the umbilicus (RUQ & LUQ)
* **Iliac:** below the umbilicus (RLQ & LLQ)
33
**List which organs are found in each of the quadrants of the stomach**
| Ch 22
* **RUQ:** Liver & Gallbladder
* **RLQ:** Ascending colon, cecum, appendix, bladder
* **LUQ:** Spleen, stomach, small intestine
* **LLQ:** Descending colon, sigmoid colon
34
**What is dysphagia?**
| Ch 22
difficulty swallowoing
35
**What is dysphasia?**
| Ch 22
Difficulty speaking
36
**What factors are important to keep in mind when performing an abdominal assessment on aging adults?**
| Ch 22
* increased fat accumulation
* abdominal muscles relax
* decreased saliva, sense of tase (increased use of salt & sugar)
* Delayed esophageal emptying (increases risk of aspiration)
* Decreased gastric acid secretion
* Increased incidence of gallstones
* Liver size decreases after age 80
37
**What can striae indicate?**
| Ch 22
ascites
38
**What is ascites?**
| Ch 22
fluid accumulation in the abdomen
39
**What are 4 types of contour used to describe the abdomen?**
| Ch 22
* flat
* rounded
* scaphoid (concave)
* protuberant
40
**What do normal bowel sounds sound like & what is the normal range?**
| Ch 22
* high pitched, gurgling, cascading
* irregular, 5-30 per minute
41
**How many sounds per minute is the range for hypoactive bowel sounds**
| Ch 22
< 5 per minute
42
**How many sounds per minute is the range for hyperactive bowel sound?**
| Ch 22
> 30 per minute
43
**What must you do to determine that bowel sounds are absent?**
| Ch 22
Listen to **each abdominal quadrant** for **5 minutes**
44
**Which side of the stethoscope is used to auscultate for vascular sounds on an abdominal exam?**
| Ch 22
BELL
45
**What is a bruit?**
| Ch 22
abnormal vascular sound caused by stenosis of an artery that results in turbulent blood flow (whooshing sound)
46
**What is the predominant sound produced when percussing the abdomen?**
| Ch 22
tympany
47
**What sounds can be expected over organs & bones when percussing?**
| Ch 22
**Organs:** dull sound
**Bones:** flat sound
48
**What tests are used to test for ascites?**
| Ch 22
* Fluid wave
* Shifting dullness
49
**What does a positive Blumberg's sign indicate / what is Blumberg's sign used to test for?**
| Ch 22
appendicitis
50
**What is Murphy's sign used to test for?**
| Ch 22
inflamed gallbladder
51
**What can costovertebral (CVA) tenderness indicate?**
| Ch 22
Kidney stones / Kidney infection
52
**List 3 types of hernias**
| Ch 22
* **Umbilical Hernia**
* **Epigastric hernia:** above umbilicus
* **Incisional Hernia:** anywhere there's an incision
53
**What is another name for Blumberg's Sign?**
| Ch 22
rebound tenderness
54
**When the patient reports that a certain spot in the abdomen is tender, it is best to...**
**a.)** Palpate that spot last to prevent pain from interfering with the rest of the examination
**b.)** Palpate that spot first to avoid prolonging the patient's anticipation
**c.)** Avoid the spot entirely as other clinicians are going to palpate it after you
**d.)** Palpate in the same order you always would to avoid missing something because you broke your routine
**a.)** Palpate that spot **last** to prevent pain from interfering with the rest of the examination
55
**Which of the following is not in the list of common causes for abdominal distention?**
**a.)** Flatus
**b.)** Fetus
**c.)** Fluid
**d.)** Follicles
**e.)** Fat
| Ch 22
**d.)** Follicles
56
**Which of the following are are true? (select all that apply)**
**a.)** Listen for bowel sounds in each quadrant
**b.)** Always auscultate before palpating as palpation may alter bowel sounds
**c.)** Use the bell of the stethoscope to auscultate for bowel sounds
**d.)** Listen for at least 5 minutes before documenting that bowel sounds are absent
| Ch 22
**a.)** Listen for bowel sounds in each quadrant
**b.)** Always auscultate before palpating as palpation may alter bowel sounds
**d.)** Listen for at least 5 minutes before documenting that bowel sounds are absent
57
**A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is...**
**a.)** Diarrhea
**b.)** Peritonitis
**c.)** Laxative use
**d.)** Gastroenteritis
| Ch 22
**b.)** Peritonitis
58
**When examining a patient with good muscle wall relaxation the nurse observes abdominal pulsations between the xiphoid & umbilicus. The nurse would suspect that these are...**
**a.)** Pulsations of the renal arteries
**b.)** Pulsations of the interior vena cava
**c.)** Normal abdominal aortic pulsations
**d.)** Increased peristalsis from a bowel obstruction
| Ch 22
**c.)** Normal abdominal aortic pulsations
59
**Which artery is the main blood supply in the arms?**
| Ch 21
Brachial artery
60
**Which artery is the main blood supply for the legs?**
| Ch 21
Femoral artery
61
**What are the 4 key lymph nodes Professor Bell emphasized & what do they drain?**
| Ch 21
* **Cervical:** head & neck
* **Axillary:** arms & breasts
* **Epitrochlear:** hands
* **Inguinal:** groin & lower extremities
62
**What is arteriosclerosis?**
| Ch 21
peripheral blood flow grows **more rigid with age**
63
**What is atherosclerosis?**
| Ch 21
fatty plaque build up inside of the arteries
64
**What is intermittent claudication?**
| Ch 21
**cramping pain in the calves** (or another specific muscle group) **induced by exercise / walking & caused by obstruction of the arteries**
65
**What can the use of a doppler ultrasonic stethoscope confirm?**
| Ch 21
low or no pulse
66
**Where are epitrochlear lymph nodes located?**
| Ch 21
Anticubital region
67
**What is the modified Allen test used to screen for?**
| Ch 21
carpal tunnel & PVD
68
**Where is teh doralis pedis pulse located?**
| Ch 21
extender toe on top of the foot
69
**Where is the posterior tibial pulse located?**
| Ch 21
inside the ankle, near the ankel bone
70
* **What does the Ankle-brachial index (ABI) do?**
* **What can it indicate?**
* **What is the normal value?**
| Ch 21
* checks BP in lower extremties compared to BP in the arm (ankle systolic pressure / arm systolic pressure)
* **Indicates:** PVD
* * **Normal:** 1.06 or 106%
71
**What are the different variations in arterial pulse?**
| Ch 21
* **1+:** weak, "thready" pulse
* **2+: NORMAL**
* **3+:** full, bounding pulse
72
**The relevant variable when discussing claudication with a patient is:**
**a.)** Related foods
**b.)** Distance
**c.)** Blood glucose
**d.)** Emotional state
| Ch 21
**b.)** Distance
73
**Where is the APEX of the heart located?**
| Ch 20
5th intercostal space at the midclavicular line
74
**Where are S1 and S2 heard the loudest?**
| Ch 20
* **S1 loudest at APEX**
* **S2 loudest at BASE**
75
**Explain the path of blood flow through the heart**
| Ch 20
**RIGHT**
**1.)** SVC/IVC
**2.)** Right Atrium **(RA)**
**3.)** Tricuspid Valve **(TV)**
**4.)** Right Ventricle **(RV)**
**5.)** Pulmonary Valve **(PV)**
**6.)** Pulmonary Artery **(PA)**
**LEFT**
**1.)** Pulmonary Veins **(PV)**
**2.)** Left Atrium **(LA)**
**3.)** Mitral Valve **(MV)**
**4.)** Left Ventricle **(LV)**
**5.)** Aortic Valve **(AV)**
**6.)** Aorta
76
**What causes the first heart sound (S1)?**
| Ch 20
**Closure of the AV valve**
* Tricuspid
* Mitral
77
**What causes the second heart sound (S2)?**
| Ch 20
**closure of the semilunar valve**
* Pulmonic
* Aortic
78
**When would a third heart sound be heard (S3)?**
| Ch 20
**AFTER** S2 (early diastole)
79
**What conditions can cause a third heart sound (S3)?**
| Ch 20
* CHF
* acute MI
* late pregnancy
* elderly patient with CAD
* young children
80
**When would a fourth heart sound be heard (S4)?**
| Ch 20
**BEFORE** S1 (late diastole)
81
**What groups of people can have & what conditions can cause a fourth heart sound (S4)?**
| Ch 20
* atheletes
* elderly
* chronic HTN
* aortic stenosis
* cardiomyopathy
82
**What do jugular veins give us information about?**
| Ch 20
**RIGHT** sided heart pressure
83
**JVD shows more in which jugular veins & what can JVD indicate?**
| Ch 20
* Shows more in the **R jugular vein**
* JVD can indicate **HF**
84
**What is dyspnea?**
| Ch 20
difficulty breathing
85
**What is orthopnea?**
| Ch 20
difficulty breathing while lying flat
86
**What is fatigue related to regarding the cardiovascular system?**
| Ch 20
related to **cardiac output**
87
**What can cyanosis or pallor indicate regarding the cardiovascular system?**
| Ch 20
**decreased** cardiac output
88
**What side of the stethoscope is used to auscultate carotid arteries / listen for bruit?**
| Ch 20
**bell**
89
**JVD is most obvious when a patient is in what position?**
| Ch 20
supine (lying flat)
90
**Where is the apical pulse located?**
| Ch 20
5th intercostal space at the midclavicular line
91
**What is the most common irregular heart rhythm?**
| Ch 20
A Fib
92
**How long should the apical pulse be listened to?**
| Ch 20
1 minute
93
**How is the pulse deficit calculated?**
| Ch 20
(Apical Pulse) **--** (Radial Pulse)
94
**Which side of the stethoscope should be used when listening to the 5 ausculatory areas of the heart?**
| Ch 20
DIAPHRAGM
95
**What are the 5 ausculatory areas of the heart?**
| Ch 20
**1.) A**ortic area
**2.) P**ulmonic area
**3.) E**rb's point
**4.) T**riscuspid area
**5.) M**itral area
| **APE T**o **M**an
96
**Where is the aortic area (1) found?**
| Ch 20
**2nd intercostal space at the R sternal border**
97
**Where is the pulmonic area (2) located?**
| Ch 20
**2nd intercostal space** (L side)
98
**Where is Erb's point (3) located?**
| Ch 20
**3rd intercostal space** (L side)
99
**Where is the Tricuspid area (4) located?**
| Ch 20
**5th intercostal space** (slightly L of midline)
100
**Where is the Mitral area (5) located?**
| Ch 20
**5th intercostal space at the midclavicular line**
101
**What do murmurs sound like?**
| Ch 20
swishing sound
102
**Which side of the stethoscope should be used to listen for S3 & S4? How should the patient be positioned when listening for S3 & S4?**
| Ch 20
* listen with the **bell**
* Place the patient in a **L lateral position**
103
**What is a thrill?**
| Ch 20
**vibration you can feel** (usually at the base)
104
**True or False: it is important to document the heart sounds in precisely the correct locations to accurately correlate those sounds with particular valves.**
| Ch 20
**False**
105
**The first heart sound is produced by:**
**a.)** closure of the semilunar valves
**b.)** closure of the AV valves
**c.)** opening of the semilunar valves
**d.)** opening of the AV valves
| Ch 20
**b.)** closure of the AV valves
106
**Which of the following is an appropriate position to have the patient assume when auscultating the heart sounds?**
**a.)** Roll toward the left side
**b.)** Roll toward the right side
**c.)** Trendelenburg's position
**d.)** Recumbent position
| Ch 20
**d.)** Recumbent position
107
**A bruit heard while auscultating the carotid artery of a 65-year-old woman is caused by which of the following?**
**a.)** Decreased velocity of blood flow through the carotid artery
**b.)** Turbulent blood flow through the carotid artery
**c.)** Rapid blodo flow through the carotid artery
**d.)** Increased viscosity of blood
| Ch 20
**b.)** Turbulent blood flow through the carotid artery
108
**Which salivary glands are accessible to examen (NOT palpable)?**
| Ch 14
* **Parotid** (in cheeks)
* **Submandibular** (beneath mandible)
* **Sublingual**
109
**What is a goiter?**
| Ch 14
enlarged thyroid gland
110
**What is the isthmus**
| Ch 14
middle of the thyroid
111
**What lymph nodes are accessible for inspection & palpation?**
| Ch 14
* Cervical
* Epitrochlear
* Axillary
* Inguinal
112
**What is the size of a normal lymph node?**
| Ch 14
less than or equal to 1 cm
113
**What are the lymph nodes we're responsible for in lab?**
| Ch 14
**1.)** Preauricular
**2.)** Posterior Auricular (mastoid)
**3.)** Occipital
**4.)** Jugulodigastric
**5.)** Submental
**6.)** Submandibular
**7.)** Superifical Cervical
**8.)** Deep Cervical
**9.)** Posterior Cervical
**10.)** Supraclavicular
114
**You should be concerned for malignancy or cancer when lymph nodes are...**
| Ch 14
* fixed
* hard
* non-tender
115
**Normal lymph nodes should be...**
| Ch 14
* freely movable
* < 1 cm
116
**What can enlarged or inflammed lymph nodes indicate?**
| Ch 14
acute infection or illness
117
**Which of the following is the most appropriate health history question?**
**a.)** Any unusually frequent or unusually severe headaches?
**b.)** Have you had headaches recently?
**c.)** Have you ever had a headache?
**d.)** When di dyour headaches start?
| Ch 14
**a.)** Any unusually frequent or unusually severe headaches?
118
**Which of the following is the most appropriate health history question?**
**a.)** Any unusually frequent or unusually severe headaches?
**b.)** Have you had headaches recently?
**c.)** Have you ever had a headache?
**d.)** When di dyour headaches start?
| Ch 14
**a.)** Any unusually frequent or unusually severe headaches?
119
**What are the characteristics of a tension headache?**
| Ch 14
* **Location:** bilateral; across frontal, temporal, and/or occipital region (forehead, sides, back of head)
* **Character:**bandlike tightness, non-throbbing, non-pulsating
* **Duration:**gradual onset; lasts 30 minutes to days
* **Quantity & severity:** Diffuse, dull aching pain; mild - moderate pain
* **Aggravating Symptoms or Triggers:** stress, anxiety, depression, poor posture; NOT worsened by physical activity
120
**What is the definition of a tension headache?**
| Ch 14
* headache of muskuloskeletal origin
* mild - moderate pain
* less disabling form of migraine
121
**Describe the characteristics of a cluster headache**
| Ch 14
* **Location:** always 1 sided; often behind or around the eyes, temple, forehead, cheeks
* **Character:** continuous, burning, piercing, excrutiating
* **Duration:** abrupt onset, peaks in minutes, lasts 45 - 90 minutes
* **Quantity & severity:** can occur multiple times a day; in "clusters" lasting weeks; severe, stabbing pain
* **Timing:** 1-2 / day each lasting 1/2 to 2 hour for 1 - 2 months; then remission for months or years
* **Aggrevating symptoms or triggers:** exacerbated by EtOH, stress, daytime napping, wind or heat exposure
122
**What is the definition of a cluster headache?**
| Ch 14
* rare intermittent headache
* excrutiating
* unilateral with autonomic signs
123
**What are the characteristics of a migraine headache?**
| Ch 14
* **Location:** Commonly 1 sided, but may occur on both sides; pain is often behidn the eyes, the temples, or forehead
* **Character:** throbbing, pulsating
* **Duration:** rapid onset, peaks 1-2 hours, lasts 4 - 72 hours, sometimes longer
* **Quantity & severity:** moderate to severe pain
* **Timing:** ~ 2 per month, last 1-3 days (~ 1 in 10 patients have weekly headaches)
* **Aggrevating symptoms or triggers:** hormonal fluctuations (premenstrual)**;** foods (EtOH, caffeine, MSG, nitrates, chocolate, cheese)**;** Hunger**;** Letdown after stress**;** Sleep deprivation**;** sensory stimuli (flashing lights, perfumes, etc.)**;** changes in weather**;** physical activity
124
**What is the definition of a migraine headache?**
| Ch 14
* headache of genetically transmitted vascular & trigeminal nerve origin
* Headache + prodrome, aura, & other symptoms
* 2 - 3 times as common in women as in men
125
**What are the 3 types of headaches & what are the major differences?**
| Ch 14
**Tension:**
* musculoskeletal origin
* bandlike tightness
* usually occurs bilaterally
* gradual onset
* mild to moderate pain (diffuse, dull aching)
**Migraine:**
* genetically transmitted vascular & trigeminal nerve origin
* commonly 1-sided, can occur on both sides
* pain often behind eyes, forehead, or temples
* throbbing, pulsating pain
* rapid onset
* moderate to severe pain
**Cluster:**
* rare, intermittent headache
* unilateral
* continuous, burning, piercing, excrutiating
* abrupt onset
* severe, stabbing pain
126
**What is the definition of a migraine headache?**
| Ch 14
* headache of genetically transmitted vascular & trigeminal nerve origin
* Headache + prodrome, aura, & other symptoms
* 2 - 3 times as common in women as in men
127
**Which of the following is a true statement regarding the findings related to percussion?**
**a.)** useful techniques for identifying small lesions in lung tissue
**b.)** notes are not influenced by overlaying chest muscle and fat tissue
**c.)** helpful only in identifying surface alterations of lung tissue
**d.)**a dull note elicited with percussion is the expected finding
**c.)** helpful only in identifying surface alterations of lung tissue
128
**What is a common side effect of dysphagia?**
**a.)** lack of nutrition
**b.)** high blood pressure
**c.)** orthostatic hypotension
**d.)** abdominal pain
**a.)** lack of nutrition
129
**What percentage of carotid stensosis will get surgical intervention?**
**a.)** 5 - 10%
**b.)** 20 - 30%
**c.)** 30 - 40%
**d.)** 50 - 60%
**d.)** 50 - 60%
130
**What can cause an increase in tactile fremitus?**
liquid in the lungs from **pneumonia**
131
**What conditions would NOT increase tactile fremitus?**
* asthma
* emphysema
* pneumothorax
132
**Do veins or arteries have a pulse wave & high pressures?**
**ARTERIES** have pulse wave & high pressures
133
**Which lymph nodes supply the upper arm, lower arm, & hand?**
epitrochlear lymph nodes
134
**What is a palpable impulse that can be felt by the left lower sternal border?**
heave / lift
135
**What is the main difference between a thrill & a heave/lift?**
* You can **see & feel** a **heave / lift**
* You can **hear** a **thrill**
136
**What causes crackles and where are they heard most often?**
* caused by **liquid**
* heard in the **bases**
137
**What causes a stridor?**
restricted airways
| harder to breath causes an INCREASE in sounds
138
**What is the difference in arterial sclerosis & atherosclerosis?**
* **Arterial Sclerosis = tightening of BP** (systolic & diastolic numbers are closer together)
* **Atherosclerosis = fatty build up in vessels**
139
**A patient in anaphylaxis may present with which adventitious lung sound?**
**a.)** Crackles
**b.)** Stridor
**c.)** Clear Lung Sounds
**d.)** Pleural Rub
**b.)** stridor
140
**Describe chronic arterial symptoms (PAD)**
| Ch 21
* **Location: deep muscle pain** (usually calf, but may be lower leg or dorsum of foot)
* **Character: intermittent claudication** (feels like "cramp", "numbness & tingling", "feeling of cold")
* **Onset & Duration: chronic pain, gradual onset after exertion**
* **Aggrevating Factors: activity & elevation**
* **Releiving Factors: rest, dangling**
* **Associated Symptoms:** low ankle-brachial index**;** cool, pale skin**;** diminished pulses**;** pallor on elevation
* **Those at risk:** older & middle-aged adults, African Americans, individuals who smoke, have HTN, DM, obesity, vascular disease, hypercholesterolemia
141
**Describe the characteristics of acute arterial symptoms**
| Ch 21
* **Location: varies** (distal to occlusion, may involve entire leg)
* **Character: throbbing**
* **Onset & Duration: sudden onset** (within 1 hour)
* **Associated Symptoms: P**ain, **P**allor, **P**ulseness, **P**aresthesia, **P**oikilothermia (coldness), **P**aralysis (indicates severe)
* **Those at risk:** history of vascular surgery, arterial invasive procedure, abdominal aneurysm (emboli), trauma, chronic A-Fib
142
**What are the main differences in chronic & acute arterial symptoms?**
| Ch 21
**CHRONIC**
* deep muscle pain
* intermittent claudication
* chronic pain, gradual onset after exertion
* aggravated by activity & elevation
* releived by rest & dangling
**ACUTE**
* distal to occlusion (may involve entire leg)
* throbbing
* sudden onset
143
**What are the characteristics of Chronic Venous Symptoms?**
| Ch 21
* **Location: calf, lower leg**
* **Character: aching, tiredness, feeling of fullness**
* **Onset & Duration: chronic pain, increases at end of day**
* **Aggrevating Factors: prolonged standing, sitting**
* **Releiving Factors: elevation, lying, walking**
* **Associated Symptoms: edema, varicosities, weeping ulcers at ankles**
* **Those at risk:** anyone with job involving prolonged standing or sitting, obesity, multiple pregnancies, prolonged bed rest**;** Hx of HF, varicosities, or thrombophlebitis**;** veins crushed by trauma or surgery
144
**What are the characteristics of Acute Venous Symptoms?**
| Ch 21
* **Location: calf**
* **Character: moderate to intense, sharp; deep muscle tender to touch**
* **Onset & Duration: sudden onset** (within 1 hour)
* **Aggrevating Factors: pain may increase with palpation**
* **Releiving Factors: Pain medication**
* **Associated Symptoms: Red, warm, swollen legs**
145
**What are the main differences in Chronic & Acute Venous Symptoms / Disease**
| Ch 21
**CHRONIC**
* calf, lower leg
* aching, tiredness, feeling of fullness
* chronic pain, worse at end of day
* aggrevated by prolonged standing & sitting
* releived by elevation, walking, lying
* **Associated Sx: edema, varicosities, weeping ulcers at ankles**
**ACUTE**
* calf
* moderate to intense, sharp, deep muscle tender to touch
* sudden onset
* pain may increase with palpation
* releived with pain medication
* **Associated Sx: red, warm, swollen**
146
**What signs & symptoms do arterial diseases cause?**
| Ch 21
oxygen deficit
147
**What signs & symptoms do venous diseases cause?**
| Ch 21
metabolic waste buildup
148
**Venous diseases cause signs & symptoms of ..........**
**Arterial diseases cause signs & symptoms of ............**
| Ch 21
**Venous Dx =** s&s of **metabolic waste buildup**
**Arterial Dx =** s&s of **oxygen deficit**
149
**Explain the Modified Allen Test?**
you occlude both radial & ulnar pulses then release the ulnar pulse
150
**Explain the Manual Compression Test**
**1.)** compress the vein
**2.)** feel for a wave
| **No Wave =** competent veins
**Wave = ** incompetent veins
151
**What does the Manual Compression Test evaluate?**
Assesses **Vein Competence**
152
**What does the Modified Allen Test evaluate?**
Assesses **overall blood flow in the hands**
153
**What is hemoptosis?**
coughing up blood
154
**What is deep vein thrombosis (DVT)?**
* blocked venous return
* cyanosis
* edema
* inflammation
* sudden onset
* intense sharp muscle pain
155
**Which peripheral vascular disease is moderate to intense deep muscle pain with palpation & resolved with medication?**
**a.)** Chronic Arterial
**b.)** Acute Arterial
**c.)** Chronic Venous
**d.)** Acute Venous
**d.) acute venous**
156
**Where would you find bronchiovesicular sounds?**
**a.)** anterior throat
**b.)** posterior near the upper spine
**c.)** lateral chest
**d.)** posterior beneath scapula
**b.) posterior near the upper spine**
157
**Which peripheral vascular disease is a chronic pain, releived by walking, aggravated by prolonged sitting or standing?**
**a.)** Chronic arterial
**b.)** Acute arterial
**c.)** Chronic venous
**d.)** Acute venous
**c.)**Chronic Venous
