Exam 2 Flashcards
respir. assessment parts
inspection, palpation, percussion, auscultation
lung reference lines- anterior
anter. axillary line (R and L)
midclavicular line (R and L)
midsternal line
lung reference lines- posterior
scapular line (L and R) vertebral or mid-spinal line
lung reference lines- lateral
anter. axillary line (near pectoral fold)
mid-axillary line
poster. axillary line (inside latis. dorsi)
anterior thoracic landmarks- sternum
suprasternal notch- v at top of sternum
sternum
manubriosternal angle- trachea birfurcation anteriorly (opposite 2nd rib)
costal angle- under xphoid process (norm= < or equal to 90 degrees)
posterior thoracic landmarks
superior border scapula- 2/3rd rib infer. border scapula 10th rib (normal respir) 12th rib (deep respir) tracheal bifurcation (4-5ribs)- can listen heart sounds
lung borders- anterior
above the clavicle (apex) to 6th rib
lung borders- lateral and purpose
high axilla to 8th
can assess all 3 R lung lobes in one position
lung borders- posterior
T-1 to T-10 or T-12
10=normal respir
12= deep respir
low SA 02 manifestations
sleepy/ confused
normal breathing rate v inc and dec
eupnea, unlabored 12-20
trachypnea- >20
bradypnea- <10 or 12
apnea
without respir
nasal flaring common in what populations
infants and kids
labored respir signs
cyanosis, lvl of conciousness, nasal flaring, pursed lips, position, ICS retractions/ bulging, super clavicular retraction
rib angle of insertion ant and post
ant- 90 to the sternum
post-45 to spine
norm configuration/ transverse values
1:2 or 5:7
laternal v front/back
COPD-Emphysema manifestations
access. muscle use
pursed lips, ICS, labored respir, hypertrophied musc, weight loss
dis. linked to hyperresonance
COPD-emphy
pneumothorax
purpose percussion
5-7cm
determine density underlying tissue
where is resonance heard
periph lungs
dullness heard
over liver and heart
tympany heard
stomach
flatness heard where in thoracic area
over clav and scapula
bronchial breath sounds
E>I
anterior only, normal over trach
abnorm= anywhere else bc consolidation
bronchovesicular breath sounds
E=I norm over major airways rib 2 anter rib 4/5 post if heard anywhere else= abnorm bc fluid
vesicular breath sounds
I>E
crackles
discontin
fulid in alveoli
bc heart failure and pneumonia
wheezing
contin
high pitched
obstructed air flow - asthma
rhonchi
low pitched wheezing
continuous
thick secretions
stridor
continu
upper airway obstruction
areas tactile frem more intense
trach and major airways
sounds heard w/ pneumonia
bac infection
crackles
pneumonia manifestations
tachy, dyspnea, nasal flaring, febrile, cough, fever, fatigue
inc breath sounds def
bronchial or bronchovesicular heard in abnorm locations
occur w/ consolidation
diminished breath sound causes
obesity, hyperinflat, air/fluid in pleural space, foreign body
pneumothorax sounds
diminished/absent
pneumothorax manifestations
dyspnea, tachy, dec o2 sat, cyanos, inc respir, dec bp, unequal chest expansion, dec tactile frem, trach deviation, hyperreson.
emphysema sounds
hyperreson.
diminished
emphysema patho results
dec tact frem, barrel chest, ICS, access. muc use, tripod posit, trach, inc heart rate, dyspnea,
asthma sounds
wheezing
asthma manifestations
SOB, dyspn, chest tightness, ICS, access. muscle use
cardiac assessment- PND
paroxysmal nocturnal dyspnea
SOB when laying down/ sleeping due to heart failure
laying dwn inc vol intrathoracic blood
heart cannot accom inc load/blood vol
chest pain causes
cardiac, GI, musculoskeletal, repspiratory
location of heart in relation to sternum (%)
2/3 to L of sternal border
1/3 under sternum
heart landmark- anteriorly
precordium
inc area heart overlays and great vessels
chest pain- diff btw sex- women
wmn- inc SOB, more fatigue, flu-like sympt (nausea/vomiting)
shoulder and back pain
nocturia
inc urination at night
fluid shifts from legs to core (inc blood to heart= inc kidney perfusion)
risk for black, native and hispanic
inc for cardia/cerebralvascular (stroke)
risk for cardiac problems w/ age
inc
greater in men until women hit menopause
risk for cardiac problems assoc w/ diabetes
2x risk coron. artery dis
inc lvl cholesterol and LDL
HTN is risk for what cardiac condition
main contributor to heart dis/ stroke
smoking risk
2-4x inc risk dev. cornonary a disease
orthopnea/ PND
diff breathing laying on back (supine)
sympt associated w/ chest pain +locations
locations- substernal, can radiate down arm and to jaw
sympt- sweating, nausea, vomiting, SOB, fatigue, feeling of indigestion, “elephant on chest”
concerns for family hx w/ cardiac problems
male hx cardiac dis before 55
wmn hx cardiac dis before 65
atrioventricular valves
semi-lunar valves
R- tricuspid and pulmonic
L- mitral and aortic
flow of conduction through heart
SA node, av node, L atria, L/R ventr. bundle branches, Purkinje fibers
electrical events v mechanical
electrical before mech and L sided heart action before R
heart ICS location
2nd-5th
diastole v systole
diastole- vent filling, AV valves open,
systole- AV closed, SL valves open, contraction/ ejecting blood
pre- ventricular systole
atrial kick
ejects last 25-30% blood
S1 and S2
s1- systole- av v closed, beginning ventricular systole
Mitral before tricuspid (L before R), heard loudest at apex
s2- semi lunar closed, aortic before pulmonic, end of systole, begin. of diastole, loundest at base
apex location- heart
5th intercostal space mid-clavicular line over mitral area
base location- heart
top part of heart
2nd ICS to R/L sternum
S2- physiological (normal) split
aortic close before pulmon
heard as two sounds
present during inspir/ dec w/ expir and sitting
delay in R value closure, inc blood return to R side heart
shortened LV systole
lub- dub- lub- T-dub
heard best in pulmonic valve area
S3
lub- duppa- lub- duppa after S2 early diastolic sound (during filling) best heard at apex (5th ICS) norm in children, young adults, pregnancy abnorm w/ heart failure
S4
late diastolic, w/ atrial contraction/kick before S1 dalub- dup- dalub- dup norm- occasionally in adults heard best at apex (5ICS)
murmurs- systolic
between s1 and s2
early
murmurs normal v abnorm
normal- pregnancy, children, after exercise
abnorm- valve incompet (backwards flow, vent hypertrophy, non-rigid valve, inc high flow)
murmurs- diastolic
between S2 and S1
late
apical pulse v apical impulse
pulse- ausc for @ 5ICS @MCL (felt in 50% adults)
impulse- seen 5ICS @MCL
thrill
palap murmur
abnorm!
just bc no thrill doesn’t mean no murmur
loud turbulence of blood flow
lifts/heaves
observable lifts of entire heart
abnorm
hypertrophy of heart
aortic valve area
close= S2 sound
heard best at base
2nd ICS R of sternal border
pulmonic valve area- what sound/best heard
close= S2 sound
heard best at base
2nd ICS L of sternal border
Erb’s point valve area
3ICS L of sternal border
*common place to hear mumurs
tricuspid valve area
4/5 ICS L of sternal border
close= S1 sound
mitral valve area
apex of heart
5 ICS L of sternal border in MCL
close= S1 sound
heart Valve area assessment process
go over all spots w/ diagphram and back again w/ bell
supine
turn pat. onto left side- listen apex (mitral area) w/ bell
sitting up/ leaning forward/exhale- go over spots again
diaphragm sounds
high pitched s1-s2
bell sounds
low pitched s3, s4 and murmurs
orthostatic Hypotension- common ass w/
BP/ pulse supine, sitting, standing 30sec - min apart
slight dec is normal!
drop SBP > 20mmHg and/or pulse inc 20bpm
common in prolonged bed rest, older age, hypovolemic, antihtn meds, history syncope/ LOC
arterial system
pumps blood to musc
thick walls, high P
pulse created by P wave from each heart beat
oxygenated blood
pulse sites
abdominal aorta, carotid, temporal, radial, brachial, ulnar, femoral, popliteal, dorsal pedialis, posterior tibial
venous system
high elastic (accom changes in blood vol), thin walls, dexygenated blood (except pulm v), no valves in jugular veins, low P, drain blood from tissues to heart
deep venous system incl
90% blood carrying
femoral/ popliteal
factors for blood flow in venous system
musc P through contraction, intraluminal valves, inspiration dec thoracic P and inc abdomin P
axillary nodes location
high in axilla
epitrochlear node location
in grove btw/ bicep and tricep (inner elbow)
inguinal nodes- upper and lower
upper- diagonal angle btw thigh and pelvis
lower- “femoral lymph nodes”
leg pain/ cramps indicate- cause
arterial circ. problems
“claudiation” inadeq blood flow (/ 02) to tissues
can be intermitent- inc w/ exercise, dec w/ rest
cause= periph. artery dis (atheroscler and arterialscler)
risks w/ prolonged standing/ sitting/ bedrest
venous problems, pooling, clots
edema in peripher vasc- v or a? and risk for what complication
venous
if painful, red and warm = clot (most commonly DVT/VTE)
thrombophlebitis
inflamm of vein w/ clot
dec hair distribution, cyanosis, clubbing, dec cap refill, cool extremities, musc atrophy bc
arterial
edema, dec leg pain w/ elevation
venous
bruits
abnorm sound (whooshing) heard w/ steth. over artery related to arterial circ
carotid assessment
use bell
lower aspect of neck
allen’s test
occlude radial/ulnar arteries squeeze hand multiple times till pallor present release radial- hand should return pink occulde b again release ulnar- hand should return pink
calf tenderness- Homan’s sign
if negative= no tenderness
to assess have pat move foot in Dorsal and plantar motions, ask if pain is present
normal changes in elderly- cardiac
dec hair distrib, inc thickness nails, think skin
pulse should remain normal
varicose veins
enlrgment superficial v
sympt- aching/ swelling
low chance of dev PE
superficial thrombophlebitis- sign and treatment
clots/ inflamm of superficial v
tender, red, warm, firm
treatment- moist heat and pain control
DVT or Venous Thromboembolism VTE- common in and sympt
risk for PE
common w/ bedrest, dehyd, orthopedic surgery, hypercoaguable blood, cancer, after baby delivery
sympt- swelling, Red( not always), pain, tenderness
pitting edema
press against bony prom.
if doesn’t pit- due to lymphatic dis
venous circ problems
jugular distention purpose
general estimate venous P
indicates R atrial P
inc bulging = inc P
jugular disten assessment
supine (distention is normal, no valve btw superior vena cava and r atrium)
45°- vein shouldn’t be greater than 3-4cm above clav
90°- vein should not be visible
arterial abnormalities
dec pulse, dec cap refil, cyanosis, cold extremities, no edema, shinky skin, dec hair, nail thickening (e/x elderly), claudication, pain w/ elevation, hanging legs alleviates pain
venous abnormalities
edema, brown pigmentation, varicosities, elevation makes pain better, standing makes pain worse, thickened skin, edema
