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Health Assesment > Exam 2 Study Guide > Flashcards

Exam 2 Study Guide Flashcards

1
Q

Tactile Fremitus (Test)

A
  • Palpable vibration in the lungs.
  • Use ulnar edge of palm and repeat “99”. Move along the back from each location to the next and feel for vibrations.
  • You are looking for symmetry of vibrations between the 2 sides
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2
Q

Tactile Fremitus (Abnormal Findings)

A

Increased Tactile Fremitus
- Increased tactile fremitus means consolidation (air that fills airways is replaced with something else)(consolidation, pneumonia)
Decreased Tactile Fremitus
- Obstruction or thickening.

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3
Q

Normal Respiratory Rate

A
  • 12-20 Respirations per minute

Tachypnea - Increased respirations greater than 20. Could be due to either fever or exercise

Bradypnea - Decreased respirations less than 10. Could be due to diabetic coma or overdose

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4
Q

Respiration Rate (Abnormal Findings)

A

Hyperventilation - Increased rate and depth of respirations. (Diabetic ketoacidosis) Blowing out carbon dioxide
Hypoventilation - Shallow and decreased respirations that do not allow enough oxygen in. Common with overdose
Cheyne-Strokes Respiration - Fast with periods of apnea(normal). Common with renal failure or overdose.
Biot’s - Like Cheyne-Strokes but irregular pattern. Can be due to heat stroke or meningitis.

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5
Q

Proper Stethoscope Placement of Lung Auscultation

A
  • Listen from apices (top point) of C7 vertebra down to T10 vertebra. Then laterally from axilla down to 7th or 8th rib.
  • Stethoscope should be pressed hard enough to see an imprint of the stethoscope.
  • Take deep breath with every position but move slowly enough so your patient doesn’t get dizzy
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6
Q

Orthopnea

A
  • Shortness of breath when laying down (supine)

- Note how many pillows they need to use in order to avoid feeling shortness of breath in bed

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7
Q

Barrel Chest

A
  • Patients should normally have a 1:2 ratio between anteroposterior (AP) Diameter and Transverse Diameter.
  • If AP diameter equals Transverse Diameter it is called Barrel Chest. Chest looks like it is in continuous inspiration and is common with COPD (chronic emphysema and asthma) patients.
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8
Q

Adventitious Lung Sounds

A
  • Abnormal lung sounds that can include crackles, wheezes, stridor, and friction rubs
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9
Q

Fine Crackles

A
  • High pitched, short, popping sounds during inspiration.
  • They are NOT cleared when coughing
  • Happens when air collides with previously closed airways
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10
Q

Coarse Crackles

A
  • Loud, low pitched bubbling or gurgling.
  • Decreased with coughing and suctioning but will re-appear.
  • Happens when air collides with secretions in trachea and large bronchi.
  • Due to pulmonary edema, pneumonia, pulmonary edema. or depressed cough reflex
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11
Q

Atelectasis Crackles

A
  • Similar to fine crackles but do not last.
  • Disappear with deep breathing and coughing
  • Due to alveoli not fully aerated, causing deflation and accumulated secretions
  • Common with postoperative patients who are bed ridden
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12
Q

High Pitched Wheeze

A
  • Similar to musical squeaking.
    Polyphonic - multiple pitches at once.
  • Usually heard during expiration but can be heard during inspiration.
  • Happens due to air being squeezed through narrow passageways.
  • Common in airway obstructions, asthma, or chronic emphysema
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13
Q

Low Pitched Wheeze

A
  • Monophonic (single pitch) musical snoring or moaning
  • Maybe somewhat cleared when coughing.
  • Caused by airway obstruction with bronchitis, bronchus obstruction, or airway tumor
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14
Q

Stridor

A
  • High pitched monophonic inspiratory crowding sound.
  • Louder in neck than over chest wall.
  • Can be heard without a stethoscope
  • Caused by upper-airway obstruction and indicates inflamed tissue, lodging of foreign body, croup, and children with acute epiglottis.
  • LIFE THREATENING (air is not being let in or out)
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15
Q

Pleural Friction Rub

A
  • Superficial sound.
  • Coarse and low-pitched
  • Caused by pleurae becoming inflamed and lose normal lubrication.
  • If there is pain it is called pleuritis.
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16
Q

Normal Breathing Sounds

A

Bronchial - Only heard on anterior side. High pitched, loud, and more prominent during inspiration. Harsh and hollow sound

Bronchovesicular - Moderate pitch and amplitude, heard equally during inspiration and expiration. Sounds of mixed quality

Vesicular - Low pitched, soft, heard more during inspiration than expiration. Sounds like rustling through the trees.

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17
Q

Unequal Chest Expansion

A

Chest expansion is done by placing hands over posterolateral chest wall with thumbs at level of T9 and T10 Vertebra
- Thumbs should move up symmetrically
ABNORMAL
- Atelectasis (collapsed lung), Pneumonia, Pleural Effusion
- Pain during palpation can also indicate pleural inflammation

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18
Q

Aortic Valve Auscultation

A
  • Right side of heart in second intercostal space

S2 is heard loudest here

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19
Q

Pulmonic Valve Auscultation

A
  • Left side of heart second intercostal space.

S2 heart loudest here

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20
Q

Erb’s Point Auscultation

A
  • Left of sternum in 3rd-4th intercostal space.

S1 and S2 are heard equally here

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21
Q

Tricuspid Valve Auscultation

A
  • Left side of sternum in 4th or 5th intercostal space

S1 is heard loudest here

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22
Q

Mitral Valve Auscultation

A
  • Auscultated over the left midclavicular line in the 5th-6th intercostal space.
    (S1 is heard loudest here)
    Apical Pulse - Point of maximal impulse (PMI) is palpated here at the apex of the heart.
23
Q

Cardiac Thrills Palpation

A
  • Thrills are palpated with the palm of your hand gently over the chest wall
  • If there is thrill you will feel a slight vibration on your palm.
  • Thrills may indicate high pressure in the valves.
  • If thrill is noticed on the right side it could mean aortic stenosis or systemic hypertension
  • If thrill is noticed on the left side it could mean pulmonic stenosis or pulmonic hypertension.
24
Q

Heart Valves

A
  • Prevent backflow of blood. They only open one way
    4 valves in the heart
    2 Atrioventricular Valves
    2 Semilunar Valves
25
Q

Atrioventricular (AV) Valves

A

Tricuspid Valve - Right side of heart
Bicuspid (Mitral) Valve - Left side of heart

  • Thin leaflets anchored by collagenous fibers.
  • Open during heart filling phase (diastole) to allow blood to enter ventricles
  • Close during pumping phase (systole) to prevent blood from regurgitating back into atria.
26
Q

Semilunar (SL) Valves

A

Between ventricles and arteries.
Pulmonic Valve - Right side of the heart
Aortic Valve - Left side of the heart

  • SL Valves open during pumping phase (systole) to allow blood to be ejected by the heart to ensure blood keeps moving in the right direction
  • There are no valves between the vena cava and right atrium, or between pulmonary veins and left atrium.
27
Q

S1, S2, S3, S4

A

S1 - Heard loudest at apex (bottom) of heart. (Systole)
S2 - Heard loudest at base (top) of heart. (Diastole)
S3 - Low pitched sound after S2. Normal in younger adults and pregnant women. May be abnormal in older adults and indicate heart disease. (Above age 40)
S4 - Extra sound that occurs after S1. Always considered abnormal and commonly heard with heart failure

28
Q

Assessing Jugular Vein Distension

A
  • Patient lie back in 45 degree angle (Fowlers) with head turned to side
  • When shining over their neck take a measurement of the height of the jugular vein from surface of neck
    NORMAL
  • Should not protrude enough to measure
    ABNORMAL
  • Indicates Hypovolemia most likely due to congestive heart failure.
29
Q

Edema

A
  • When generalized may indicate heart failure

- Local obstruction or inflammation may is unilateral edema

30
Q

Grading Pitting Edema

A

1+ - Mild pitting, slight indentation, no perceptible swelling of leg (2mm)
2+ - Moderate pitting, indentation subsides rapidly (4mm)
3+ - Deep pitting, indentation remains for a short time, leg looks swollen (6mm)
4+ Very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted (8mm)

31
Q

Pulse Grading

A

0 - No palpable pulse
1+ - Weak, Thready
2+ - Normal
3+ - Full, bounding

32
Q

Deep Vein Thrombosis

A
  • Increased risk from prolonged bed rest, prolonged immobilization and heart failure.
  • Common in aging and myocardial infarction.
  • Low dose anticoagulant medications reduce risk for venous thromboembolism.
33
Q

Deep Vein Thrombosis

A
  • Wells Score for Leg DVT
  • Separated into low, moderate, and high probability
  • Score of 1-2 is a moderate probability and score of 3 or more is a high probability of DVT
34
Q

Venous (Stasis) Ulcer

A
  • Happens after acute DVT or chronic incompetent valves in deep veins.
  • Accounts for 80% of lower leg ulcers
  • Aching pain in calf or lower legs, worse at end of the day or prolonged standing/sitting.
  • Pain lessens with leg elevation
35
Q

Venous (Stasis) Ulcer

A

Signs

  • Lower leg edema does not resolve with diuretic therapy
  • Firm, brawny edema; coarse, thickened skin, normal pulse, brown pigment discoloration, petechiae dermatitis.
  • Causes increased venous pressure which causes red blood cells to leak out of veins into skin.
  • Borders are irregular.
  • Shallow and ay contain granulation tissue.
36
Q

Order of Operations (Abdominal)

A

Percussion and Palpation may increase peristalsis (muscle contractions in digestive tract) which could lead to false readings with auscultation.

1 - Inspection
2- Auscultation
3 - Percussion
4 - Palpation

37
Q

Normal Abdominal Inspection Findings

A
  • Shape should be flat, round.
  • Abdomen should be symmetrical
  • Skin should be smooth, even, and homogenous color.
  • Pulsing aorta is normal for thin people with good muscle wall relaxation.
  • Waves of peristalsis normal in very thin people.
38
Q

Abnormal Abdominal Inspection

A
  • Protuberant abdomen indicates abdominal distension
  • Bulges or masses can indicate a hernia or protrusion of viscera through abdominal opening in muscle wall.
  • Distension
    Could be caused by ascites (fluid collects in space of abdomen), feces, cysts, or pregnancy.
  • Umbilical Hernia - Intestines goes through umbilicus
  • Epigastric Hernia - Small fatty nodule you can feel
  • Incisional - Bulging near scar
  • Diastasis Recti - Separation of abdominal muscles, common after childbirth
39
Q

RLQ Sounds

A
  • Bowel sounds are normally present in the ileocecal valve area.
    Hyperactive - Loud, high pitched, rushing sounds indicates increased motility
    Hypoactive - Normal during post surgical or peritoneal inflammation
    Borborygmus - Intense growling in the stomach
    Assess for a whole 5 minutes if sounds are absent
40
Q

RUQ Contents

A
  • Liver
  • Gallbladder
  • Transverse colon
  • Ascending colon
  • Pancreas
41
Q

LUQ Contents

A
  • Liver
  • Stomach
  • Transverse Colon
  • Descending Colon
42
Q

RLQ Contents

A
  • Right Ureter
  • Cecum
  • Appendix
  • Right Fallopian Tube
  • Right Ovary
43
Q

Spleen is not Palpable

A
  • When a spleen is palpable it means that it is 3x its normal size
  • If spleen is felt, stop palpating it as it may rupture
44
Q

Peritonitis

A
  • Causes parietal pain (sharp, localized)
  • Guarding their abdomen or lying very still/resisting movement may indicate peritonitis

Inflammation of peritoneum typically caused by bacterial infection or after rupture of an organ (appendicitis)

45
Q

Costovertebral Angle Tenderness

A
  • Assessed by placing one hand over the 12th rib at costovertebral angel on back.
  • Thump the hand with ulnar edge of other fist
    NORMAL
  • Patient should feel no pain
    ABNORMAL
  • Sharp pain will occur with kidney inflammation
46
Q

Auscultation of Bowel Sounds

A
  • Use diaphragm side of stethoscope.
  • Bowel sounds are usually high pitched (pushing too hard may stimulate more bowel sounds)
  • Start in RLQ at ileocecal valve area and move clockwise
  • RLQ, RUQ, LUQ, LLQ
  • Listen to each quadrant for 5 minutes if bowel sounds are absent
47
Q

Abdomen Normal Auscultation

A
  • Note presence of bruits over large vessels like Aorta
  • Use firm pressure with bell side of stethoscope to listen to check over aorta, renal arteries, iliac, and femoral arteries (especially in people with hypertension)
  • Usually there is no sound present.
48
Q

Abdomen Abnormal Auscultation

A

Succussion Splash - Splash heard in upper abdomen when baby is rocked side to side
(Caused by increased air and fluid from pyloric obstruction or hiatal hernia)

Hypo/Hyperactive bowel sounds

49
Q

Rebound Tenderness

A
  • Assessed when patient reports abdominal pain or when you elicit tenderness during palpation.
  • Hold hand at 90 degrees or perpendicular to abdomen. Push down slow and deeply then lift up suddenly.
  • Normal (negative) response should be no pain upon release
  • Pain in right lower quadrant when pressure is applied to left lower quadrant (Blumberg sign) may indicate appendicitis.
  • Preform test at the end of examination because it may cause severe pain
50
Q

Percussion Sounds of Abdomen

A

Tympany - Normal
Dullness - Distended bladder, adipose tissue, fluids, mass.
Percussion is to assess density of abdomen, locate organs, screen for abnormal fluid or masses.
- Always move clockwise and percuss lightly in all 4 quadrants.
- Tympany is the main sound because air rises to the surface when a patient is supine.

51
Q

Spleen

A
  • Dull sound from 9th-11th intercostal space just behind midaxillary line
  • Splenic dullness should be not wider than 7cm
  • When percussing lowest intercostal space in left anterior axillary line, tympany should result.
  • If dullness is heard this is a positive sign of splenic enlargement
52
Q

Liver

A
  • Begin in area of lung resonance and percuss down right midclavicular line until dull sound is heard (5th intercostal space)
  • Find abdominal tympany on midclavicular line and percuss up until sound is dull (normally at right costal margin)
  • Normal liver ranges from 6-12 cm
  • Increased liver span indicates liver enlargement or hepatomegaly.
53
Q

Abdominal Vessels

A

Health Assesment (14 decks)

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