exam 3 Flashcards
medical conditions/ assessments for protein deficiency?
lab tests, Kwashiorkor: a disease marked by severe protein malnutrition and bilateral extremity swelling
marasmus: a severe form of malnutrition that occurs when the body doesn’t have enough calories, protein, carbohydrates, or fats to function normally
physical exam findings of a client with adequate nutrition ?
evident by a persons physical appearance, weight, measurements, BMI 18.5-24.9
symptoms of dyspnea:
difficulty breathing, difficulty in facial expression, distressed, retraction, flaring of nose, labored breathing
most important technique when auscultating lung sounds
compare sounds between symmetrical lung fields on each side of the chest, moving systematically from the apex to the base while asking the patient to take deep breaths through their mouth, sitting up
important factors to observe and document when assessing the adult anterior chest
increases systolic, arteries get hard, on left side of heart, but diastolic stays the same
voice sound tests
bronchophony: pt repeats 99, soft, muffled, and indistinct, abnormal if 99 sounds distinct
egophony: listen while pt says “eeee”, should hear “eee” abnormal if you hear “aaaa”
whispered pectoriquoly: pt whispers “1,2,3” as you listen, it should be faint, muffled, almost inaudible, abnormal would be if sound was very clear
Guidelines to correctly listen to breath sounds
have to assess inspection, palpation, percussion, auscultation
Expected findings in the normal adult lung—tactile fremitus and resonant percussion
tactile fremitus: palpable vibration (99 test)
resonant percussion: normal percussion of lungs sounds
Bronchial, vesicular, bronchovesicular breath sounds
bronchial: loud, harsh, high-pitched breath sounds that are usually heard over the trachea or at the right apex of the lungs
vesicular: soft, low-pitched sounds that are heard when a person breathes in and out, and are a sign of normal lung function
bronchovesicular: medium-pitched sounds that are heard in the lungs when a person breathes in and out, posterior chest between the scapulae and in the center part of the anterior chest
how many lobes do the lungs have?
right lung: shorter because of liver , three lobes
left lung: narrower because of heart bulging to left, two lobes
pleura:
a thin layer of tissue that lines the inside of the chest cavity and covers the lungs
History taking for respiratory ailments
pertinent past medical history (e.g. asthma/COPD), inhaler use, smoking history, occupational exposures, and even childhood illnesses
Assessing voice sounds during a respiratory assessment
in tactile fremitus, soft, muffled, and indistinct; you can hear sound through stethoscope but cannot distinguish exactly what is being said
Symptoms associated with orthopnea and what may cause the symptoms
orthopnea: difficulty breathing laying down
causes: heart failure, COPD, pulmonary hypertension, obesity, pneumonia, stress
Adventitious breath sounds—definition and the types of sounds that may be auscultated
stridor: high pitch inspiration crowing sound caused by upper airway obstruction louder over the neck than the chest wall
crackle: abnormal discontinuous adventicious lung sound heard on inspiration
wheeze: high pitch musical squeaking adventicious lung sound also used with low pitched adventicious sounds
barrel chest assessment findings
AP diameter, greater than 1-2, COPD
reasons why someone has crackles, wheezes:
fluid gets in lungs
diastole
hearts filling phase, bottom #
systole
hearts pumping phase, top #
Action that produces S1 sound
Occurs with closure of AV valves—signals beginning of systole
Correct technique for palpating the carotid arteries
Palpate only one carotid artery at a time to avoid compromising arterial blood to brain, feel contour and amplitude of pulse, normal strength 2+, findings should be same bilaterally
Correct sequence for auscultating heart sounds
- Second right interspace: aortic valve area
- Second left interspace: pulmonic valve area
- Left lower sternal border: tricuspid valve area
- Fifth interspace at around left midclavicular line: mitral valve area
APE to man
Diastole and the S2 heart sound
heart relaxes, occurs with closure of semilunar valves—signals end of systole, S2 loudest at base
Electrical sequence of the cardiac cycle
start in SA node then AV, bundle of his, bundle branches, Purkinje fibers
Cardiovascular changes NOT expected in the aging adult
resting heart rate — the number of heartbeats per minute at rest — does not change significantly with normal aging
Anatomy of the heart—heart wall, chambers, and valves
heart wall: precordium, note any heave or thrill
chambers: the right and left atria, and the right and left ventricles
valves: aortic valve, mitral valve, tricuspid valve, and pulmonary valve
Blood flow through the heart
superior cena cava, inferior cena cava, Right Atrium, tricuspid valve,Right Ventricle, Pulmonary Artery, Lungs,
Pulmonary Vein, Left Atrium, mitral valve,
Left Ventricle, aortic valve, aorta, body
Blowing/whooshing sound in the aortic and pulmonic anatomical regions
murmurs, they are the result of vibrations caused by turbulent blood flow patterns
what valves are in AV valves and SL valves:
AV: tricuspid (right side), mitral (left side)
SL: pulmonic (right), aortic (left)
First sounds that should be identified when auscultating the heart
S1 and S2
Anatomical location of the auscultating the pulmonic valve
second left intercostal space near the upper sternal border
signs and symptoms of varicose veins
create incompetent valves leading to increased venous pressure, which further dilates the vein, bulging bluish veins, discomfort, swelling in legs
Anatomical location of the dorsalis pedis pulse
a pulse in the foot that can be felt by pressing fingertips into the dorsum of the forefoot near the ankle, Normally it is just lateral to and parallel with extensor tendon of
big toe
Arterial insufficiency
stops the flow of blood, pallor when leg raised
Risk factors that contribute to DVT
standing for a long time, prolonged bedrest, hypercoagulation, obesity, pregnancy, heart failure, kidney disease
Lymphedema precautions
avoid getting BP on same arm with it because it could cut off circulation
Peripheral vascular disease with associated pain in lower extremities
peripheral artery disease (PAD), a chronic condition that occurs when blockages in the arteries reduce blood flow to the legs, claudication is pain in the legs or arms that occurs while walking or using the arms
Popliteal pulse
the soft spot in the back of the knee, behind the kneecap, anchor your thumbs on knee, and
curl your fingers around into popliteal fossa
Assessment of peripheral pulses
a clinical tool that involves palpating the blood moving away from the heart through the extremities, femoral, posterior tibial, dorsalis pedis, and sometimes the popliteal arteries
Assessment of extremity edema
performing a pitting test and measuring the circumference of the extremity
Anatomical locations of the ulnar and radial pulses
ulna is on the pinkie side of the wrist, and radial is on the thumb side
Timing to determine absence of bowel sounds
5 mins each quad
Purpose of fluid shifting dullness test
finding ascites (abnormal accumulation of serous fluid within the peritoneal cavity, associated wih heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer)
Normal findings when palpating abdomen
Abdomen soft to touch with no masses, swelling, pain, and rigidity, no tenderness, symmetric
Sequence of abdominal assessment and reasoning
inspect, auscultation, percussion, palpation, can cause peristalsis if palpate before auscultate
Costovertebral angle tenderness
meaning kidney enlarged, this is where you assess the back and the angle between ribs, you “punch” to see if any tenderness
Know anatomical locations of organs in the abdomen
Sequence of auscultating the abdomen
rlq, ruq, luq, llq, use diaphrgam
Anatomical location for auscultating the abdominal aorta
about two-thirds of the way down the abdomen, between the xiphoid (epigastrium) and the umbilicus, epigastric region
Definition of hepatomegaly
abnormal enlargement of liver
Palpation of an enlarged spleen—precautions when enlarged
Normally not palpable and must be
enlarged 3 times its normal size to be felt, friable and can
rupture easily during palpation—therefore
it should not be palpated due to danger
of rupture and significant blood loss
