Exam 3 Flashcards
how many pairs of ribs are there
12
what are the 4 major functions of the respiratory system
supply oxygen to the body for energy
remove carbon dioxide (waste)
maintain acid-base balance (homeostasis) of arterial blood
maintain heat exchange
what can environmental tobacco smoke (ETS) cause in a baby
sudden infant death syndrome
negative behavioral/cognitive functioning
increased rates of adolescent smoking
does residual volume increase in the aging adult
yes
what is the most common chronic disease in children
asthma
objective data of the lungs includes
inspection
palpation
percussion
auscultation
what is Tactile (vocal) Fremitus
use hands to assess for palpable variations
hands over skin
have them say “99” or “blue moon”
what is a sound that is not pathologic
atelectic crackles
short popping, crackles, few breaths disappear
what is the normal outcome of Tactile (vocal) Fremitus when auscultation
soft, muffled, indistinct
hear sound, not distinguish what is said
what do diseases cause in tactile fremitus
increase intensity and enhance transmission of sounds
Bronchophony
auscultate posterior chest
99 should be muffled and soft
if loud (consider lung consolidation)
Egophony
evaluates intensity of voice
say “eee”
if “aaa” is heard, consider lung consolidation
Whispered Pectoriloquy
performed when (+) bronchophony is auscultated whisper (1, 2, 3) should be faint/muffled
what are normal differences of infants lungs/thoracic cavity
rounded thorax
equal anterioposterior to transverse chest diameter
by what age does the thorax reach adult ratio
6
1:2
are crackles in the lungs of a newborn common
yes
what are normal RR for infants
30-40
may spike to 60
when may RR be different in infants
extremes in temperature
feeding
sleeping
are brief period of apnea in infants normal? if so, for how long?
yes
10-15 seconds
when breathing, what may happen to the HR
it may speed up
what are normal findings in the aging adult related to respiratory system
increase in AP diameter Kyphosis (hunchback) outward curvature of thoracic spine chest expansion may decrease but still symmetric tend to tire easily when auscultating
what is the ratio of a barrel chest
1:1
whats the ratio of normal chest
1:2
what are pulmonary embolisms typically caused by
DVT
what are s/s of pulmonary embolism
chest pain (worse on inspiration) dyspnea apprehension (impending doom) anxiety restless diaphoresis hypotension crackles wheezes Partial Pressure <80 mm
what is crepitus
it is noticed palpating surface of ones skin
can sound like bubble wrap
can be sign of an open thoracic injury (punctured lung leaking air)
where is the apex of the heart
bottom
where is the base of the heart
top of the heart
what are the great vessels
arteries and veins that are connected to the heart
what are the two continious loops of blood vessels
Pulmonary Circulation
Systemic Circulation
what are the two AV valves
tricuspid (right)
Bicuspid/Mitral (left)
when are the two AV vales closed
during systole (emptying) to prevent regurg of blood back into aorta
what are the semilunar valves
Pulmonic (right)
Aortic (left)
what is the blood flow of the heart
right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle
when does S3 occur
when ventricles are resistant to filling during early rapid filling phase (Protodiastole)
when does S4 occur
at the end of diastole, at presystole, ventricle resistant to filling
what is S4 a sign of
HF
MI
when is S3 normal
it is okay in children, pregnancy, and conditioned athletes
what are murmurs caused by
the backflow of blood
what is heard if a murmur is present
blowing/swooshing
what are the conditions that result in murmurs
increased velocity of blood
decreased viscosity of blood
structural defects in valves
what is the node that initiates the electric impulse
Sinoatrial Node (SA Node)
what is the equation for cardiac output
Heart Rate X Stroke Volume
how much does blood volume increase in pregnancy
30-40%
arterial BP decreases
what are the electrocardiogram differences in older adults
prolonged PR interval
prolonged QT interval
QRS is the same
what is the most common underlying cause of death globally
CVD
what are the risk factors of CVD
HTN Smoking Increased Serum Cholesterol Physical Activity Diet
what is Paroxysmal Nocturnal Dyspnea
SOB at night, feeling of smothering when sleeping
signs of heart issues in infants can include
diaphoresis when eating
SOB when eating
fall asleep then wake up soon and still be hungry
cyanosis
what is a bruit
something you hear
what can a bruit be a sign of in the carotid
atherosclerosis
build up of plaque
what does the jugular venous pressure give information on
the hearts efficiency to pump
information about the right side of the heart
if there is JVD, what is it a sign of
right sided heart failure
what should you observe the precordium
possible pulsations
masses
what is at the second right interspace
aortic valve
second left interspace
pulmonic valve
3rd lower sternal border
tricupsid valve
5th interspace at midclavicular line
mitral valve (apical pulse)
what should be noted about murmurs
timing loudness pitch pattern quality location radiation posture change in position
what is the HR after birth
100-180
what should infant HR stabilize to
120-140
does an immediate newborn with a murmur mean it has a heart issue
no
typically disppear in 2-3 days
does an absence of a murmur in a newborn mean it is healthy
not necessarily
is a venous hum harmful
no
what is a common murmur in children
Innocent (functional) Murmur
what are the characteristics of the innocent murmur
soft, relatively short
medium pitch, vibratory
best heard at left lower sternal/midsternal
no radiation
what piece of education if important for parents with a child with an innocent murmur
that it is just “a noise” and it has no significance
how much can a pregnant womens HR increase
10-15 bpm
what is different about a pregnant womans heart
decrease in BP
apical pulse in different location
after age 35, if S3 is heard, what can it be a sign of
can be the earliest sign of HF (ventricular gallop)
what causes a pericardial friction rub
inflammation in the pericardial sac as it rubs against the pericardium
what does a pericardial friction rub sound like
high pitched and scratchy
sandpaper
have patient sit up and hold their breath
what are the subjective findings of mitral regurgitation
fatigue
palpitations
orthopnea
what are the objective findings of mitral regurgitation
thrill in systole at apex of the heart (sounds like cat purring)
displaced apical pulse (down and to the left)
S1 diminished
S3 often heard
what arteries are accessable for examination
temporal/carotid
arms
legs
what does peripheral arterial disease affect
noncoronary vessels and arteries affecting the limbs
why are veins called capacitance vessels
their ability to stretch
what doe veins carry
deoxygenated blood and wastes
what are the functions of the lymphatics
conserve fluid/plasma proteins that leak from capillaries
immune system, defend against diseases
absorb lipids from intestinal tract
what organs are involved in the immune response
spleen
tonsils
thymus
how is the spleen involved in the immune response
produce antibodies
filter microorganisms out of the blood
destroy old RBC’s
store RBC’s
why do hemorrhoids, edema, and varicose veins occur in pregnant women
as uterus gets larger, it obstructs the drainage
what are the signs/symptoms of intermittent claudication (IC)
burning and cramping when walking when you sit down it goes away
what increases the risk of DVT in older adults
progressive enlargement of calf veins
increased imoblitiy
what race is more at risk for PAD
african americans
what are the risk factors for developing PAD
smoking diabetes HTN obesity increased cholesterol levels
what should a normal angle of the nail be
160
pitting edema scale
\+1 = mild, slight indentation \+2 = moderate, indentation disappears rapidly \+3 = deep, indentation remains, legs look swollen \+4 = very deep, lasts long, leg grossly swollen
if their is an expected arterial deficit, what should you do
raise legs off table, wag feet for 30 seconds to drain venous blood
sit with legs over side of table
compare feet color/time it takes color to return to feet (less than or equal to 10 seconds)
what is a doppler used to detect
weak pulses
magnifies pulsatile sounds from heart/blood vessels
what does an increased Wells Score indicate
increased risk/probability of DVT
more than what indicates a high probablity for DVT
3 or higher
what should health promotion and education be with veins/arteries/etc
FOCUS ON FOOT CARE
what is the Raynaud Phenomenon
vessels being too cold, constrict and there is no blood flow
what are the s/s of Raynaud Phenomenon
extreme pain
abrupt color change in digits (loss of color)
what can cause Raynaud Phenomenon
too cold
stress
smoking
what is lymphedema
lymph nodes cause edema
what causes chronic venous stasis ulcer
valves in veins aren’t good at bringing blood back to heart
what is the main symptom/sign of chronic venous stasis
staining/discoloration to the lower extremeties (brown)
because of the breakdown of RBC’s
arterial disease cause what symptoms
symptoms of oxygen deficit
cool pale skin
smoking
diabetes
what kind of disease is intermittent claudication
arterial disease
what symptoms do venous diseases cause
symptoms of metabolic waste build up
what are internal organs called
viscera
what are the midline organs
aorta
uterus if enlarge
bladder if distended
what organs are in the Right Upper Quadrant (RUQ)
liver gallbladder duodenum head of pancreas right kidney/adrenal gland hepatic flexure of colon part of ascending/transverse colon
what organs are in the Left Upper Quadrant (LUQ)
stomach spleen left lobe of liver body of pancreas left kidney/adrenal gland splenic flexure of colon part of transverse/descending colon
what organs are in the Right Lower Quadrant (RLQ)
cecum appendix right ovary tube (female) right ureter right spermatic cord (male)
what organs are in the Left Lower Quadrant (LLQ)
part of descedning colon sigmoid colon left ovary tube (female) left ureter left spermatic cord
what type of anemia is common in the aging adult
pernicious anemia
can’t absorb B12
decrease gastric acid is the cause
what is celiac disease
autoimmune
intolerant to gluten
what is a peptic ulcer caused by
acids eating away at the stomach in the small intestine
what are causes of peptic ulcers
NSAIDS Alcohol H. Pylori radiation smoking stomach cancer
what is black tarry stool called
melana
what can green stool indicate
bacterial
what can pale and clay color stool indicate
liver issues
what is the order of assessing the abdomen
LOOK, LISTEN, FEEL
where does auscultation of the abdomen start
RLQ
what is Borborygmus
hyperperistalsis
to call bowel sounds absent, what must you do
listen to same spot for 5 minutes
how do you check for costovertebral angle of tenderness (CVA)
place hand over 12th rib and use opposite hand to thump
how large must the spleen be to be felt
3 times normal size
when is the spleen often palpable
Infections Mono leukemia lymphamos HIV portal HTN
what can occur if the spleen is enlarged
it is fribale, it can rupture
what tests can be done for ascites
fluid wave test
shifting dullness test
after what age should the stomach no longer be protruberent when laying supine
age 4
what are s/s of peptic/duodenal ulcers
dull aching and gnawing pain does not radiate relieved by food may awaken them from sleep vomiting
why may there be diminished bowel sounds
abdominal surgery
bowel obstruction
peritonitis (infection)
what is the suffix “megaly”
irregular enlargement of a body organ
what is hepatomegaly
enlarged liver
how many lobes does the right lung have
3 lobes
how many lobes does the left lung have
2 lobes
