Module 3 Flashcards
Signs of feeding intolerance in infants
Tires easily
Sweating while feeding
Cyanosis
apical impulse
visible at about the midclavicular line in the fifth left intercostal space
Left ventricular size- how to find
better judged by the location of the apical impulse
Right ventricle enlarges _______ diameter rather than _____
anteroposterior, laterally
aortic valve area
Second right intercostal space at the right sternal border
Pulmonic valve area
Second left intercostal space at the left sternal border
Second pulmonic area
Third left intercostal space at the left sternal border
Tricuspid area
Fourth left intercostal space along the lower left sternal border
Mitral (or apical) area
Apex of the heart in the fifth left intercostal space at the midclavicular line
Indicators of heart function in infants
vigor and quality are indicators of heart function
Innocent murmurs of childhood
Murmur changes with position or respiration
Usual occur during systole
No other abnormalities noted
Nonradiating to other parts of chest
Low amplitude
Still murmur: best heard at the lower left sternal border and changes with position.
Pathologic murmurs of childhood
Blowing, squeaky, or a whooshing sound
Louder, harsher sound
Holosystolic
Does not change with position change
May be accompanied by clicks or rubs
Sound transmits to other parts of the chest and back
Angina
Pain caused by myocardial ischemia
Bacterial endocarditis
Bacterial infection of the endothelial layer of the heart and valves
Congestive heart failure
Heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary or systemic circulation
Pericarditis
Inflammation of the pericardium
Cardiac tamponade
Excessive accumulation of effused fluids or blood between the pericardium and heart
Cor pulmonale
Enlargement of the right ventricle secondary to chronic lung disease
Myocardial infarction
Ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium
Myocarditis
Focal or diffuse inflammation of the myocardium
Sick sinus syndrome
Arrhythmias caused by a malfunction of the sinus node
Conduction disturbances
Proximal to bundle of His or diffusely throughout conduction system
Ventricular septal defect
Opening between the left and right ventricles
Tetralogy of Fallot
Ventricular septal defect,
pulmonic stenosis,
dextroposition of the aorta,
right ventricle hypertrophy
Patent ductus arteriosus
Failure of the ductus arteriosus to close after birth
Atrial septal defect
Congenital defect in the septum dividing the left and right atria
Acute rheumatic fever
Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection
Atherosclerotic heart disease
Narrowing of small blood vessels that supply blood and oxygen to the heart
Senile cardiac amyloidosis
Amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart
A third heart sound is created by:
Diastolic filling
Thrill
A palpable rushing vibration over the base of the heart
FRAIL
fatigue, resistance, ambulation, illness, and loss of weight
Peripheral clues may suggest pulmonary or cardiac difficulties
Fingers: clubbing
Breath: odor
Skin, nails, and lips: cyanosis or pallor
Lips: pursing
Nares: flaring
Tactile fremitus
Palpable vibration of the chest wall that results from speech or other verbalizations
Hyperresonance with pulmonary percussion
hyperinflation
Dullness with pulmonary percussion
diminished air exchange.
Vesicular
Low-pitched, low-intensity; heard over healthy lung tissue
Bronchovesicular
Heard over the major bronchi; moderate in pitch and intensity
Abnormal if heard over peripheral lung tissue
Bronchial
Highest in pitch and intensity
Ordinarily heard only over the trachea
Abnormal if heard over peripheral lung tissue
Crackles (formerly called rales)
Heard more often during inspiration and characterized by discrete discontinuous sounds
Fine: high pitched and relatively short in duration
Coarse: low pitched and relatively longer in duration
Rhonchi (sonorous wheezes)
Deeper, rumbling, pronounced during expiration, prolonged and continuous, less discrete than crackles
Caused by the passage of air through an airway obstructed by thick secretions, muscular spasm, tumor, or external pressure
Wheezes (sibilant wheeze)
Continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration
Caused by a relatively high-velocity airflow through a narrowed or obstructed airway
May be caused by the bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis
Friction rub
Occurs outside the respiratory tree
Dry, crackly, grating, low-pitched sound; heard in both expiration and inspiration
Caused by inflamed, roughened surfaces rubbing together
Mediastinal crunch (Hamman sign)
Found with mediastinal emphysema
Loud crackles, clicking and gurgling; synchronous with the heartbeat and not respiration
Stridor
high-pitched, piercing sound most often heard during inspiration
Due to obstruction high in the respiratory tree
Asthma
Small airway obstruction, airway inflammation, and excess mucus production
Atelectasis
Incomplete expansion of the lung at birth or the collapse of the lung at any age
Bronchitis
Inflammation of the large airways
Pleurisy
Inflammatory process involving the visceral and parietal pleura
Pleural effusion
Excessive nonpurulent fluid in the pleural space
Empyema
Purulent exudative fluid collected in the pleural space
Lung abscess
Well-defined, circumscribed, inflammatory, purulent mass that can develop central necrosis
Pneumonia
Inflammatory response of the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral)
Influenza
Viral infection of the lung; secondary bacterial infection
Tuberculosis
Chronic infectious disease that most often begins in the lung but may then have widespread manifestations
Pneumothorax
Presence of air or gas in the pleural cavity
Hemothorax
Presence of blood in the pleural cavity
Lung cancer
Bronchogenic carcinoma, a malignant tumor that evolves from bronchial epithelial structures
Pulmonary embolism
Embolic occlusion of pulmonary arteries; common condition; difficult to diagnose
Epiglottitis
Acute, life-threatening infection involving the epiglottis and surrounding tissue
Tracheomalacia
Lack of rigidity/floppiness of the trachea or airway
Cystic fibrosis
Autosomal recessive disorder of exocrine glands involving the lungs, pancreas, and sweat glands
Bronchiolitis
Bronchiolar (small airway) inflammation leading to hyperinflation of the lungs occurring in infants younger than 6 months
Croup (laryngotracheal bronchitis)
Syndrome that results in infection from viral agents occurring most often in children ≤3 years of age
Chronic obstructive pulmonary disease (COPD)
Group of respiratory problems; cough, chronic/excessive sputum production; dyspnea
Smokers at greatest risk
Emphysema
Lungs lose elasticity; alveoli enlarge.
Bronchiectasis
Chronic dilation of bronchi/bronchioles caused by pulmonary infections/bronchial obstruction
Chronic bronchitis
Large airway inflammation
The “triangle of safety”
is an anatomical region in the midaxillary line formed by the lateral border of the pectoralis major muscle anteriorly, lateral border of the latissimus dorsi posteriorly, and the nipple line (4th or 5th intercostal space) inferiorly. This triangle represents a “safe position” for chest tube insertion.
right lung lobes
upper, middle, lower
left lung lobe
upper, lower
right main bronchus is
wider, shorter, and more vertical than the left main bronchus and directly enters the hilum of the lung
The left main bronchus
extends inferolaterally from below the aortic arch and anterior to the esophagus and thoracic aorta and then enters the lung hilum
visceral pleura
covers the outer surface of the lungs.
the parietal pleura
lines the pleural cavity along the inner rib cage and the upper surface of the diaphragm
The principal muscle of inspiration
diaphragm
tachypnea
> 25 breaths/min
The ratio of the anteroposterior (AP) diameter to the lateral chest diameter is usually
0.7 to 0.75 up to 0.9 and increases with aging.
Cheyne–Stokes Breathing
Periods of deep breathing alternate with periods of apnea (no breathing). This pattern is normal in children and older adults during sleep. Causes include heart failure, uremia, drug-induced respiratory depression, and brain injury (typically bihemispheric).
Ataxic Breathing (Biot Breathing)
Breathing is irregular—periods of apnea alternate with regular deep breaths which stop suddenly for short intervals. Causes include meningitis, respiratory depression, and brain injury, typically at the medullary level.
most anterior structure of the heart
right ventricle
atrioventricular (AV) valves
the mitral and tricuspid valves
semilunar valves
aortic and pulmonic valves
systole
the period of ventricular contraction when the left ventricle ejects blood into the aorta
the aortic valve is open, allowing ejection of blood from the LV into the aorta. The mitral valve is closed, preventing blood from regurgitating back into the left atrium.
the pulmonic valve opens, and the tricuspid valve closes as blood is ejected from the RV into the pulmonary artery
diastole
This period of ventricular relaxation
the aortic valve is closed, preventing regurgitation of blood from the aorta back into the LV. The mitral valve is open, allowing blood to flow from the left atrium into the relaxed LV
the pulmonic valve closes, and the tricuspid valve opens as blood flows into the relaxed right ventricle
The second heart sound, S2, and its two components, A2 and P2, are caused by
primarily by closure of the aortic and pulmonic valves, respectively
during inspiration, two different sounds. expiration, one sound
A2 is
normally louder, reflecting the high pressure in the aorta. It is heard throughout the precordium
P2 is
relatively soft, reflecting the lower pressure in the pulmonary artery and as such is best auscultated near its anatomic location, the second and third left intercostal spaces close to the sternum. It is here that you should search for the splitting of S2.
each electrical impulse originates in the
sinus node,
Cardiac output
, the volume of blood ejected from each ventricle in 1 minute, is the product of heart rate and stroke volume
Stroke volume is
the volume of blood ejected with each heartbeat,
The ejection fraction (EF)
is the percentage of ventricular volume ejected during each heartbeat and is normally 60%
Preload
refers to the load that stretches the cardiac muscle before contraction
Myocardial contractility
refers to the ability of the cardiac muscle, when given a load, to shorten
Afterload refers to
the degree of vascular resistance to ventricular contraction
Factors Affecting Blood Pressure
Left ventricular stroke volume
Distensibility of the aorta and the large arteries
Peripheral vascular resistance, particularly at the arteriolar level
Volume of blood in the arterial system
Jugular venous pressure (JVP) reflects
right atrial pressure, which, in turn, equals central venous pressure and right ventricular end-diastolic pressure.
paroxysmal nocturnal dyspnea
“Do you experience any nighttime episodes of sudden dyspnea that awakens you usually 1 or 2 hours after falling sleep, prompting you to sit up and stand up?”
Anasarca is
severe generalized edema extending to the sacrum and abdomen.
Internal Jugular Pulsations
Rarely palpable
Soft biphasic undulating quality, usually with two elevations and characteristic inward deflection (x descent)
Pulsations eliminated by light pressure on the vein(s) just above the sternal end of the clavicle
Height of pulsations changes with position, normally dropping as the patient becomes more upright
Height of pulsations usually falls with inspiration
Carotid pulsations
Palpable
A more vigorous thrust with a single outward component
Pulsations not eliminated by pressure on veins at sternal end of clavicle
Height of pulsations unchanged by position
Height of pulsations not affected by inspiration
pulsus alternans
, the rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of alternating strong and weak ventricular contractions. Pulsus alternans almost always indicates severe left ventricular dysfunction. It is usually best felt by applying light pressure on the radial or femoral arteries.
Paradoxical pulse
or pulsus paradoxus is a greater-than-normal drop in systolic blood pressure during inspiration
heaves
, use your palm and/or hold your fingerpads flat or obliquely against the chest. Heaves are sustained impulses that rhythmically lift your fingers, usually produced by an enlarged right or left ventricle (depending on the location of the heave) and occasionally by ventricular aneurysms.
thrills
press the ball of your hand (the padded area of your palm near the wrist) firmly on the chest to check for a buzzing or vibratory sensation caused by underlying turbulent flow.
systolic murmur
falling between S1 and S2
coincide with the carotid upstroke
diastolic murmur
, falling between S2 and S1
usually represent valvular heart disease.
A bisferiens pulse is
an increased arterial pulse with a double systolic peak, detected during moderate compression of the artery. Causes include pure aortic regurgitation, combined aortic stenosis and regurgitation, and hypertrophic cardiomyopathy.
A bigeminal pulse is
caused by a normal beat alternating with a premature contraction.
normal left ventricular PMI:
Location: in the fourth or fifth left intercostal space, at the midclavicular line
Diameter: discrete, or ≤2 cm
Amplitude: brisk and tappiing
Duration: ≤2/3 of systole
Grade 1/6
Softer in volume than S1 and S2, very faint
Grade 2/6
Equal in volume to S1 and S2, quiet, but heard immediately
Grade 3/6
Louder in volume than S1 and S2, moderately loud
Grade 4/6
Louder in volume than S1 and S2, with palpable thrill
Grade 5/6
Louder in volume than S1 and S2, with thrill; may be heard when the stethoscope is partly off the chest
Grade 6/6
Louder in volume than S1 and S2, with thrill; may be heard with stethoscope entirely off the chest
Crackles sign of
pneumonia, chf
Knife like pain
Pericarditis
Wheezing
Asthma
SOB
Asthma
Characteristics of murmur
timing, shape, location, radiation, intensity, pitch and quality
Normal cholesterol
<200
