S1_L5_Obj - 7-8 Flashcards
part of stethoscope: for low pitch sounds
bell
part of stethoscope: for high pitch sounds
diaphragm
t or f Listening to breath sounds through the pt gown or clothing is
the right way
f, Place bell/diaphragm directly against the chest wall
t or f Keep tubing free from contact from any objects
t, note: common error is tube rubbing against bed rails or other objects
t or f Eliminate noise from the environment while taking heart sounds
t, note: common error is auscultation in a noisy room
t or f do not wet the chest hair if thick
f, wet the chest hair bc chest hair can be interpreted as adventitious sound
t or f Ask pt to sit, if possible; or roll comatose pt to one side
t, common error is acceessing onlt convenient areas
HEART SOUNDS: found in what valves (5)
Aortic valve
Pulmonary valve
Erb’s point
Tricuspid valve
Mitral valve
Concentration of the 4 valves is found at _
erb’s point
t or f Apical pulse is similar to the location of the tricuspid valve
f, Apical pulse is similar to the location of the “mitral valve”
Aortic Valve landmark
2nd (R) ICS; sternal border
Pulmonic valve landmark
2nd (L) ICS; sternal border
tricuspid Valve landmark
4th (L) ICS; sternal border
erb’s point landmark
3rd (L) ICS; sternal border
mitral valve landmark
5th (L) ICS; midclavicular line
cardiac apex landmark
5th (L) ICS; midclavicular line
Normal Heart Sounds:
(“Lub-dub”)
Normal Heart Sounds:
s1, s2
abnormal heart sounds
s3, s4
First Heart Sound (S1) heard when _
Closing of AV valves; onset of ventricular systole
Duration of S1
0.10 seconds
Second Heart Sound (S2) heard when
Closing of semilunar valves; start of ventricular
diastole
Duration. of s2
<30 milliseconds
During inspiration, splitting of S2 is audible
(physiologic split) in what heart sound
s2
During _, splitting of S2 is audible
(physiologic split)
inspiration
splitting of s2 is called
physiologic split
abnormal heart sounds are also called
gallops
S3 also called as
ventricular gallop
S4 also called as _
atrial gallop
Faint, low-frequency heart sound
s3
s3 reflects _
early diastolic ventricular filling after AV
valves open
if there is s3, what is the possible condition
Possible CHF indicative of ventricular dysfunction
S4 signifies __
rapid ventricular filling that occurs after
atrial contraction
s4 heard at _ just before _
late diastole, S1
Vibrations resulting from turbulent blood flow
murmurs
murmurs heard using
stethoscope
murmurs description based on:
■ Position in cardiac cycle: systole or diastole
■ Duration
■ Loudness
Systolic murmurs heard between _ and _
s1, s2
Diastolic murmurs heard between _ and _
s2, s1
grading of heart sounds: faint
Grade I
grading of heart sounds: faint, audible immediately
Grade II
grading of heart sounds: louder than II
Grade III
grading of heart sounds: loud
Grade IV
grading of heart sounds: very loud
Grade V
grading of heart sounds: audible w/o stethoscope
Grade VI
BREATH SOUNDS (4)
bronchial
vesicular
bronchovesicular
tracheal
breath sound below the suprasternal notch
Bronchial
breath sound heard over the lung field
vesicular
breath sound heard on proximal body of the sternum
bronchovesicular
Landmarks for breath sounds
T2, T6, T10/Axilla, Nipple, Subcostal
Follow the 2 and S pattern, what is this
■ 2 is anterior
■ S is posterior
Not specific to Lung Segments
landmarks
2 and S pattern
Specific to Lung Segments, Make sure to never auscultate
over the scapula, but by the ribs in anterior upper lobe t or f
f, Make sure to never auscultate over the scapula, but by the ribs in posterior upper lobe
Make sure to never auscultate over the scapula, but by
the ribs in _
posterior upper lobe
lobes in lungs (3)
upper lobe
middle lobe
lower lobe
segments of upper lobe (3)
apical
anterior
posterior
segments of middle lobe (2)
lateral
medial
segments of lower lobe (5)
superior basal
anterior basal
posterior basal
lateral basal
medial basal
where will u find the right and left apical upper lobe
Above/Below the clavicle (ant)
lateral and below C7 (post)
where will u find the right and left anterior upper lobe
Between the clavicle and nipple
where will u find the right posterior upper lobe
Root of the spine of right scapula
where will u find the left posterior upper lobe
None
where will u find the right lateral middle lobe
Lateral to right nipple
where will u find the right medial middle lobe
Medial to right nipple
where will u find the left medial middle lobe
Inf: below the left nipple
where will u find the left lateral middle lobe
Sup: above the left nipple
where will u find the right and left superior basal lower lobe
Medial to scapula, between the root of the scapular spine & inferior angle
where will u find the right and left anterior basal lower lobe
Lateral and below the nipples; above the subcostal margin
where will u find the right and left posterior basal lower lobe
Medial and below the inferior angle of scapula
where will u find the right and left lateral basal lower lobe
Midaxillary line, level just below the inferior angle of scapula
where will u find the right and left medial basal lower lobe
Cannot be auscultated, too deep
abnormalities for bronchial breath sound:
tubular breath sounds on peripheral lung tissues
non-bronchial sounds on a bronchial area is normal sometimes t or f
f, non-bronchial sounds on a bronchial area is abnormal
Absent breath sound may be d/t”
hyperinflation caused by
emphysema,
chest deformities,
pain on chest wall,
chest tumors,
neuromuscular weakness
Adventitious Breath Sounds (5)
rales/crackles
rhonchi
stridor
wheeze
friction rubs
crackles sound like _
crumpling plastic
snore sound
rhonchi
high pitch wheeze heard in inspiration
stridor
friction rubs are like _ rubbing together
2 rubbers
Fine, crackling during inspiration
rales or crackles
Continuous, low-pitched, sonorous
breath sounds, heard more on expiration
Rhonchi
Inspiratory wheeze
stridor
Continuous sounds, high-pitched, musical; Heard more on expiration
wheeze
Coarse grating sounds
Heard on inspiration or expiration
friction rubs
VOICE SOUNDS (3)
Bronchophony
Whispered Pectoriloquy
Egophony
whisper “99” or any words several times
Whispered Pectoriloquy:
say “99” several times
Bronchophony:
say “ee” continuously
egophony
Abnormal in egophony:
muffled & if “ee” is heard as “ay”
abnormal in whispered pectoriloquy
faint or no sound at all
abnormal in bronchophony
loud or muffled
produces sputum
productive cough
Grade for cough ax
F, WF, NF, 0
Normal, Strong, crisp explosive cough
and can clear secretions
functional
decreased strength and labored cough,
weaker
weak functional
No secretions expelled, attempting to cough
but not full coughing
nonfunctional
t or f in NF there is sputum but not productive
t
cough is absent
0
Sputum Assessment: what to assess
color
odor
amount
texture or consistency
red sputum suggests
blood; Tuberculosis, hemoptysis
pink sputum suggests
pulmonary edema
yelllow sputum suggests
infection start to celar
green sputum suggests
acute infection; COPD except emphysema
Rust sputum suggests
pneumonia
Flecked sputum suggests
Carbon particles
Asbestosis, pneumoconiosis
Purple sputum suggests
Neoplasia
Gray sputum suggests
Emphysema, abscess
You assess the odor by smelling their breath t or f
f, You assess the odor by asking the patient what
they smell
Fetid texture suggests
Foul-smelling; Anaerobic infection,
bronchiectasis, lung abscess, cystic fibrosis
frothy texture suggests
White, pink, foamy thin; Pulmonary edema
hemptysis texture suggests
Bloody; Massive hemorrhage
mucoid texture suggests
White, clear; Chronic cough
mucopurulent texture suggests
Mixture, yellow to pale green; Start or end of infection
purulent texture suggests
Copious, thick. Yellow, green; Pus, infection
tenacious texture suggests
Thick, sticky; Bronchial asthma
t or f CHEST SYMMETRY AND MOBILITY also applies
to palp
t
in chest symmetry, palpate the posterior of a female t or f
t
At least have how many cycle of deep inspiration/expiration
per level of the chest wall
one cycle of deep inspiration/expiration
per level of the chest wall
Levels to assesss in chest symmetry and mobility
Upper chest wall: from 4th rib above; anterior
Middle chest wall: level of axilla; anterior
Lower chest wall: just below the scapula; posterior
Upper chest wall
from 4th rib above; anterior
Lower chest wall:
just below the scapula; posterior
Middle chest wall:
level of axilla; anterior
