Test 2 Lung And Cardiac Flashcards
This is the ridge where the manubrium attaches to sternum. Also where 2nd rib is
Sternal angle
The angle between the ribs and costal margins
Costal angle-90 degrees
During cpr, where are the hands placed to avoid breaking xiphoid process off and causing complications?
Above xiphoid process
When you flex your neck forward, which spinous process protrudes mostly? This is used as a landmark to inspect and auscultate lungs
C7
How many lobes does the right vs left lung have?
Left has 2 and right has 3 lobs but they’re both same size
In which direction do we auscultate lungs?
From apex to base (top to bottom) and each side. One full breath in and out per section
What can sometimes happen when a central venous catheter is placed in the chest wall?
Needle may accidentally nick the lung causing a pneumothorax or collapsed lung
Why are lung sounds always auscultate after a patient is intubated?
The right mainstream bronchus is more likely to aspirate and unsuccessful endotracheal intubation. If sounds are only hear on left side after tube placement, right side is blocked so we slowly pull out until we can hear on right side
What happens when the nurse hears crackles on auscultation?
Crackles usually signify fluid filling alveoli. Can be coarse or fine. Have patient breath in and cough 3 times, then listen again. They sounds like hair rubbing or Velcro opening. Mostly heard on inspiration
Sound heard in lung that’s a continuous high pitched musical sound. Caused by air squeezing through narrowed airways. Occurs in asthma.
Wheezing
Lung sound that’s a continuous, low pitched snoring sound from secretions moving around in airways. May clear with coughing. Heard mostly in patients with chronic bronchitis
Ronchi
What are the 3 voice sounds that are abnormal and found with consolidation or compression with pneumonia and pulmonary edema?
Egophony bronchophony, whispered pectoriloquoy
What are the accessory muscles patients use if having difficulty breathing?
Sternocleidomastoid, scalene, abdominal, internal intercostal, trapezius muscle
Normal respiratory rate for adults
12-20 breaths/minute
A high pitched crowing sound from upper airway. Results from tracheal or laryngeal spasm or constriction. lIFE THREATENING emergency requiring immediate attention
Stridor
Term for free air that creates a crackling sensation similar to bubble wrap or rice crispy cereal under the skin (felt)
Crepitus
Assessment is made to evaluate density of lung tissue. Place palmar base or lunar surface of hand on patient’s chest above scapula. Ask patient to say “99”. Vibrations of air in the bronchial tree are transmitted to chest wall when patient speaks. Note intensity and symmetry on each side. Normal = vibrations felt ok both sides
Tactile Fremitus
The 3 normal breath sounds?
Vesicular (lung periphery), bronchovesicular (heard more central) bronchial (heard over trachea and larynx)
What happens when you hear crackles on auscultation?
Fluid fills alveoli (crackles cause CRAZY fluid)
What are 2 membranous sacs in the thorax?
Visceral and parietal
How is breathing different for older adults?
Lungs lose elasticity, decrease in cartilage, thorax gets barrel shaped and rounded, risk for atelectasis, hypoxia, hypercapnia, acidosis, decreased gag reflex and cough
This is an adventitious breath sound that involves air moving through wet secretions can be fine (high pitched) or coarse (low pitched) long
Crackles
This is a continuous high pitched sound caused by small airways by severe toons, swelling, tumors -adventitious breath sound
Wheezing
This is an adventitious breath sound involving grating or creaking caused by pleural rubbing against chest wall, loud, coarse, low pitched
Pleural friction rub
Low pitched snoring or gurgling sound. May clear with coughing. Sometimes moves in inspiration and expiration
Ronchi
An adventitious breath sound that is loud, high pitched crowing or honking sound. Louder in upper airway and is an emergency
Stridor
When listening for voice sounds, ask patient to say 99 and it’s easily understood
Broncophony
When listening to voice sounds, ask patient to say “ee” and I sounds like a long A
Egophony
When listening for voice sounds, whisper one, 2, 3 and if it sounds louder or clear mer then whispered sound
Pectgriloqux
Where does the nurse start when auscultation the lungs? What landmarks?
- Above clavicle(apex of lungs)
- 2nd intercostal space (right and left lobes)
- 4th intercostal space (right and left middle lobes)
- Midaxillary line at 6th intercostal space (right and left lower lobes)
Posterior
1. Right above scapulae (apex of lungs)
2. Find c7 then go to t3 (listen to right and left upper lobes)
3. T3 to t10 (listen to right and left lower lobes
Have patient lean forward to get better access posteriorly
What are the 3 normal lung sounds called?
Vesicular ( anterior and posterior and heard over peripheral lungs)
Bronchial (heard over tracheal area) high pitch, loud on inspiration slightly shorter than expiration
What arteries transport blood from heart to the head?
Carotid
Functions as the pacemaker of heart
SA node
Most common type of heart failure
Left sided
Spread of depolarization of atria/contraction
P wave
Time from firing of sa node to ventricular depolarization
PR interval
This is seen on an ECG where ventricles contract
QRS complex
What is a common symptom of A-fib?
Fatigue, palipitations, heart failure with decreased atrial kick
It’s important to find info about symptoms, follow orders the perform focused cardiac or lung assessment, call provider to order chest X-ray or ecg if needed
These heart sounds are best heart at the apex of the heart with the bell of stethoscope while patient is on their left side
S3. S4, heart murmurs—-note it’s normal to not have these sounds
What are the grades of heart murmurs?
Grade 1- hard to hear, grade 2-faint but heard, grade 3-easy to hear, grade 4-loud with a chest thrill, grade 5 very loud: can hear with corner chest piece tilted off chest
Grade 6-loudest can hear with whole chest piece lifted off chest
Caused by ventricle resistance from Atrial kick during presystole. Sounds like “TA-LUB-DUB”
S4
Heart after s2 and sounds like LUB-DUB-TA caused by vibrations of ventricle filling from a resistant ventricle due to fluid volume or heart failure
S3
This is a blowing or swishing noise from blood turbulence in the chambers of the heart (wall defect) or valve problem (stenosis or regurgitation)
Heart murmur
