TEST 3 Flashcards
What are the subjective data questions you ask for heart?
Chest pain?
Dyspnea (trouble breathing)
Orthopnea (diff breathing laying flat)
Cough
Fatique
Cyanosis
Edema
Nocturia
Past history
Risk factors
What is different in IPPA for cardia?
No percuss for cardiac
What are we inspecting neck for?
Symmetry
Lumps
Pulsations
Jugular venous pulse - normal when laying flat/not normal when sitting up
What does a jugular venous pulse mean when sitting upright?
Increased pressure in heart
What does a Brutis mean if you hear it on carotid?
Carotid artery narrowing from plaque build up
What are you inspecting on precordium?
Shape, abnormalitlies, heave lift
What does it mean if you see heart pounding through chest?
Enlargment of heart at R or L ventricle —where ever you see it
Normal heart sounds are what frequency? Murmurs are heard with what frequency?
Normal - high - diaphragm
Murmur - low - bell
What are the 5 areas we asculatate heart sounds?
- Aortic
- Pulmonic
- Erbs point
- Tricuspid
- Mitral
What sound is S1?
Closure of AV valves
Loudest at apex
Beginning of systole
What sound is S2?
Closure of semilunar valves
loudest at base
end of systole
What are murmurs
Structural defects in valves or unusual openings in chambers resulting in backwash of blood going backward
When documenting murmurs what do you note?
Location - intercostal space, Arotic? mitral? what area
Timing - S1? S2? after?
What is a systolic murmur?
AFter S2.
Lubb swish dubb
What is a diastolic murmur?
After S2
lubb dubb swich
What are the gradings for murmurs?
1 - barely audible
2 - faint
3. Moderate, easy to hear
4. Loud w/ thrill
5. Very loud, can hear with part of stethoscope off chest, thrill
6. Loudest, can hear w/o stethoscpe. Thrill
What are the risk factors for cAD and stroke?
African america
High blood pressure
Smoking
High cholesterol
Obesity
diabetes
Decreased activity level
What defines heart failure?
Pump failure
Low Cardiac output >4-6l/min
Low BP
What signs are Left sided heart failure?
BACK UP IN LUNGS
Pulmonary congestion
Dyspnea
Orthopnea
What signs are Right sided heart failure?
BACK UP IN BODY TISSUES
Extremity edema
JVD
Kidneys retain water
**treatment diuretic
What are we assessing when looking at peripheral vascular system
?
Vessels transpoting blood, fluid or lumph
*Arteries/veins/lymph
What do arteries do?
High pressure system
Supply oxygen and nutrients to tissues
What arteries do we examine?
Temporal, carotid
Brachial, Radial
Femoral, popliteal, dorsalis pedis, posterior tibial
What are veins?
Parallel to arteries
Low pressure system
- Contracting skeletal muscles milk blood back to heart
- Pressure gradient
_Valves ensure unidirectional flow
What veins do we examin?
Jugular, subclavian
Cephalic, basilic, median cubital
Great saphenous, small saphenous
What is the lumphatic system?
Retrieves excess fluid from tissue spaces
Propelled by skeletal muscles contract, pressure changes when breathing, valves
What are the 2 main trunks of lymphatic system?
Right lymphatic duct - head
Thoracic ducts - left side and rest of body
What is the function of lymphatic system
-Conserve fluid and plasma proteins
-Major part of immune system
-Absorbs lipids from intestinal tract
What subjective data do we ask for perpherial vascular?
Do you any pain in arms or legs?
Any skin changes?
Swelling/edema
lymph node enlargement?
What would pain in arms and legs indicate?
Claudication - Part blockage, lack of oxygenated blood flow
What would skin changes indicate in peripheral vascular?
Poor circulation
If you touch a patient and they are cold what does it indicate?
Problem with circulation
What are the grades for edema?
1+ mild, slight indentation
2+ moderate, indent subsides rapidly
3+ deep, remains for short time, leg looks swollen
4+ very deep, indent last long time, leg very swollen
What are the risk factors for venous issues?
Prolonged standing or sitting
Prolonged bed rest
Hypercoaguable states
Vein wall trauma - IV’s
Obesity
Later months pregnancy
What are risk factors for arterial disease?
Older adults
Hypertension
Smoking
diabetes
INcrease lipid levels
Obesity
What are the differences between Arterial and Venous disease?
Arterial
Claudication
Relief w/ rest
Pale, cyanosis, pulseless, cool, atrophic
Ischemic ulcer
Venous
Pain with standing, sitting/end of day = worse
Relief w/ walking
Brown discoloration, red warm swollen - bc of blood pooling
Stasis ulcer
S1 is the closure of what valve?
Mitrial and tricuspid
Where does gas exchange take place?
Alveoli
The R and L lung have how many sections?
R - 3 RUL, RML, RLL
L - 2 LUL, LLL
What is the Visceral pleura?
Lining of lungs
What is the parietal pleura?
Lining of chest wall
What is Hemothorax?
Blood in intrapleural space
What is empyema?
Puss in intrapleural space
What is pneumothorax?
Air in intrapleural space
What can happen if the intrapleural space gets filled with air?
lungs could collapse
What is the subjective data we ask for lungs?
Do you have a history of coughing?
Is it productive/nonproductive?
COCA - Sputum?
Any shortness of breath?
What are you doing when you have SOB?
Chest pain?
Smoking?
Environmental exposure?
What are you looking for when you inspect the lungs?
Shape - front-back should be less than side to side
Level of consciousness - awake/lathargic?
Position of patient -relaxed, upright?
Use of accessory muscles
Location of trachea
Skin color and condition
Respiratory rate
What is a barrel chest?
Front to back same size as left to right
What is scoliosis?
Genetic Lateral deviation of spine
What is kyphosis?
Hunched over, spine toward back
*bad posture
What is pectus excavatum?
Caved in sternum
What is pectus carinatum?
Protruding sternum, pigeon chest
What is tachypnea?
Shallow breathing(not deep) <20bpm
What is Bradypnea?
Slow >12bpm
What is hyperventilation?
Deep and fast - losing C02 Fast = alkaline
What is Cheyne-stokes?
near end of lif, regular-irregular pattern w/ periods of apnea
When we are palpating the lungs what are we palpating for?
Symmertric expansion - place hands at base t10, thumbs near spine, patient takes deep breath, should be equal
Tactile fremitus - vibration, have patient say 99 then palpiate lungs - vibration should be equal
Note areas of tenderness, lumps or masses
What part of IPPA do we not do for lungs?
Percuss!
How many places do we auscultate on front and back ?
10 on front
18 on back
How many places do we auscultate on front and back ?
10 on front
18 on back
What do crackles sound like and what does it mean?
Popping/bubbling
Due to fluid, mucus or pus
What does wheezing sound like?
Like whistling
due to airway constriction/narrowing
What does stridor sound like?
Its in trachea
High pitched whistle during inspiration
Due to obstruction of upper airway
What does Ronchi sound like?
Like snoring
Due to airway narrowing and secretion
What is Atelectasis?
Collapse of aveloi
*postop // treatement is deep breathing
What are the 2 areas of COPD?
Chronic bronchitis - ,mucus
Emphysema - avleoli problem/lose elasticity
What is Asthma?
Presents like bronchitis but some have mucous some dont
What is pleural effusion?
Something is in intrapleural space
What is pleural effusion caused by heart failure?
Blood backs up into intrapleural space
What is hemothorax?
Bleeding into intrapleural space from trauma
What is Pneumothorax?
Collapsed lung
–Cynaosis, tachy, tracheal deviation, decreased breath sounds
What are the signs of tuberculosis?
Rust colored sputum
Fever
Night sweats
*need to wear N95
What are clubbed fingers and who gets them?
Patients with prolonged hypoxia and its a distortion of fingertips
What organs are on RIGHT side top to bottom?
Liver
Gallbladder
Appendix
What organ is on left side of body
Spleen
What organ is middle pelvis?
Bladder
What are the quadrants of abdomin? 3 top to bottom
Epigastric
Umbilical
Hypogastric
WHat subjective questions do you ask for abdominial assessment?
Hows appetite?
Any dysphagia - difficulty swallowing
Ab pain?
Medications?
Bowel habits?
STool? COCA?
past ab history
What is different about IPPA for abdomin?
IAPP
Why do we do Palpation last for abs?
To prevent pain and guarding
What do we inspect for ab?
Even skin tone
Symmetry
Umbilicus
No pulsations **DONT touch any PULSATIONS!
Hair distribution
What could pulsation on AB be?
Anersym
What are the 4 ways to document the ab section on a patient laying down?
Flat
Scaphoid - sinking inward
Rounded - slight puff
Protuberant - like pregnant looking
What is peristalsis?
Waves that move fecal material through colon
Water is absorbed into capillaries
What is constipation?
What is diarrhea?
What is Colostomy?
Constipation - feces stays in large intestine for long time
Diarrhea - feces moves quickly
Colostomy - obstruction/damage/disease
What do we ausculte for on AB?
Bowel sounds - 5-30 sounds per min
**if absent bowel sounds for 5 mins call provider 911
Where do we ausculte bruits on AB?
Aorta (middle)
R&L Renal artery
R&L iliac artery
R&L femoral artery*
How do we percus on AB?
Place middle finger firmly then tap on finger –should hear hollw sound - tympany
What do we palpate for on AB?
Mass or tenderness
Rebound tenderness- pain apon release of pressure - appendicitis
**Keep area of pain for last
What would a bluish-purple periumbilical indicate?
Bleeding in GI
Cullens signs
What are the signs of cholecystitis? (murphys signs)
Pain in upper right quad/ inflammation of gallbladder
Where am I looking for blood in AB assess?
Stool, gums, urine, skin color
Where is the pain in a patient with pancreatitis
Epigastric area
What do gallstones do?
Block ducts from releasing bile. STool will then look gray, white, clay
Bile will also back up into the liver and create jaundice in patients
bile helps absorb fat
What is Mcburneys point?
Right Lower Quad
Rebound of tissues = pain
appenditis
Where is bile produced? where is it stored?
Produced in liver
stored in gallbladder
If Bile doesnt come out of the gallbladder what happens?
backs up into the liver and gets into the system creating jaundice
Pancreatitis?
Pancreasis located in epigastric area
