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Lifespan > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

What are the most importantly points about the health history for respiratory system?

A

SOB, pain, Family history cigarettes, cough

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2
Q

How do you calculate the number of packs per year

A

Years x packs per day

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3
Q

Describe the pleura and its function

A

Serous membrane from an envelope between the lungs and chest wall
-reduces friction/lubrication

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4
Q

What are the structures in the respiratory dead space?

A

Trachea and bronchi

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5
Q

What are the mechanics of respiration

A

Inspiration and expiration
Control of respirations

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6
Q

What are the elements included in the inspection of the respiratory system

A

Thoracic cage
Respirations
Skin and nails positions
Facial expressions
Level of consciousness

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7
Q

What the 2 types of adventitious breath sounds?

A

Discontinuous (fine, coarse, crackles)
Continuous sounds (wheeze, high pitched and low pitched, pleural rub)

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8
Q

The eternal angle is also called ______. Why is it a useful landmark?

A

Angle of Louis
-it is useful to start when counting ribs

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9
Q

How many degrees is the normal costal angle?

A

90% or less

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10
Q

List 3 factors that affect the normal intensity of the tactile fremitus (vibration)

A

Relative location of bronchi
Thickness of chest wall
Pitch and intensity

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11
Q

What is the expected sound in percussion

A

Resonance

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12
Q

What are the 3 types of normal breath sounds? What are the locations?

A

Bronchial -scapulae
Bronchovesicular -parasternally
Vesicular -peripheral

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13
Q

You are examining a hospitalized woman who is on bedrest and has difficulty turning. Which is your best approach to completing the inspection, palpation, and auscultation of the thorax?
A. Inspect, palpate, and auscultate the anterior and lateral thorax only, omitting the posterior thorax to optimize patient comfort.
B. Find an assistant to help you turn the woman side to side, and perform the complete assessment while comparing bilaterally as much as possible
C. Have the woman turn as best as she can, omitting assessment of areas of the thorax that are not accessible
D. Omit inspection of the posterior thorax and push down the mattress to move your hand and stethoscope end piece under the woman while palpating and auscultations

A

B

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14
Q

You are taking a health history on a 44 year old man who reports use of cigarettes. You calculate a 24 pack year history of smoking, and learn that he has never attempted to quit before. What is your best statement to facilitate a discussion of quitting smoking?
A. Smoking is deadly; you really need to stop as soon as possible
B do you have any family members who have died because of smoking related illnesses?
C here is a risk of resources forgone you are ready to quit smoking
D are you interested in exploring options to help you quit smoking

A

D

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15
Q

A patient reports dry cough, shortness of breath with activity, and orthopnea. You auscultate fine inspiratory crackles over the bilateral posterior lung bases. What is your next best action?

A. Request pulmonary function studies to check for emphysema
B request an x-ray image to check for lobar pneumonia
C. Auscultate for absent breath sounds to check for pneumothorax
D. Report to provider; these finding are consistent with heart failure

A

D

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16
Q

Which of the following assessments best confirms symmetric chest expansion?
A place hands on posterolateral chest wall with thumbs at the level of T9 or T10
B inspect the shape and configuration of the chest wall
C compare bilateral auscultatory points for the presence of any adventitous sounds.
D percuss the posterior chest

A

A

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17
Q

You are auscultating breath sounds on a 70 year old man who states he feels dizzy. Which is your next best action?
A. Quickly move through the remaining auscultatory points
B stop the exam and record that the patient could not tolerate auscultation portion
C ask the patient to hold his breath for 10 seconds, then continue with auscultation
D allow the patient to take a break, then resume auscultation while monitoring for any worsening dizziness

A

D

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18
Q

On auscultating a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient reports pain with breathing. These findings are consistent with:
A fine crackles
B wheezes
C atelecatic crackles
D pleural friction rub

A

D

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19
Q

You are examining a patient and count a respiratory rate of 30 breaths per minute. There are no adventitious sounds, but you do note that the breath sounds are decreased and the patient’s breathing seems shallow. Which term best describes this breathing pattern?
A hyperventilation
B hypoventilation
C tacypnea
D Cheyenne-stokes respirations

A

C

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20
Q

You are examining a patient with respiratory distress. Which of the following assessments would best determine if that patient has acute hypoxemia?
A inspect the nail beds for presence of clubbing
B. Palpate for areas of decreased tactile fremitus
C. Auscultate for presence of any adventitous breath sounds
D inspect the nail beds and mucous membranes for presence of cyanosis

A

D

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21
Q

What is the difference between scapular and vertebral landmarks?

A

Vertebral is down the spine on the back
Scapular is verticals down the scapula

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22
Q

What is the difference between anterior axillary, midclavicular, and midsternal

A

Anterior axillary- vertical through armpit
Mid clavicular- vertical through middle of clavicle (through nipple)
Mid sternal -vertical through sternum

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23
Q

What is the difference between R and L lung lobes?

A

R=shorter above liver, 3 lobes
L=narrow, next to heart, 2 lobes

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24
Q

What do you ask the parent of an infant when assessing lungs?

A

When was his feeding, what food, how is he eating?

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25
Q

How many colds are normal for kids in a year?

A

4-6

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26
Q

What are some questions to ask when assessing lungs

A

Environmental exposures
Allergies
Difficulty breathing
Exercise
Coughs
History smoking
Can you catch your breath
Chest pain

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27
Q

What is hyperresonance?

A

Booming sound, lower pitch sound
Hear when to much air is present

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28
Q

What are the qualities of bronchial?
Pitch—
Amplitude—
Duration—
Quality—
Normal location—

A

Pitch—high
Amplitude—loud
Duration= I<E
Quality—loud, high pitched
Normal location—right above clavicle

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29
Q

What are the qualities of bronchovesicular?
Pitch—
Amplitude—
Duration—
Quality—
Normal location—

A

Pitch—moderate
Amplitude—medium
Duration—I=E
Quality—intermittent
Normal location—1st and 2nd intercostal spaces between scapula

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30
Q

Where is the first sound S1 loudest. And what makes the sound

A

Closure of AV tricuspid and mitral valves
Loudest at apex

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31
Q

Where is the second heart sound listened at? and what makes the sound

A

Closure of semilunar valves
Loudest at base

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32
Q

Where Do you listen to pulmonic>

A

2nd intercostal space

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33
Q

Where do you listen to aortic

A

2nd right intercostal space

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34
Q

Where do you listen to tricuspid

A

4th left intercostal space, left lower steal border

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35
Q

Where do you listen to the apex

A

5th left intercostal space

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36
Q

What are the characteristics of S3

A

Occurs when ventricles resistant to filling during early rapid filling phase
Occurs inmmediatley after s2

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37
Q

What are the characteristics S4 sounds

A

occurs at the end of diastole at presystole, before S1 ventricle resistant to filling

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38
Q

What are the qualities of vesicular?
Pitch—
Amplitude—
Duration—
Quality—
Normal location—

A

Pitch-low
Amplitude—soft
Duration—I>E
Quality —rustling like wind through trees
Normal location— over peripheral lung fields

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39
Q

What are conditions that can cause heart murmers

A

Velocity of blood increases
Viscosity of blood increases
Structural defects in valves

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40
Q

What causes crackling sounds?

A

Fluid in alveoli
Crackles= fine(rubbing) vs coarse(Velcro)
Pleural friction rub-dry rubbing or squeaking

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41
Q

What are the musical sounds?

A

Wheeze—high
Rhonchi—low
Strider—high pitched crowing sound, inflammed tissue in epiglottis

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42
Q

What are the normal findings of bronchophony and what are the abnormal findings?

A

Ask the person to repeat ninety-nine
Normal—muffled and indistinct
Abnormal—clear ninety-nine

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43
Q

What are the normal and abnormal findings of egophony?

A

Ask the person to say long ee-eee-ee sound
Normal- should hear eee through stethoscope
Abnormal—bleating goat

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44
Q

What is the normal and abnormal findings of whispered pectoriloquy?

A

Ask the person to whisper one-two-three
Normal-response is faint, muffled, and almost inaudible
Abnormal- very clear and transmitted

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45
Q

Chest is smaller than head till what age

A

2 years

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46
Q

Infants are nose breathers until what age

A

3 months

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47
Q

What is unique for counting infant respirations?

A

Count for the full minute

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48
Q

Describe APGAR evaluation of newborn infants

A

Check right after birth 1-5 minutes old (7-10 is good)(4-6 moderate)(0-2 ventilation)
Heart rate= 0-absent, 1-below 100, 2-over 100
Respiratory effort= 0-absent, 1-slow irregular, 2- good cry
Muscle tone= 0-limp, 1-some flexion, 2-active motion
Reflex= 0-no response, 1-grimace, 2-cough or sneeze
Color=0-blue pale, 1=body pink extremities blue, 2-completely pink

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49
Q

What is pleural effusion?

A

Excess fluid between pleural
Compress lung tissue

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50
Q

What is pneumothorax?

A

Air in pleura

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51
Q

What is pulmonary embolism

A

Lung blood clots

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52
Q

Describe crackling sounds?

A

(Rales)
Fine hair moving through fingers
Collapsed small airways and alveoli popping open
Location=lower lobes

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53
Q

Describe wheezes

A

High pitched
Due to air moving through narrowed airways
Asthma exacerbation

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54
Q

Describe rhonchi

A

Low pitched rumbling gurgling
Due to narrowed airways
Location=trachea and bronchi
Chronic bronchitis

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55
Q

Describe stridor

A

High pitched monophonic crowing sound
Due to obstruction from swollen inflamed tissues
Foreign body

56
Q

Where is the location of tricuspid (AV) valve?
Where is the location of the mitral (AV) valve

A

T=Between right atrium and right ventricle
M= between left atrium and left ventricle

57
Q

What valve does the blood from the left ventricle go through to run through the body?

A

Aortic valve

58
Q

What valve does the blood from the right ventricle go through?

A

Pulmonary valve

59
Q

What circulates blood?

A

Circulation of blood driven by pressure gradient

60
Q

What happens at diastole?

A

Ventricles relax and fill with blood

61
Q

Heart sounds are described by?

A

Frequency of pitch; high or low
Internists or loudness; loud o soft
Duration: very short for heart sounds; silent periods are longer
Timing: systole or diastole

62
Q

Carotid artery pulse is located between ____ and _____

A

Trachea and sternomastoid muscle

63
Q

Carotid artery pulse closely coincides with ______

A

Ventricular systole

64
Q

Jugular venous empties ____ blood directly into _____

A

Deoxygenated
Superior vena cava

65
Q

A pt is taking digoxin, how do we count apical pulse

A

Must be counted for 1 minute, no exceptions with this drug

66
Q

What is the routine for auscultation areas for the heart

A

1 rate and rhythm (if not same take apical pulse-radial pulse=deficit
2 identify of S1 and S2
3 assess s1 and S2 separately
4 listen for extra heart sounds
5 Listen for murmurs

67
Q

What are the grade scale for murmurs

A

Grade 1– barely audible
Grade 2-clearly audible but faint
Grade 3- moderately loud; easy to hear
Grade 4 loud; associated with a thrill palpable on the chest wall
Grade 5- very loud;heard with one corner of the stethoscope lifted off the chest wall; associated thrill
Grade 6-loudest; still heard with entire stethoscope lifted just off the chest wall; associated thrill

68
Q

What are cardiac pregnancy considerations

A

HR increases
Arterial BP decreases due to peripheral vasodilation
Increased blood volume

69
Q

What are the Hemodynamic changes with aging?

A

Pulse pressure increases
Left ventricle becomes thicker
Ectopic beats common in aging people
Presence of supraventricular and ventricular dysrhythmia increases with age
Tachyarrhthmias may be less tolerable

70
Q

What are the infant cardiac considerations

A

heart is more horizontal—apex is higher(4th IC)
—reaches adult position by age 7 (5th IC)
Auscultate the heart rather than radial pulse
Use pediatric size stethoscope
HR averages 120-140 (sleeping 70-90)
—6 weeks under 90bpm is concerning
—older kids under 60 is concerning
Heart sounds louder in infants

71
Q

What what ages do you listen for apical pulse in different positions

A

Until age 4—4h IC left of midclavicular line
4yo-6yo—at 4th IC at midclavicular line
Age 7—at 5th IC right of midclavicular line
Heart murmurs are common-typically innocent

72
Q

What are symptoms of Dyspnea?

A

Shortness of breath on exertion (SOBOE) from pulmonary congestion

73
Q

What is jugular vein distention from?

A

Venous congestion

74
Q

What does an infarct do to cardiac output?

A

Infarct may be caused of decreased cardiac output

75
Q

What are symptoms of heart failure

A

Dyspnea, crackles, wheeze, decreased BP, nausea and vomiting, edema, jugular vein distention, infarct, fatigue, weak pulse

76
Q

T/F there is a cure for heart failure

A

F, there is no cure, can only treat symptoms

77
Q

Which assessment finding is most likely to be immediately life threatening?
A bronchial breath sounds over a peripheral lung field
B stridor
C absent breath sounds over one lung lobe
D soft high-pitched expiratory wheezing with forced expiration

A

B

78
Q

After examining a pt, you now; fever, increased RR, chest expansion decreased on the left side, dull to percussion over the left lower love, and breath downs louder with fine crackles over the left lower lobe. What condition are these findings consistent with?

A

Lobar pneumonia

79
Q

Define Eschemia

A

Lack of O2

80
Q

What are the arteries in the leg?

A

Femoral, popiteal, anterior tibial, dorsalis pedis

81
Q

Peripheral arterial disease (PAD) affects _____ vessels and refers to arteries affecting the limbs.

A

Non-coronary

82
Q

What makes the pressure system for veins?

A

Movement of muscles, calf pump or peripheral heart

83
Q

Describe varicose veins

A

Dilated and tortuous (varicose) veins create incompetent valves leading to increased venous pressure, which further dilatation of the vein

84
Q

What are the functions for lymphatic system?

A

1 one way drainage system
2 major part of immune system to defend body against diseases
3 absorb lipids form small intestine

85
Q

What is it called when there is too much lymph?

A

Lymphedema

86
Q

Are lymphatic ducts palpable?

A

Normally, no
They are palpable during infection

87
Q

What are the functions of the spleen?

A

Destroy old RBC
Produce antibodies
Stores RBC
Filter microorganisms from blood

88
Q

Lymph nodes are relatively ____ in children. Often ___ even when child is healthy

A

Large, palpable

89
Q

Pregnant Women
Hormonal changes cause_____ and a resulting drop in blood pressure
Growing uterus obstruct drainage of iliac veins and inferior vena cava, this can lead to dependent ____

A

Vasodilation
Edema

90
Q

When does a child’s lymph nodes go to adult size?

A

10 to 11

91
Q

AGING ADULT
Peripheral blood vessels grow more rigid with age, resulting in _____ with increased prevalence of PAD.

A

Arteriosclerosis

92
Q

How do you assess arteriosclerosis

A

—asses for presence of intermittent claudication(pain in calf by walking, relieved with rest)
Decrease is size

93
Q

AGING ADULT
What do you do when you assess progressive enlargement of intramuscular calf veins?

A

Assess for increased risk for DVT (deep vein thrombosis)and PE as a result of prolonged bed rest, immobile and heart failure

94
Q

T/F loss of lymphatic tissue leads to fewer numbers of lymph nodes in older people and size of remaining nodes

A

T

95
Q

Describe modification allen test

A

Holding ulnar and radial arteries, pump hand, assess re-coloration
If circulation re-coloration> 7 seconds or longer= positive test (poor circulation)

96
Q

What is the pitting edema grade scale?

A

1+ mild/slight indent
2+moderate/subsides quickly
3+ deeper pitting/remains longer/leg looks swollen
4+ deepest/remains long time/very swollen

97
Q

For color changes, What do you do if you suspect an arterial deficit?

A

Raise legs about 12 inches off table and ask the person to wag feet for 30 seconds to drain of venous blood

98
Q

What do you use a Doppler ultrasonic probe

A

To assess weak peripheral pulse, BP on infants, low BP, Lower extremity BP

99
Q

What is the ankle-brachial index?

A

Used to determine extent of peripheral vascular disease
—must be lying flat
—no smoking within 2 hours with 5 to 10 minute rest period prior to measurement
Lower the # the higher the risk for peripheral vascular disease

100
Q

What does Wells score indicate

A

Probability of DVT (deep vein thrombosis)
Higher the score=higher the risk

101
Q

_______ _____ should be ____ and _____ in both upper and lower extremities

A

Pulse force
Regular
Symmetric

102
Q

____ lymph nodes occur often in healthy infants and children

A

Palpable
—Small, firm, mobile, nontender

103
Q

What are normal findings during 3rd trimester?

A

Peripheral pitting edema
Varicose veins

104
Q

What are abnormal findings in peripheral vascular disease
ARMS
LEGS
OTHER ABNORMALITIES

A

Arms—Raynard phenomenon, lymphedema
Legs—arterial (ischemic) ulcer, venous (stasis) ulcer
Other abnormalities—aneurysms, occlusion (thrombus formations)

105
Q

What are some symptoms of DVT

A

Pain, tender to touch, sudden onset, worse when touched, better with meds, swollen legs.

106
Q

What are symptoms of chronic arterial symptoms: PAD? (Diabetic ulcers—neuropathic) (arterial ischemic ulcer)

A

Deep muscular pain (calf)
Intermittent claudication
Pain is gradual after excession but chronic
Elevation aggravates it making it worse
Risk factor leavening dangling

107
Q

What are the differences between arterial and venous ulcers?

A

Arterial—intermittent claudication pain, no edema, no or weak pulse, round smooth sores, black Escher, usually on does and feet
Venous—dull achy pain, lower leg edema, pulse present drainage, sores with irregular borders, yellow ruddy skin, sores usually on ankles

108
Q

What are some abnormal condition that may affect the location of the apical impulse

A

Cardiac enlargement
L ventricular dilation

109
Q

What are the mechanisms producing the first and second heart sounds

A

S1 closure of the AV valves
S2-closure of the semilunar valves

110
Q

Where is the S1 the loudest

A

Apex

111
Q

Where is S2 the loudest

A

The base

112
Q

What is a bruit

A

Blowing swishing sound, indicates blood flow turbulence
Artherosclerosis may cause bruit

113
Q

What is the difference between preload and after load

A

Preload is volume of blood refilled
After load is the pressure of blood contracted through the aortic valve

114
Q

The recording is
A a synonym for mediastinum
B the area on the chest where the apical impulse is felt
C the area on the anterior chest overlying the heart and great vessels
D a synonym for the area where the superior and inferior vena cava return unoxygenated blood to the right side of the heart

A

C

115
Q

Select the description of the tricuspid valve
A left semilunar valve
B right artrioventricular valve
C left artrioventricular valve
D right semilunar valve

A

B

116
Q

The function of the pulmonic valve is to:
A divide the left atrium and left ventricle
B guard the opening between the right atrium and right ventricle
C protect the orifice between the right ventricle and pulmonary artery
D guard the enter ace to the aorta from the left ventricle

A

C

117
Q

Atrial systole occurs:
A during ventricular systole
B during ventricular diastole
C concurrently with ventricular systole
D independently of ventricular function

A

B

118
Q

The second heart sound is the result of
A opening of the mitral and tricuspid valves
B closing of the mitral and tricuspid valves
C opening of the aortic and pulmonic valves
D closing of the aortic and pulmonic valves

A

D

119
Q

A 74 yo woman has a history of coronary artery disease. Which 3 signs and symptoms lead you to suspect the woman may have heart failure. SATA
A reports 2 month history of orthopnea, sleeping on 3 pillows because it is easier to breath
B report burning epigastric pain after eating
C 2+ bilateral pretibial edema
D S3 gallop
E clear adventitious breath sounds
F warm flushing skin

A

A C D

120
Q

When auscultating the heart, your first step is to:

A

Identify S1 and S2

121
Q

A murmur is heard after s1 and before S2. This murmur would be classified as:
A diastolic (possibly benign)
B diastolic (always pathological
C systolic (possibly benign)
D systolic (always pathological)

A

C

122
Q

When assessing the carotid artery, you will palpate:

A

Medial to the sternomastoid muscle, one side at a time

123
Q

For a patient experiencing orthopnea, which physical assessment finding would be most relevant. SATA
A right side carotid bruit
B elevated jugular venous pressure
C presence of a split S2 towards the end of every expiration
D presence of an S3 heart sounds in both supine and sitting positions

A

B D

124
Q

A 62 yo man complains of chest pain. You ask him to describe the chest pain. Which statement would cause you to consider an ischemic cardiovascular cause
A the pain is much worse when I take a deep breath, and I keep coughing too
B it feels sharp and stabbing, but its a bit better when I learn forward
C this pain is burning, I notice it more after I eat and my mouth tastes terrible
D my chest feels tight and heavy, but it does go away when I rest for a few minutes

A

D

125
Q

is it normal for a patient at 45 degrees have an undulating pulsation that moves down the neck when the person takes a deep breath and it disappears entirely when the patient sits up to 90 degrees?

A

Yes this is the jugular venous pulse, and it is a normal finding

126
Q

While auscultating a pt’s heart rate and rhythm, you note it sounds irregular. What additional assessments would help you determine the cause. SATA
A note if there is any pattern to the irregularity
B note if the rate varies with inspiration and expiration
C carefully listen to the bilateral carotid arteries
D auscultate the apical beat while palpating the radial pulse, and note any differences in rate

A

A B D

127
Q

What is the difference between endocardium, myocardium, and pericardium?

A

Pericardium- tough, fibrous, double walled space that surrounds the protects the heart
Endocardium- thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
Myocardium-muscular wall of the heart

128
Q

You are auscultating the precordium to rule out a pericardial friction rub.
Listen with the ___ of the stethoscope, with the patient ___, and instruct the patient to _____

A

Diaphragm, sitting up and leaning forward, breath out and hold

129
Q

What are the 3 mechanisms that help return venous blood to the heart

A
  1. Contract skeletal muscle
    2 pressure gradient caused by breathing
    3 intraluminal valves in veins
130
Q

What are the organs in the lymphatic system

A

Bone marrow, lymph nodes, spleen, tonsils, thymus

131
Q

What is the grading scale for assessing the force on an arterial pulse

A

0 absent
1+ weak
2+ normal
3+ increased, full bound

132
Q

What is the pitting edema grading scale

A

1+ mild pitting, slight indentation
2+ moderate pitting
3+ deep pitting, remains for short period
4+ very deep pitting, remains for long time

133
Q

Inspection of a person’s R hand reveals a red swollen area. To further assess for infection, you would palpate the:
A cervical node
B axillary node
C epitrochlear node
D inguinal node

A

C

134
Q

To screen for deep vein thrombosis, you would:
A measure the circumference of the ankle
B check the temp with the palm of the hand
C compress the dorsalis pedis pulse, looking for blood return
D measure the widest point on the calf with a tape measure

A

D

135
Q

After raising a pt’s legs 12 inches off the table for 30 seconds and then having the person sit up and dangle the legs, you note the color returned to both legs in 30 seconds, what should be your next action?
A notify the provider of a potential acute arterial occlusion
B assess pulse amplitude and ask the patient about symptoms of claudication
C order a lower extremity venous ultrasound test
D proceed with the exam, as this is a normal finding

A

B

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