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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
How many colds are normal for kids in a year?
4-6
26
What are some questions to ask when assessing lungs
Environmental exposures Allergies Difficulty breathing Exercise Coughs History smoking Can you catch your breath Chest pain
27
What is hyperresonance?
Booming sound, lower pitch sound Hear when to much air is present
28
What are the qualities of bronchial? Pitch— Amplitude— Duration— Quality— Normal location—
Pitch—high Amplitude—loud Duration= I
29
What are the qualities of bronchovesicular? Pitch— Amplitude— Duration— Quality— Normal location—
Pitch—moderate Amplitude—medium Duration—I=E Quality—intermittent Normal location—1st and 2nd intercostal spaces between scapula
30
Where is the first sound S1 loudest. And what makes the sound
Closure of AV tricuspid and mitral valves Loudest at apex
31
Where is the second heart sound listened at? and what makes the sound
Closure of semilunar valves Loudest at base
32
Where Do you listen to pulmonic>
2nd intercostal space
33
Where do you listen to aortic
2nd right intercostal space
34
Where do you listen to tricuspid
4th left intercostal space, left lower steal border
35
Where do you listen to the apex
5th left intercostal space
36
What are the characteristics of S3
Occurs when ventricles resistant to filling during early rapid filling phase Occurs inmmediatley after s2
37
What are the characteristics S4 sounds
occurs at the end of diastole at presystole, before S1 ventricle resistant to filling
38
What are the qualities of vesicular? Pitch— Amplitude— Duration— Quality— Normal location—
Pitch-low Amplitude—soft Duration—I>E Quality —rustling like wind through trees Normal location— over peripheral lung fields
39
What are conditions that can cause heart murmers
Velocity of blood increases Viscosity of blood increases Structural defects in valves
40
What causes crackling sounds?
Fluid in alveoli Crackles= fine(rubbing) vs coarse(Velcro) Pleural friction rub-dry rubbing or squeaking
41
What are the musical sounds?
Wheeze—high Rhonchi—low Strider—high pitched crowing sound, inflammed tissue in epiglottis
42
What are the normal findings of bronchophony and what are the abnormal findings?
Ask the person to repeat ninety-nine Normal—muffled and indistinct Abnormal—clear ninety-nine
43
What are the normal and abnormal findings of egophony?
Ask the person to say long ee-eee-ee sound Normal- should hear eee through stethoscope Abnormal—bleating goat
44
What is the normal and abnormal findings of whispered pectoriloquy?
Ask the person to whisper one-two-three Normal-response is faint, muffled, and almost inaudible Abnormal- very clear and transmitted
45
Chest is smaller than head till what age
2 years
46
Infants are nose breathers until what age
3 months
47
What is unique for counting infant respirations?
Count for the full minute
48
Describe APGAR evaluation of newborn infants
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
49
What is pleural effusion?
Excess fluid between pleural Compress lung tissue
50
What is pneumothorax?
Air in pleura
51
What is pulmonary embolism
Lung blood clots
52
Describe crackling sounds?
(Rales) Fine hair moving through fingers Collapsed small airways and alveoli popping open Location=lower lobes
53
Describe wheezes
High pitched Due to air moving through narrowed airways Asthma exacerbation
54
Describe rhonchi
Low pitched rumbling gurgling Due to narrowed airways Location=trachea and bronchi Chronic bronchitis
55
Describe stridor
High pitched monophonic crowing sound Due to obstruction from swollen inflamed tissues Foreign body
56
Where is the location of tricuspid (AV) valve? Where is the location of the mitral (AV) valve
T=Between right atrium and right ventricle M= between left atrium and left ventricle
57
What valve does the blood from the left ventricle go through to run through the body?
Aortic valve
58
What valve does the blood from the right ventricle go through?
Pulmonary valve
59
What circulates blood?
Circulation of blood driven by pressure gradient
60
What happens at diastole?
Ventricles relax and fill with blood
61
Heart sounds are described by?
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
Carotid artery pulse is located between ____ and _____
Trachea and sternomastoid muscle
63
Carotid artery pulse closely coincides with ______
Ventricular systole
64
Jugular venous empties ____ blood directly into _____
Deoxygenated Superior vena cava
65
A pt is taking digoxin, how do we count apical pulse
Must be counted for 1 minute, no exceptions with this drug
66
What is the routine for auscultation areas for the heart
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
What are the grade scale for murmurs
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
What are cardiac pregnancy considerations
HR increases Arterial BP decreases due to peripheral vasodilation Increased blood volume
69
What are the Hemodynamic changes with aging?
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
What are the infant cardiac considerations
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
What what ages do you listen for apical pulse in different positions
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
What are symptoms of Dyspnea?
Shortness of breath on exertion (SOBOE) from pulmonary congestion
73
What is jugular vein distention from?
Venous congestion
74
What does an infarct do to cardiac output?
Infarct may be caused of decreased cardiac output
75
What are symptoms of heart failure
Dyspnea, crackles, wheeze, decreased BP, nausea and vomiting, edema, jugular vein distention, infarct, fatigue, weak pulse
76
T/F there is a cure for heart failure
F, there is no cure, can only treat symptoms
77
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
B
78
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?
Lobar pneumonia
79
Define Eschemia
Lack of O2
80
What are the arteries in the leg?
Femoral, popiteal, anterior tibial, dorsalis pedis
81
Peripheral arterial disease (PAD) affects _____ vessels and refers to arteries affecting the limbs.
Non-coronary
82
What makes the pressure system for veins?
Movement of muscles, calf pump or peripheral heart
83
Describe varicose veins
Dilated and tortuous (varicose) veins create incompetent valves leading to increased venous pressure, which further dilatation of the vein
84
What are the functions for lymphatic system?
1 one way drainage system 2 major part of immune system to defend body against diseases 3 absorb lipids form small intestine
85
What is it called when there is too much lymph?
Lymphedema
86
Are lymphatic ducts palpable?
Normally, no They are palpable during infection
87
What are the functions of the spleen?
Destroy old RBC Produce antibodies Stores RBC Filter microorganisms from blood
88
Lymph nodes are relatively ____ in children. Often ___ even when child is healthy
Large, palpable
89
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 ____
Vasodilation Edema
90
When does a child’s lymph nodes go to adult size?
10 to 11
91
AGING ADULT Peripheral blood vessels grow more rigid with age, resulting in _____ with increased prevalence of PAD.
Arteriosclerosis
92
How do you assess arteriosclerosis
—asses for presence of intermittent claudication(pain in calf by walking, relieved with rest) Decrease is size
93
AGING ADULT What do you do when you assess progressive enlargement of intramuscular calf veins?
Assess for increased risk for DVT (deep vein thrombosis)and PE as a result of prolonged bed rest, immobile and heart failure
94
T/F loss of lymphatic tissue leads to fewer numbers of lymph nodes in older people and size of remaining nodes
T
95
Describe modification allen test
Holding ulnar and radial arteries, pump hand, assess re-coloration If circulation re-coloration> 7 seconds or longer= positive test (poor circulation)
96
What is the pitting edema grade scale?
1+ mild/slight indent 2+moderate/subsides quickly 3+ deeper pitting/remains longer/leg looks swollen 4+ deepest/remains long time/very swollen
97
For color changes, What do you do if you suspect an arterial deficit?
Raise legs about 12 inches off table and ask the person to wag feet for 30 seconds to drain of venous blood
98
What do you use a Doppler ultrasonic probe
To assess weak peripheral pulse, BP on infants, low BP, Lower extremity BP
99
What is the ankle-brachial index?
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
What does Wells score indicate
Probability of DVT (deep vein thrombosis) Higher the score=higher the risk
101
_______ _____ should be ____ and _____ in both upper and lower extremities
Pulse force Regular Symmetric
102
____ lymph nodes occur often in healthy infants and children
Palpable —Small, firm, mobile, nontender
103
What are normal findings during 3rd trimester?
Peripheral pitting edema Varicose veins
104
What are abnormal findings in peripheral vascular disease ARMS LEGS OTHER ABNORMALITIES
Arms—Raynard phenomenon, lymphedema Legs—arterial (ischemic) ulcer, venous (stasis) ulcer Other abnormalities—aneurysms, occlusion (thrombus formations)
105
What are some symptoms of DVT
Pain, tender to touch, sudden onset, worse when touched, better with meds, swollen legs.
106
What are symptoms of chronic arterial symptoms: PAD? (Diabetic ulcers—neuropathic) (arterial ischemic ulcer)
Deep muscular pain (calf) Intermittent claudication Pain is gradual after excession but chronic Elevation aggravates it making it worse Risk factor leavening dangling
107
What are the differences between arterial and venous ulcers?
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
What are some abnormal condition that may affect the location of the apical impulse
Cardiac enlargement L ventricular dilation
109
What are the mechanisms producing the first and second heart sounds
S1 closure of the AV valves S2-closure of the semilunar valves
110
Where is the S1 the loudest
Apex
111
Where is S2 the loudest
The base
112
What is a bruit
Blowing swishing sound, indicates blood flow turbulence Artherosclerosis may cause bruit
113
What is the difference between preload and after load
Preload is volume of blood refilled After load is the pressure of blood contracted through the aortic valve
114
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
C
115
Select the description of the tricuspid valve A left semilunar valve B right artrioventricular valve C left artrioventricular valve D right semilunar valve
B
116
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
C
117
Atrial systole occurs: A during ventricular systole B during ventricular diastole C concurrently with ventricular systole D independently of ventricular function
B
118
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
D
119
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 C D
120
When auscultating the heart, your first step is to:
Identify S1 and S2
121
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)
C
122
When assessing the carotid artery, you will palpate:
Medial to the sternomastoid muscle, one side at a time
123
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
B D
124
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
D
125
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?
Yes this is the jugular venous pulse, and it is a normal finding
126
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 B D
127
What is the difference between endocardium, myocardium, and pericardium?
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
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 _____
Diaphragm, sitting up and leaning forward, breath out and hold
129
What are the 3 mechanisms that help return venous blood to the heart
1. Contract skeletal muscle 2 pressure gradient caused by breathing 3 intraluminal valves in veins
130
What are the organs in the lymphatic system
Bone marrow, lymph nodes, spleen, tonsils, thymus
131
What is the grading scale for assessing the force on an arterial pulse
0 absent 1+ weak 2+ normal 3+ increased, full bound
132
What is the pitting edema grading scale
1+ mild pitting, slight indentation 2+ moderate pitting 3+ deep pitting, remains for short period 4+ very deep pitting, remains for long time
133
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
C
134
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
D
135
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
B

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