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NUA 311: Holistic Assessment In Nursing > Week 4 > Flashcards

Week 4 Flashcards

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1
Q

Thoracic cage: what is it how how is it defined?

A

Bony structute with a conical shape which is more narrow at the top
- sternum, 12 pairs of ribs and 12 thoracic vertebrae

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2
Q

Diaphragm

A

Flood the of thoracic cage, a musculotendinous septum that separates thoracic cavity from abdomen

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3
Q

Describe the different types of ribs

A

First 7 ribs are attached to sternum by costal cartilages
Rubs 8-10 are attached to costal cartilage above
Ribs 11 and 12 are “floating” with free palpable tips

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4
Q

Costochondral junctions

A

Points at which ribs join their cartilages; they are not palpable

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5
Q

Suprasternal notch

A

Hollow U-shaped depression just above sternum between clavicles.

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6
Q

Sternum

A

“Breastbone” has 3 parts — manubrium, body and xiphoid process

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7
Q

Manubriosternal angle

A

“Angle of Luis” at articulation of manubrium and sternum, and continuous with second rib

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8
Q

Each intercostal space is numbered by what

A

Each intercostal space is numbered by rib above it

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9
Q

What does the Angle of Louis mark?

A

The site of tracheal bifurcation into right and left main bronchi; corresponds with upper border of atria of the heart and it lies above 4th thoracic vertebra on back

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10
Q

Costal angle

A

The right and left costal margins form an angle where they meet at the xiphoid process

— usually 90 degrees or less, increases when rib cage is chronically overinflated, as in emphysema

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11
Q

What are reference lines you can imagine on your patient when they are facing anteriorly?

A

Anterior axillary line, midclavicular line, midsternal line (lateral to medial)

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12
Q

What are lines you can imagine on your patient when they are facing you posteriorly?

A

Scapular line, vertebral line (lateral to medial)

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13
Q

What are lines you can imagine on your patient when you are looking at them from the side?

A

Posterior axillary line, mid axillary line, anterior axillary line

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14
Q

Anterior axillary line

A

Extends down from anterior axillary fold where pectoral is major muscle inserts

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15
Q

Posterior axillary line

A

Continues down from posterior axillary fold where latissimus Doris muscle inserts

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16
Q

Midaxillary line

A

Runs down from apex of axilla and lies between anterior and posterior axillary lines

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17
Q

Mediastinum

A

Middle section of thoracic cavity containing esophagus, trachea, heart and great vessels

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18
Q

Right and left pleural cavities

A

Encase lungs

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19
Q

Lung borders

A

In anterior chest, apex of lung tissue is 3 of 4 cm above inner third of clavicles

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20
Q

Laterally, the lung tissue extends from apex of axilla down to that

A

7th or 8th rib

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21
Q

Posteriorly, the location of C7 marks what?

A

Apex of lung tissue, and T10 usually corresponds to base

— deep inspiration expands lungs, and their lower border drops to level of T12

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22
Q

Why is the right lung shorter than the left

A

Because liver is under it

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23
Q

Why is the left lung more narrow then the right

A

Heart bulges to the left

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24
Q

How many lobes does each lung have?

A 
Right = 3 
Left = 2
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25
Q

What is the most remarkable point about posterior chest?

A

It is almost all lower lobe

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26
Q

Upper lobes occupy a smaller band of tissue from their apices at what part of posterior chest?

A

T1 down to T3 to T4

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27
Q

Lobes of the lung, lateral chest:

A

Lung tissue extends from apex of axilla down to 7th or 8th rib
— right upper lobe extends from apex of axilla down to horizontal fissures at 5th rib

— right middle lobe extends from horizontal fissure down and forward to 6th rib at midclavicular line

— right lower lobe continues from 5th rib to 8th rib in midaxillary line

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28
Q

Lobes of left lung: the 2 lobes of the left lung are seen where?

A

Laterally as two triangular areas separated by oblique fissue

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29
Q

Lobes of the left lung, things to keep in mind

A

Left lung has no middle lobe
Anterior chest contains mostly upper and middle lobe with very little lower lobe
Posterior chest contains almost all lower lobe

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30
Q

Pleurae

A

Thin, slippery pleurae form envelope between lungs and chest wall

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31
Q

Visceral pleura

A

Lines outside of lungs, dipping down into fissures

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32
Q

Parietal pleura

A

Lining inside chest wall and diaphragm

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33
Q

Pleural cavity is a potential space, meaning what

A

Filled only with few mL of lubricating fluid

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34
Q

Pleural cavity normal has a vacuum, or negative pressure, which does what

A

Holds lungs tightly against chest wall

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35
Q

Trachea

A

Lies anterior to esophagus and is 10 to 11 cm long in the adult
— begins at level of cricoid cartilage in next and bifurcated just below sternal angle into right and left main bronchi

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36
Q

Where is the trachea bifurcation posteriorly

A

T4 or T5

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37
Q

Describe the anatomy of right main bronchus

A

Shorter, wider, and more vertical then the left main bronchus

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38
Q

Trachea and bronchus role

A

Transport gases between the environment and lung parenchyma

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39
Q

Bronchi are lined with goblet cells and cilia, which do what

A

Secrete mucus that entraps particles

— also lined with cilia, which sweep particles upward where they can be swallowed or expelled

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40
Q

Acinus

A

A functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs and the alveoli

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41
Q

4 major functions of respiratory system

A

A. Supply o2 to the body for energy production
B. Remove CO2 as a waste product of energy reactions
C. Maintain pH balance for homeostasis
D. Maintaining health exchange

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42
Q

How to the lungs help maintain balance by adjusting level of CO2 through respiration

A

A. Hypoventilation causes CO2 to build up in blood

B. Hyperventilation causes CO2 to be blown off

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43
Q

Normal stimulus to breath for most of us?

A

Increase in CO2 in blood (hypercapnia)

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44
Q

Describe the development of an infants respiratory system

A

Infants body systems all develop in utero, but the respiratory system alone does not function until birth; birth demands its instant performance
— during the first 5 weeks, primitive lung bud emerges
— respiratory development continues throughout childhood

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45
Q

Conditions associated with environmental tobacco smoke in infants and children

A

Sudden infant death syndrome, negative behavioral and cognitive functioning, increased rates of adolescent smoking

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46
Q

Prenatal and postnatal exposure to second hand smoke increase the child’s risk for what

A

Low birth weight
Chronic otitis media
Obesity

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47
Q

Enlarging uterus elevates diaphragm how much during pregnancy

A

4 cm
— decreases vertical diameter of thoracic cage, but this decrease is compensated for by an increase in horizontal diameter
— increase in estrogen level relaxes chest cage ligaments

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48
Q

Aging adults and costal cartilages

A

Become calcified which produce less mobile thorax

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49
Q

Why is aging lung harder to inflate

A

More rigid in structure

50
Q

Why is there less surface area available for gas exchange in the aging lung

A

Histologic changes (gradual loss of intra-alveolar septa and a decreased number of alveoli)

51
Q

Why does the aging lung base become less ventilated

A

As a result of closing off a number of airways

52
Q

Histologic complications increase the older persons risk of what

A

Postoperative pulmonary complications

53
Q

Subjective data collection for respiratory system

A

History of present health concern (COLDSPA)
Past health history
Family history
Lifestyle and health practices

54
Q

Objective data preparation for collecting data on respiratory system

A

Provide respect and comfort while allowing for access of examination techniques

55
Q

Tripod position seen in COPD: what is it?

A

Client leans forward
Uses arms to support weight
Lifts chest to increase breathing capacity

56
Q

Inspection: respiration’s

A

Observe quality and pattern
Breathing characteristics (rate, rhythm, depth)
Labored and noisy (could indicated asthma or bronchitis)

57
Q

What actions to you perform for respiratory system

A

Inspection, palpation, percussion, auscultation

58
Q

Inspection: thoracic cage

A

Note shape and configuration of chest wall

Spinous process should appear in a straight line; thorax is symmetric, in an elliptical shape, with downward slopping ribs, about 45 degrees relative to spine; scapulae are placed symmetrically in each hemithorax

59
Q

Symmetric expansion: confirm

A

Confirm symmetric expansion by placing your warmed hands on posterolateral chest wall with thumbs at level of T9 and T10

60
Q

Symmetric expansion: slide

A

Slide hands medically to pinch up small fold of skin between your thumbs; ask person to take a deep breaths

61
Q

Symmetric expansion: note

A

Your hands serve as mechanical amplifiers; as a person inhales deeply, your thumbs should move apart symmetrically; note any lag in expansion

62
Q

Tactile fremitus

A

Palpable vibration
- sounds generation from larynx are transmitted through bronchi and through lung parenchyma to chest wall, where you feel vibrations

Use palmer base of fingers or ulnar edge of one hand and touch persons chest while they say a phrase

63
Q

Percussion: posterior chest — lung fields

A

Determine predominant note over lung feilds; start at apices and percussion band of normally resonant tissue across tops of both shoulders

Then, percussing in interspaces, made side-to-side comparison all the way down lung region

64
Q

Percussion posterior chest - how many cm between each percussion

A

5 cm intervals - avoid damping effect of scapulae and ribs

65
Q

Resonance

A

Low-pitched, clear, hollow sound that predominates in healthy lung tissue
— relative term and has no constant standard

66
Q

Percussion posterior chest: what must be yielded to note an abdominal percussion note

A

Abnormal findings must be 2-3 cm wide to yield an abnormal percussion note; lesions smaller than that are not detectable by percussion

67
Q

You should expect to hear three types of normal breath sounds in an adult or older child - what are they?

A

Bronchial
Bronchovesicular
Vesicular

These are found on the chest wall of adult and older child

68
Q

Adventitious sounds

A

Added sounds that are not normally heard in lungs

69
Q

Adventitious sounds: cause

A

Moving air colliding with secretions in tracheobronchial passageways or by popping open of previously deflated airways

70
Q

Palpation of anterior chest: palpate symmetric chest expansion

A

Place your hands on anterolateral wall with thumbs along costal margins and pointing towards xiphoid processes

71
Q

Why is limitation of thoracic expansion easier to detect on anterior chest

A

Because greater range of motion exists with breathing

72
Q

Auscultation breath sounds: auscultation

A

Auscultation lung fields over anterior chest from apices in supraclavicular areas down to 6th rib

73
Q

Auscultation breath sounds: progress

A

Progress from side to side as you move downward, and listen to one full respiration in each location

74
Q

Auscultation breath sounds: use

A

Use sequence indicated for percussion; do not place stethoscope directly over female breast; displace breast and listen directly over chest wall

75
Q

Auscultation breath sounds: evaluate

A

Evaluate normal breath sounds, noting any abnormal breath sounds and any adventitious sounds

76
Q

Auscultation breath sounds: assess

A

If situation warrants, assess voice sounds

77
Q

Breast surface anatomy contains

A

Nipple, areola, montgomery glands (elevated subcutaneous glands)

78
Q

What are the 4 groups of lymph nodes that drain impurities from the breast

A

Central axillary nodes
Pectoral (anterior)
Sub-scapular (posterior)
Lateral

79
Q

Where does drainage flow from the central axillary nodes

A

Up to the infraclavicular and supraclavicular nodes

80
Q

Anterior nodes drain what

A

They drain the anterior chest wall and breast.

81
Q

The posterior nodes drain what

A

Posterior chest wall and part of the arms

82
Q

The lateral nodes drain what

A

Most of the arms

83
Q

The central nodes receive drainage from what

A

Anterior, posterior and lateral lymph nodes

84
Q

Describe the drainage from the nipples to the lymph nodes

A

Drain from nipple - up

85
Q

What is the most common area for tumors to grow on the breast?

A

Tail of Spence

86
Q

What quadrants is the breast divided into

A

Upper inner quadrant
Upper outer quadrant
Lower outer quadrant
Lower inner quadrant

87
Q

When does estrogen stimulate breast changes

A

Puberty

88
Q

Beginning of breast development process menarche about ____ years

A

2

89
Q

When do breast begin to occur during pregnancy?

A

2nd month of pregnancy

90
Q

Colostrum

A

Thick yellow fluid that is a precursor for milk, containing some amount of protein and lactose, but practically no fat
— rich with antibodies to protect newborn against infections, so breast feeding is important

91
Q

When is colostrum present

A

May be expressed about month 4 of pregnancy

— breast produce colostrum for first few days after delivery

92
Q

Developmental Competence: Aging women (5)

A
  1. After menopause, ovarian secretion of estrogen and progesterone decreases, causing breast glandular tissue to atrophy
  2. Decreased breast size; makes inner structures more prominent
  3. A breast lump may have been present for years, but is suddenly palpable
  4. Around nipple, the lactiferous ducts are more palpable and feel firm and stringy because of fibrosis and calcification
  5. Axillary hair decrease
93
Q

Gynecomastia

A

During adolescence it is common for breast tissue to temporarily enlarge
— may appear in aging males due to lowered testosterone

94
Q

What women are at an increased risk for developing breast cancer

A

Women who inherit mutations of BRCA-1 and BRCA-2 on one or both sides of the family

95
Q

When should females start getting mammograms

A

Age 40

96
Q

Breast cancer lifestyle risk factors

A

Alcohol has dose dependent effect
Continuation of physical exercise during aging helps reduce risk
Post menopausal weight gain negates effects of physical exercise

97
Q

Factors contributing to breast health care access

A

Low income, lack of health insurance, geographic, cultural, and language barriers and racial bias

98
Q

“Alcohol/Western” dietary pattern and breast cancer

A

“Alcohol/Wester” dietary pattern linked to increased risk of breast cancer, especially with estrogen or progesterone + tumors

99
Q

“Mediterranean” diet and breast cancer

A

Linked to a modest protective affect against breast cancer

100
Q

Second major cause of death from cancer in women

A

Breast cancer

101
Q

Supernumerary nipple

A

An extra nipple along embryonic “milk line” on thorax or abdomen

  • congenital
  • normal variation
102
Q

What does breast tissue feel like in nulliparous women vs after pregnancy

A

Nulliparous - firm, smooth, elastic

After pregnancy - softer and looser

103
Q

Characteristics of lump of mass: location

A

Describe distance in cm from nipple; or diagram breast in woman’s record and mark location of lump

104
Q

Characteristics of lump or mass: size

A

Judge in cm by width, length, depth

105
Q

Characteristics of lump or mass: shape

A

State whether lump is oval, round, lobulated, or indistinct

106
Q

Characteristics of lump or mass: consistency

A

State if lump is soft, firm or hard

107
Q

Characteristics of lump or mass: movability

A

Is lump freely moveable or fixed when you try to slide it over chest wall?

108
Q

Characteristics of lump or mass: distinctness

A

is lump solitary or multiple?

109
Q

Characteristics of lump or mass: nipple

A

is it displaced or retracted

110
Q

Characteristics of lump or mass: skin over lump

A

is it erythromatous, dimpled, or retracted?

111
Q

Characteristics of lump or mass: tenderness

A

is lump tender to palpation?

112
Q

Characteristics of lump or mass: lymphadenopathy

A

are any regional lymph nodes palpable?

113
Q

why do premenopausal women who are mid-cycle make it hard to detect lesions?

A

they have tissue edema and mastalgia (pain) that make it difficult

114
Q

Subjective questioning related to breast assessment (normal vs abnormal)

A

v

115
Q

normal vs. abnormal breast changes

A

g

116
Q

positioning for breast exam

A

g

117
Q

Correct techniques used for breat assessment (inspection)

A

v

118
Q

correct techniques for breast assessment (palpation)

A

v

119
Q

Assessment findings associated associated with breast cancer

A

f

120
Q

breast self-exam teaching and assessment of patient outcomes

A

g

NUA 311: Holistic Assessment In Nursing (5 decks)

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