week 5 heart and lungs Flashcards
head circ should match the chest circ from age what to what
6mo to 2 years
thorax approximates the adult shape by what age
5-6 years
from birth to 3 years, how do the ribs lie? what does this make it hard for young kids to do?
lie horizontally. makes it hard to expand their chest fully and limits TV
larynx is narrowest at the level of the what?
cricoid cartiledge- 1 mm of airway edema can narrow infants airway by 60%
do newborns produce mucous?
not as much increased risk for reps infection
where is the larynx located from age birth to 8-10 years?
2-3 cervical vertebra higher than adults making it at level c3-c4- higher risk of aspiration
what causes an increased risk for childhood airway obstruction?
size of airway and elastic, collapsible tracheal cartilage
What increases infants and toddlers risk for airway edema?
Mucus membrane lining the respiratory track are more loosely attached and very vascular
in infants and toddlers, where does the trachea bifurcate? Where does the trachea bifercate in adults?
 T3. T3 or T4.
why are infants and toddlers breath sounds higher pitched?
smaller airway, earlier place that the trachea bifurcates
Apnea that last longer than how many seconds is outside of normal limits for a neonate? Why do neonates have apnea?
Anything greater than 20 seconds is considered central apnea and is outside of normal limits. Neurologic immaturity of the respiratory drive, periodic breathing with no cyanosis or bradycardia is normal for a neonate. Apnea lesson equal to 10 seconds can be normal for neonates and infants until three months.
What age do children breathe by using the diaphragm and abdominal muscles?
Ages birth through six years
Between what age does breathing become thoracic and the respiratory rate lowers to near adult level?
Age 8 to 10 years
what does it mean that children have a higher amount of anatomical dead space?
conducting airways such as the trachea, the bronchi and the bronchioles are structures that do not have alveoli, which means they are not perfused and gas exchange does not occur. 
share are larger airway structures in a child in the airway?
soft palette, the tongue
most ventilation work is done by what in a child?
diaphragm
What is diaphragmatic breathing?
Chromatic breathing is when the abdominal rises with inspiration and is normal and infants from children until age 7
what are the causes of Tachypneachildren?
Fever, severe anemia, anxiety, pain, cardiac disorders, and lower respiratory tract disorders
prolonged expiratory phase could mean what?
overall air trapping sooo asthma
bronchial breath sounds: pitch, quality, duration, location
high pitch, harsh or hollow, short inspiration time, longer expiration time, heard over trachea
Bronchovesicular breath sounds: pitch, quality, duration, location
Moderate, mixed, inspiratory and expiratory time are equal, between first and second intercostal space at point of bifurcation of trachea, and between scapula
vesicular breath sounds: pitch, quality, duration, location
Hello, blowing sound, inspiratory time is longer than expiratory time, heard throughout peripheral lung fields
Crackles or rails breath sound: description and associated conditions
High-pitched, soft, cracking popping sound fine, crackles or low pitch gargling course crackles maybe localized or diffuse, mainly at end of inspiration, do not clear with cough.
Pneumonia, bronchiolitis, and atelectasis
Rhonchi breath sounds: description and as associated conditions
Low pitch, loud, often, rattling, bubbling, or gurgling, heard mainly at the beginning of inspiration, caused by secretions in large airways, often clears with coughing, low pitch, snoring sounds during expiration results from nearing large airways, swelling, or obstruction
Asthma, pneumonia, bronchitis, bronchiolitis
Wheezes breath sounds: description, associated conditions
High pitch, musical, whistling, or squeaky, maybe inspiratory or expiratory, predominantly expiratory, caused by airway narrowing.
Reactive, airway, disease, bronchiolitis, asthma, foreign body aspiration, and bronchospasms
strider breath sound: description and associated conditions
Loud, course, high-pitched sound, occurs as a result of upper airway narrowing due to inflammation, edema, or the presence of a foreign body. Strider mainly occurs with inspiration and can be heard without a stethoscope.
Viral croup or foreign body aspiration
What is respiratory palpation done to evaluate? When can you start it? In kids?
completed to evaluate respiratory excursions, and to assess for tactile fremitus. Can be started at age 3 and older, who can cooperate with the examination can also be done to identify tenderness, lumps, masses, or crepitus
assessing for respiratory excursion anterior.Where do you put your hands?
Both hands pointing upward on the costal margins of the xiphoid process
What is respiratory percussion assessing for and at what age do we start doing it on children?
assessing for air fluid or masses in the child’s lungs and to locate Oregon boundaries. Can be started at age 2 or older 
Age base norms for respiratory rate: newborn, infant, toddler, preschooler, children, 6 to 12 years old, adolescence, and adult
Newborn 30 to 60, infant 30 to 60, toddler 24 to 40, preschooler 22 to 34, children 6 to 12 18 to 30, adolescence, 12 to 16, adult 12 to 20,
AP diameter VS transverse diameter ratio expectied findings
1:2
In adults, what is finger clubbing associated with?
Emphysema, lung, cancer, cyanosis of congenital heart, disease, cirrhosis, or cystic fibrosis
what is crepitus? What does crepitus indicate?
Crackly or crinkly sensation that can be both palpated and heard from occultation. It indicates air in the subcutaneous tissue which could mean a rupture somewhere in the respiratory system or an infection with producing organism.
what is friction rub and what does it indicate?
Palpable and audible course grading vibration usually on inspiration. It indicates inflammation of the plural space like pleuritis.
What is tactile feminist and what does increase premise indicate versus what does decrease fremitus indicate?
tactile fremitus is the vibration of the chest wall result of sounds transmitting through the lung tissue. You do this by feeling for changes and intensity by palpating the chest wall and having the patient repeat phrases over and over.
Decrease fremitus is an indication of the lung thickness of the chest wall or emphysema
increase fremitus is an indication of lung consolidation, which means the air in the healthy long is replaced with something else, including blood, pus, inflammation exudate
testing diaphragmatic excursion
- have person hug themselves
- deep breathe and hold it
- purcuss along the scapular line until locate lower border. changes from resonace to dullness
- mark the point with a maring pen or tape
- exhale all the way and hold it
- EXCUSION DISTANVE ON BOTH SIDES IS ABOUT 3-5 cm
causes of abnromal exam of diaphramatic excursion
pnumonia, pnumothorax, massive ascites or tumor, fractured rib
what is bronchophony
greater clarity and increased loudness upon auscultation of medial lung fields when patient vocalizes
what is pectoriloquy
even a whisper can be heard clearly
egophony
when the intesnity of the spoken voice is increased and there is nasal quality (E sounds like A)
expected findings of vocal resonance
muffled and indistinct (best heard medially)
unexpected findings of vocal resonance
egophony, bronchophony, and pectoriloquy
increased or decreased in intensity of sound. decreases with loss of tissue like emphysema and increases with pnumonia and lung cancer…
three diseases that are categorized under COPD
bronchitis, bronchiectasis,a nd emphasema
chronic bronchitis: what is it, what is it caused by and what are the S and O’s?
large airway inflammation, chronic irritant exposure (smoking), usually older than 40 years old.
S: dyspnea, cough, sputum
O: wheezes, crackles, hyperinflation with decreased breathe sounds, flattened diaphragm
bronchiectasis: what is it, what is it caused by and what are the S and O’s?
chronic dialation of bronchi/bronchioles casued by pulmonary infections/bronchial obstruction
S: cough with ALRGE amount of sputum, severe hemoptysis
O: tachypnea, clubbing, crackles, rhonchi
emphysema: what is it, what is it caused by and what are the S and O’s?
lungs lose elasticity; alveoli enlarge
S: dyspnea at rest, cough is infrequent w/o production of sputum
O: barrel-shaped chest, breathe sounds diminished with scattered crackles or wheezes, overinflation lungs are hyper resonant on percussion, inspiration is limited with prolonged expiratory effort to expel air
in children under the age of 7, the heart lies more horizonatally and the apex of the heart is found where?
4th L intercostal space
you assess apical HR until age what ?
6 years
BP start taken at age what?
3 years
Fem pulses are assessed in newborn to rule out what?
coarctation or the aorta
normal PMI of a child less than 7 years is felt at the :
intersection of the 5th intercostal space in the L midclavicular line
what is precordial acitivity and what are conditions you may feel precordial palpation
from increased precordial activity
- increased R or L Ventricular stroke volume,
-ASD
moderate or large VSD - significant PDA
auscultation of S3 is associated with what? what does it sounds like? what could this mean if it is LOUD?
rapid filling of the ventricle
KunTuckY
ventricle dilation with decreased compliance such as CHF
S4 is heard when? is it normal? what does it mean and what does it sound like?
immediatly preceding the first heart sound. associated with atrial contraction and excessive flow across the atrioventricular valves. it is RARE in childre, always pathologic and suggests decreased ventricular compiance or congestive heart failure. sounds like TenNesSee
name of an innocent murmur what hapens when the patient changes position?
stills murmur and is decreases in intensity when the child stands- systolic murmur
hypertophic cardiomyopathy murmur?
potentially life-threatening, worsens when the patient stands. LEADING CAUSE OF SUDDEN DEATH IN ATHLETES
what is normal value of Jugular venous pressure (interanl) measured by inspection? what are some characteristics of this?
2-4 cm
normal visible, occludes, impalpable, complex waveform, empties below and fills above, increases with hepatojugular reflex (no more than 4cm increase), and reflects a measurement of CVP
what should we know about diastolic murmurs?
always pathologic and should be referred for eval.
normal CVP
8-12 mmhg
low jpv could mean…?
hypovolemia or dehydration
high jvp could mean…?
fluid overload (trauma patient), CHF
acronym to remember auscultation placments
APE To Man
Aortic
Pulmonic
Erbs point
Tricuspid
o
Mitral
a
n
where to listen to all 5 heart points
Aortic: R sternal bornder 2nd intercostal space
Pulmonic: L sternal border 2nd intercostal space
Erbs point: L sternal border 3rd intercostal space
Tricuspud: L sternal border 4th intercostal space
Mitral: L midclavicular line, 5th intercostal space
what is erbs point used to listen to?
closing of BOTH the aortic and the pulmonic valve
what does s1 represent? where is it best heard?
- cosing of the av valves (mitral and tricuspid)
- “Lub”
-best heard over the apex (which is positions 4& 5)
what does s2 represent? where is it best heard?
closing of the pulmonic and the aortic valves
- “dub in lub dub”
it is best heard in 1 and 2
POTENTIAL TEST QUESTION: what does s4 respresent? what does it sound like?
blood is more forcefully being pushed into the ventricles (occurs before s1) and it sounds like TEN ness see
age related changes in the heart include
cardiac function compromised around the SA node and heart valves
when av valves do not close at the exact same time, this is known as
splitting
when conducting a physical assesssment on a neonate that is 5 days old, which of the following findings suggest coarc of the aorta?
BP higher in R arm than the R leg
