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Health Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the 8 abbreviations for the anatomical lines?

A
  • MSL: midsternal line
  • MCL: midclavicular line
  • RSB: right sternal border
  • LSB: left sternal border
  • AAL: anterior axillary line
  • MAL: midaxillary line
  • PAL: posterior axillary line
  • ICS: intercostal space
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2
Q

What is the anatomical location of the heart?

A
  • located in the mediastinum in the middle 1/3 of thorax
  • from RSB to L MCL and from 2nd to 5th intercostal
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3
Q

What is the base and apex of heart?

A

base=top of heart
apex=bottom of heart

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4
Q

What is another name for clavicle?

A

collar bone

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5
Q

What are the 3 layers of the heart?

A
  • epicardium/visceral pericardium: tough fibrous double walled sac that surrounds and compresses the heart, outermost layer
  • myocardium: muscular wall of heart; the pump
  • endocardium: thin layer of endothelial tissue that lines the inner surface
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6
Q

What is the heart?

A

a hollow, muscular organ

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7
Q

What is part of the internal heart? external?

A

internal: layers, valves, chambers
external: great vessels, chambers, coronary arteries

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8
Q

what are the 4 valves of the heart?

A
  • 2 atrioventricular: tricuspid (right) & mitral (left)
  • 2 semilunar: aortic (from L ventricle to aorta) & pulmonic (from R ventricle to pulmonary artery)
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9
Q

What is the function of each valve?

A
  • tricuspid: prevents backflow from the right ventricle to the right atrium
  • mitral: prevents backflow from the left ventricle to the left atrium
  • aortic: prevents backflow from the aorta to the left ventricle
  • pulmonic: prevents backflow from the pulmonary artery to the right ventricle
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10
Q

What are the 4 chambers of the heart and the order?

A
  1. Right atrium
  2. Right ventricle
  3. Left atrium
  4. Left ventricle
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11
Q

What are the 5 great vessels?

A
  • superior vena cava: return unoxygenated blood to heart from upper body
  • inferior vena cava: return unoxygenated blood to heart from lower body
  • pulmonary artery: leaves right ventricle and splits into L/R and carries venous blood to lungs for gas exchange
  • pulmonary veins: two from each lung that carry oxygenated blood to aorta
  • aorta: carries oxygenated blood to body
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12
Q

Filling phase?

A
  • AV valves open and semilunar valves closed
  • diastole
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13
Q

pumping phase?

A
  • AV valves close and semilunar valves open
  • systole
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14
Q

What is blood flow through the heart?

A
  1. R atrium receives deoxygenated blood from superior and inferior vena cava
  2. R ventricle sends blood through pulmonary artery to the lungs
  3. L atrium receives oxygenated blood from lungs through the pulmonary vein
  4. L ventricle sends oxygenated blood through the aorta to the body
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15
Q

What is the cardiac cycle?

A

the complete heart beat

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16
Q

Diastole vs systole?

A

diastole: when ventricles are relaxed and filling w/ blood; 2/3 of cardiac cycle
systole: when ventricles are contracting

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17
Q

cardiac output vs stroke volume?

A

Cardiac output: amount of blood circulated in one minute; determined by stroke volume
Stroke volume: amount of blood ejected w/ each beat x number of beats in one minute

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18
Q

How do you calculate cardiac output?

A

CO=HR x SV

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19
Q

What 3 things determine stroke volume?

A
  • preload: blood volume in ventricles at end of diastole
  • afterload: arterial pressure heart must pump against
  • contractility: ability of heart to contract
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20
Q

What is the flow of electrical conduction?

A
  • Sinoatrial node/”cardiac pacemaker” a 60-100 bpm
  • then atrioventricular node
  • then bundle of HIS
  • then bundle branches
  • then purkinje fibers
  • ventricular contraction
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21
Q

What happens if SA node fails?

A

electrical system can generate contractions at 40-60 BPM

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22
Q

What are the 3 main points in cardiac rhythm?

A
  • P: atria depolarization (contracting)
  • QRS: ventricular depolarization (contracting) & atrial repolarization (relaxation)
  • T: ventricular repolarization (relaxation)
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23
Q

What are the two normal heart sounds?

A
  • S1: “lub”, ventricles contract, closing tricuspid & mitral valves, systole begins
  • S2: “dub”, ventricles empty, pulmonic and aortic valves close, begins diastole
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24
Q

Where is S1 heard the loudest? S2?

A

S1=apex
S2=base

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25
Q

What creates the normal heart sounds?

A

the closure of valves swinging shut

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26
Q

What are 3 abnormal heart sounds?

A
  • S3: ventricular gallop, rapid ventricular filling due to fluid overload or congestive heart failure; occurs early diastole
  • S4: atrial gallop, non-compliant ventricle due to CAD, hypertension, or cardiomyopathy; occurs late diastole
  • summation gallop: both pathological sounds occur
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27
Q

Who is S3 common in and considered normal?

A
  • young adults
  • pregnant women
  • young children
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28
Q

How do we hear S1 vs S2 sounds?

A

S1: closure of mitral and tricuspid heard together
S2: aortic and pulmonic closure split, especially during inspiration

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29
Q

What is inspiration relating to heart sounds?

A

shifts more blood to right side of heart and less to left which speeds closure of aortic valve and delays closure of pulmonic valve, making split audible

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30
Q

What is a heart murmur?

A

turbulent blood flow w/ a swooshing or blowing sound when doing auscultation

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31
Q

What are 4 causes of heart murmurs?

A
  • increased blood velocity (exercise, thyrotoxicosis)
  • narrow or incompetent valves
  • decreased blood viscosity (thickness)
  • abnormal chamber openings
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32
Q

What are the 6 grades of a heart murmur?

A

1- difficult to hear; experienced examiner and quiet environment are needed
2- is not readily heard upon laying stethoscope on chest; examiner must listen closely
3- requires effort to hear; is readily heard when stethoscope is placed on chest
4- loud w/ thrill
5- very loud; easily palpated thrill
6- audible w/ stethoscope only near chest

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33
Q

What is a thrill?

A

a palpable vibration - like cat purring

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34
Q

What 5 things should you document w/ a murmur?

A
  • location
  • timing
  • grade
  • pitch
  • quality
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35
Q

What is the pitch of a murmur dependent on?

A

pressure and rate of blood flow

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36
Q

What 11 things should you ask when gathering health history during cardiovascular assessment?

A
  • chest pain
  • dyspnea (PND)
  • orthopnea
  • cough
  • fatigue
  • cyanosis/pallor
  • edema
  • nocturia
  • cardiac history
  • personal habits
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37
Q

What is nocturia?

A

getting up and using restroom at night

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38
Q

What is PND?

A

paroxysmal nocturnal dyspnea - difficulty breathing at night, wakes from sleep

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39
Q

What are some lifestyle risk factors to cardiovascular problems?

A
  • nutrition
  • smoking
  • alcohol
  • exercise
  • drugs
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40
Q

What are 3 main risk factors for cardiovascular problems?

A
  • hypertension
  • smoking
  • cholesterol
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41
Q

Who is hypertension common among?

A
  • women taking oral contraceptives
  • African Americans
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42
Q

What does smoking cause an increase risk for?

A
  • myocardial infarction
  • stroke
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43
Q

What are 5 equipment you would need for a heart & neck assessment?

A
  • stethoscope
  • small pillow
  • penlight
  • watch
  • centimeter ruler
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44
Q

What objective data should you gather when doing a cardiovascular assessment?

A
  • heart and great vessels
  • measure blood pressure
  • count apical and radial pulse
  • assess for pulse deficit
  • note color
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45
Q

What 4 things should you do when inspecting the anterior chest for a cardiac assessment?

A
  • use tangential lighting
  • stand on client’s right side and have them elevated 30-45 degrees
  • assess for symmetry & visible pulsations
  • find apical pulse at apex
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46
Q

What is tangential lighting?

A

light at a low angle

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47
Q

Precordium relates to?

A

cavity around heart

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48
Q

Where can you see an apical pulse?

A

4th - 5h intercostal at L MCL - can see if thin chest

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49
Q

What position should client be in when palpating for apical pulse?

A

supine position

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50
Q

Where should you palpate for a right ventricular heave or lift? left?

A

right - 3rd and 4th ICS LSB
left - apex

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51
Q

What grade of murmur can a thrill or pulsation be seen w/?

A

grade 4 murmur

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52
Q

What can cause heaves or lifts?

A

heart failure

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53
Q

S1 coincide with?

A
  • carotid artery pulse
  • R wave on electrocardiogram
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54
Q

What are the 5 places you can hear heart sounds?

A
  • aortic: 2nd ICS at RSB
  • pulmonic: 2nd ICS and LSB
  • erb’s point: 3rd ICS at LSB
  • tricuspid: 4th ICS at LSB
  • mitral: 5th ICS at L MCL
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55
Q

Where can you hear an S2 split?

A

at pulmonic - this is normal

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56
Q

How long do you count apical rate?

A

for 1 minute

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57
Q

What 3 positions should you auscultate heart sounds?

A
  • supine at 45 degrees
  • lying on left side
  • sitting up and leaning forward
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58
Q

What heart sounds do you listen for w/ diaphragm? bell?

A

diaphragm: S1 & S2
bell: S3, S4, & murmurs

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59
Q

Why is it harder to evaluate heart sounds in infants?

A

they have rapid heart rates

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60
Q

What are signs of heart disease in children?

A
  • poor weight gain
  • developmental delay
  • persistent tachycardia
  • tachypnea
  • dyspnea
  • cyanosis
  • clubbing
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61
Q

What heard sound is common in children?

A

innocent heart murmurs

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62
Q

What two things occur in aging adults?

A
  • rise in systolic pressure & thickening of L ventricular wall
  • apical pulse harder to palpate due to increased chest diameter
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63
Q

what is angina associated with?

A

chest pain

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64
Q

What are two types of angina?

A
  • angina pectoris: pressure-like discomfort w/ tightness or squeezing; often resolves w/ rest
  • acute unstable angina: heavy or crushing discomfort lasting 20 mins to hours; doesn’t resolve w/ rest - CALL 911
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65
Q

What is myocardial infarction?

A

heart attack; reduced blood flow to coronary artery due to occlusion

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66
Q

what is immediate treatment of myocardial infarction?

A
  • M: morphine
  • O: oxygen
  • A: aspirin
  • N: nitroglycerine
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67
Q

What is the primary cause of MI? and other factors?

A

coronary artery occlusion
- factors: coronary atherosclerosis, vasospasm, and emboli

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68
Q

What are 9 symptoms of heart failure?

A
  • dyspnea
  • orthopnea
  • crackles or wheezes
  • cough (frothy sputum)
  • anxiety
  • ascites
  • pitting edema
  • falling O2 saturation
  • JVD: jugular venous dystension
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69
Q

What is ascites?

A

abdominal sweating

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70
Q

what are 6 steps for observing jugular venous pulsations?

A
  1. position person supine anywhere from a 30-45 degree angle
  2. stand on right side
  3. ask client to turn head slightly to left & shine a tangential light source onto neck
  4. look for pulsations of jugulars in area of suprasternal notch or around sternomastoid muscle above clavicle
  5. don’t confuse w/ carotids
  6. distension at >45 degrees may indicate increased CVP
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71
Q

What are 5 steps to estimate jugular venous pressure?

A
  1. use angle of louis as reference point & compare it w/ highest level of venous pulsation
  2. hold a vertical ruler on sternal angle
  3. align a straight edge on ruler like a T-square & adjust level of horizontal straight edge to level of pulsation
  4. read level of intersection on vertical ruler
  5. state person’s position “internal jugular vein pulsations 3 cm above sternal angle when elevated 30 degrees”
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72
Q

What is a normal finding of jugular venous pressure?

A

less than 2 cm

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73
Q

What is the hepatojugular reflux?

A

press on area and if stays elevated sign of congestive heart failure

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74
Q

What are two steps for carotid artery assessment?

A
  • palpate carotid arteries one at a time
  • auscultate carotids for a bruit
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75
Q

How to auscultate carotid artery for bruit?

A
  • lightly apply bell of stethoscope over carotid artery
  • have patient “exhale and hold breath” while listening
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76
Q

What are normal findings for a pulse?

A

2+ and should be same bilaterally

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77
Q

What makes up the peripheral vascular system?

A

arteries:
- oxygen rich
- maintain BP by constricting or dilating in response to stimuli from parasympathetic nervous system
- high pressure system
- beat creates pulsation
- walls strong & elastic to withstand pressure demands
veins:
- low pressure and act as a reservoirs for extra blood
- valves ensure unidirectional flow
- uses skeletal muscle contractions to milk blood back toward heart
- de-oxygenated

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78
Q

what is an exception of the pulmonary arteries and veins?

A
  • pulmonary arteries carry de-oxygenated blood
  • pulmonary veins carry oxygenated blood
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79
Q

What do vessels transport?

A

fluids like blood or lymph

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80
Q

What does the lymphatic system do?

A

retrieves excess fluid from tissue spaces and returns it to the bloodstream

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81
Q

What is the flow of arterial pulse?

A

heartbeat -> pressure wave (pulse) -> arteries expand & recoil

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82
Q

Where can you feel a pulse?

A

body sites where rtery lies close to kin and over bone

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83
Q

Complete blockage of pulse? partial blockage?

A

complete blockage = death of distal tissue
partial blockage = ischemia

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84
Q

8 health history questions to ask abt peripheral vascular system?

A
  • leg pain or cramps
  • skin changes on arm or legs
  • swelling
  • varicose veins
  • wounds
  • lymph node enlargement
  • medications
  • smoking history
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85
Q

What is intermittent claudication?

A

pain in lower extremity due to inadequate blood flow

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86
Q

7 lifestyle and health practice questions relating to peripheral vascular system?

A
  • tabacco use
  • regular exercise
  • oral contraceptive use
  • degree of stress
  • peripheral vascular problems interfering w/ ADLs
  • medications to improve circulation or control BP
  • support hose
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87
Q

Equipment needed for a peripheral vascular exam?

A
  • gloves
  • centimeter tape measure
  • stethoscope
  • doppler ultrasound probe
  • waterproof pen
  • blood pressure cuff
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88
Q

What should you look at when performing a peripheral vascular exam of arms?

A
  • profile sign/clubbing
  • color/temperature/capillary refill
  • symmetry
  • lesions
  • radial pulse
  • ulnar pulse
  • brachial pulse
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89
Q

What is clubbing?

A

angle greater than 160 degrees

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90
Q

What is asymmetry of legs indicative of?

A

deep vein thrombosis

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91
Q

What should you look at when performing a peripheral vascular exam of legs?

A
  • skin and hair, lesions
  • symmetry
  • color, capillary refill
  • temperature
  • calf muscle
  • femoral, popliteal, posterior tibial, dorsalis pedis pulses
  • edema
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92
Q

What are the 3 steps of capillary refill?

A
  • depress and blanch nail beds
  • release and note time for color return
  • normal if color returns 1-2 seconds
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93
Q

What can skew findings of capillary refill?

A
  • cool room
  • decreased body temp
  • cigarette smoking
  • peripheral edema
  • anemia
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94
Q

Where is the dorsalis pedis pulse? posterior tibial pulse?

A
  • dorsalis pedis: lateral to extensor tendon of great toe
  • tibial pulse: medial malleolus
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95
Q

What is the modified Allen test and how do you perform it?

A

used to evaluate collateral circulation prior to cannulating radial artery
- occlude both ulnar and radial arteries
- then release pressure on ulnar
- color should retunr in 2-5 seconds

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96
Q

What is a doppler ultrasonic probe used for?

A

to detect weak peripheral pulses

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97
Q

what is the ankle brachial index and what is the normal range?

A
  • systolic in ankle/brachial systolic
  • 1.0 to 1.2; if less than or equal to 90% = peripheral artery disease
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98
Q

What is arterial insufficiency/PAD? clinical symptoms?

A

narrowing of the arteries, commonly the pelvis and legs
- cramping
- pain
- tired legs or hip muscles that worsens during walking/activity and subsides w/ rest

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99
Q

What is venous insufficiency/PVD? clinical symptoms?

A

inadequate return of venous blood from the legs to the heart
- tired/heavy
- achy cramping in legs
- pain worsens when standing and improves w/ leg elevation and activity

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100
Q

What are some aging adult trophic changes associated w/ arterial insufficiency?

A
  • thin, shiny skin
  • thick, ridged nails
  • loss of hair on lower legs
  • varicosities
  • lymphatic tissue lost
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101
Q

What are 4 characteristics of an arterial ulcer?

A
  • ulcers are punched out w/ destruction of deep fascia
  • tendon, bones & underlying joints exposed in floor
  • covered w/ minimal granulation tissue
  • presence of ischemic changes: pallor, dry skin, hair loss, fissuring of nails
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102
Q

What should you do when assessing leg veins?

A
  • observe for varicosities while patient stands
  • observe for lesions
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103
Q

What is homan’s sign? why do we not do it?

A
  • bend knee and dorsiflex the foot, if pain in calf muscle then positive sign
  • could dislodge the clot and become a pulmonary embolism
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104
Q

What are 6 characteristics of a venous ulcer?

A
  • sloping edge
  • thin and blue of growing epithelium of edge
  • pale granulation tissue for floor
  • shallow and flat ulcer that never penetrates fascia
  • seropurulent discharge
  • base fixed deeper to structures
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105
Q

What can cause lymphedema?

A

mastectomy or surgical removal of lymph nodes

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106
Q

What is Raynaud’s disease?

A

tricolor change of fingers in response to cold, vibration, or stress

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107
Q

what are some signs of deep vein thrombosis?

A
  • calf pain
  • edema
  • warmth
  • asymmetry w/ swelling
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108
Q

If we suspect DVT what should you do?

A

emergency referral due to risk of pulmonary embolism

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109
Q

Thorax vs thoracic cage vs thoracic cavity?

A
  • thorax: extends from base of neck to the level of the diaphragm
  • thoracic cage: outer structure of thorax that provides structure and support; includes sternum, ribs, thoracic vertebra, muscles & cartilage
  • thoracic cavity: contains the respiratory components like lungs, distal portion of trachea, bronchi
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110
Q

What is the sternum and what are its 3 parts?

A
  • lies in the center of the chest anteriorly
  • 3 parts: manubrium, body, xiphoid process
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111
Q

What 3 things forms off the sternum/breastbone?

A
  • suprasternal notch: U shaped indentation on manubrium
  • sternal angle: angle of louis, bony ridge joining manubrium to body of sternum; 1 in. below sternal notch corresponds w/ 2nd rib
  • coastal angle: formed by right and left costal margins; should be <90 degrees
112
Q

How are the ribs attached to the sternum?

A
  • ribs 1-7 attached via costal cartilage
  • ribs 8-10 attached to above costal cartilage
  • ribs 11-12 float
113
Q

What are 3 reference lines we use for the anterior chest during a thoracic assessment? posterior chest? lateral chest?

A
  • anterior: MCL, AAL, MSL
  • posterior: scapular line, vertebral line
  • lateral: MAL, PAL, AAL
114
Q

How do we name the intercostal spaces?

A

by the rib above it

115
Q

what are the 2 dimensions of the thoracic cavity?

A
  • vertical axis: count ribs & interspaces
  • horizontal axis: circumference of chest; know anterior, posterior, and lateral landmarks
116
Q

What are 3 parts within the thoracic cavity?

A
  • mediastinum: middle of cavity w/ heart, great vessels, esophagus, trachea, and bronchi
  • pleural cavity
  • trachea & bronchial tree
117
Q

What 4 things make up the pleural cavity?

A
  • R pleural cavity: right lung w/ 3 lobes
  • L pleural cavity: left lung w/ 2 lobes
  • lungs: two cone shaped, elastic structures lying on each side of mediastinum
  • pleura: visceral & parietal, line the thoracic cavity; thin, double layered serous membrane
118
Q

How does the diaphragm move when we breath?

A

breath in -> descends
breath out -> ascends

119
Q

What are 4 functions of the respiratory system?

A
  • provide oxygen
  • remove carbon dioxide
  • acid-base balance
  • temp control
120
Q

What are 2 stimulus for breathing?

A
  • CO2 levels
  • Hypoxemia (low blood oxygen), hypoxic drive
121
Q

How do our muscles work for respiration?

A
  • diaphragm and intercostals used for normal respiration
  • accessory muscles used for increased respiratory effort
  • expiration is passive
122
Q

What are the 3 accessory muscles for breathing?

A

scalenes, sternomastoid, trapezius

123
Q

What subjective data should we acquire during a thorax assessment?

A
  • COLDSPA
  • dyspnea
  • chest pain
  • cough
  • GI symptoms
  • weight loss
  • night sweats
  • other: fever, cyanosis, clubbing, edema
124
Q

What is a key symptom of tuberculosis?

A

night sweats

125
Q

What different areas can dyspnea show up in and what is it a sign of?

A
  • pulmonary: COPD, asthma, pneumonia, pneumothorax, pulmonary embolism
  • cardiac: CHF, coronary heart disease, myocardial ischemia, MI
  • anxiety: “suffocating”, “tingling in lips” due to decrease in CO2
  • gradual onset: COPD
  • sudden onset: infections, asthma exacerbation, PE, myocardial ischemia/infarction
126
Q

What is sleep apnea?

A

breathing cessation during sleep causing snoring/gasping sounds

127
Q

What are some outcomes of sleep apnea?

A
  • fatigue, irritability, depression, memory loss, high BP, heart disease, stroke, accidents
128
Q

W/ chest pain what should we immediately assess for?

A

cardiac ischemia

129
Q

The different times of a cough mean what?

A
  • early AM: chronic bronchial inflammation or smoking
  • late PM: irritant exposure during day
  • night: postnasal drip or sinusitis
  • continuous: acute infection
130
Q

What do the different colors of sputum mean?

A
  • white=virus or bronchitis
  • yellow/green=bacterial infection
  • brown/black=blood
  • pink/frothy=pulmonary edema
  • rust=tuberculosis
131
Q

What are some GI symptoms that are a sign of GERD?

A

heartburn, hiccups, chronic cough

132
Q

What is wheezing and what is it associated w/?

A

wheezing-narrowing of airways (spasm or obstruction)
- associated w/ CHF, asthma, excessive secretions

133
Q

What other history should we ask about during a thorax assessment?

A
  • smoking history
  • past medical history
  • environmental exposures
134
Q

What 8 things do you need for preparation and equipment of a thorax assessment?

A
  • AIDET along w/ washing hands
  • have client remove clothing from waist up
  • ask client to sit in an upright position
  • examination gown & drape
  • gloves; stethoscope
  • light source
  • mask; skin marker & cm ruler
  • always provide privacy, warm hands, nonjudgmental but educate
135
Q

What are 3 steps to the general approach of the thorax physical exam?

A
  • move from top to bottom
  • compare side to side
  • visualize underlying structures
136
Q

What 4 things should you look at when performing an inspection of the thorax?

A
  • look for nasal flaring (sign of labored resp.)
  • look for pursed lip breathing
  • observe color of face, lips & chest (purple/ruddy in COPD or CHF, cyanosis if cold or hypoxic)
  • inspect color/shape of nails (clubbing and cyanosis)
137
Q

What 4 things should you inspect with the posterior thorax?

A
  • chest configuration & position of scapulae
  • costal angle < 90 degrees and slop of ribs at 45 degrees
  • observe for use of accessory muscles
  • tripod position seen w/ COPD
138
Q

What are 4 different chest variations?

A
  • normal chest AP <lateral (1:2 ratio)
  • barrel chest AP > lateral (1:1 ratio)
  • pectus excavatum = funnel chest, sunken sternum
  • pectus carinatum = pigeon chest, sternum protruding forward
139
Q

What are some causes of pectus carinatum?

A

genetics & vitamin D

140
Q

What are 2 thoracic deformities of the spine?

A
  • scoliosis: curving of back
  • kyphosis: rounding of upper back
141
Q

Who is kyphosis more common in?

A

women

142
Q

When does scoliosis usually occur?

A

during puberty before growth spurts

143
Q

When palpating the thorax, what 5 things do we palpate for?

A
  • tenderness & sensation
  • crepitus
  • surface characteristics
  • fremitus
  • chest expansion
144
Q

How do you palpate for tenderness and sensation of thorax?

A
  • use fingers and start over apex of left lung moving side to side & downward/out to cover all lung portions
145
Q

What is crepitus and how do we palpate for crepitus?

A

crackling sensation (like hairs rubbing) occurring when air passes thru fluid or exudate
- use same technique for palpation as tenderness & sensation

146
Q

What is fremitus and how do we palpate for it?

A

vibrations of air in bronchial tubes
- use ball or ulnar edge of hand in same pattern to palpate as client says “99” each time you place your hand
- should be symmetrical & easily felt in upper lobes, normal for it to diminish toward bases of lungs

147
Q

How do you palpate for chest expansion?

A
  • place hands w/ thumbs at T9-T10 pressing together. As client takes deep breath, thumbs should move 5-10 cm apart
148
Q

What are 3 percussion sounds during a thorax assessment?

A
  • resonance: low pitched, normal over lungs
  • tympany; drum-like normal over abdomen
  • dullness: fluid or solid, normal over heart & liver
149
Q

What are 3 abnormal lung sounds and the causes of them?

A
  • dullness: heard over areas of fluid of solids in lungs; causes by pneumonia, pleural effusion, or tumor
  • hyperresonance: caused by emphysema, pneumothorax, asthma
  • tympany: pneumothorax
150
Q

What are 3 steps when percussing for tone in thorax?

A
  1. start at apices of scapulae, percuss across top of shoulders
  2. then, percuss intercostal spaces across/down, comparing sides
  3. percuss to lateral bases, comparing sides
151
Q

What are 4 steps for percussing for diaphragmatic excursion?

A
  1. have client exhale forcefully & hold breath. percuss from (T7) scapular line thru intercostal spaces of right chest wall until tone changes from resonance to dullness
  2. mark this level & allow client to breathe. Next, have them inhale deeply & hold it. Percuss intercostal spaces from mark downward until resonance changes to dullness
  3. mark level and allow to breath. Measure distance b/w the 2 marks
  4. perform on opposite side
152
Q

For diaphragmatic excursion, what is the normal measurement?

A
  • 3 to 5 cm in adults
  • 7-8 cm in well conditioned athletes
153
Q

What are 4 steps to auscultate for breath sounds?

A
  • do not attempt to listen through clotting
  • client should breath deeply thru mouth for each area
  • auscultate from apices of lungs at C7 to bases at T10 laterally from axilla down to 7-8th rib
  • listen at each site for at least one complete cycle
154
Q

What are 8 different types of respiration?

A
  • dyspnea: labored breathing
  • apnea: cessation of breathing
  • bradypnea: <10 for adults, regular
  • tachypnea: >24 adults, shallow
  • hyperventilation: increased rate and increased depth
  • hypoventilation: decreased rate, decreased depth, irregular pattern
  • cheyne stoke: periods of apnea and hyperpnea (heart failure, drug OD, brain damage)
  • kussmaul: rapid, deep, and labored (diabetic acidosis)
155
Q

What are 3 types of breath sounds?

A
  • bronchial: short during inspiration & long during expiration; found in trachea and thorax
  • bronchovesicular: same during inspiration & expiration; over major bronchi
  • vesicular: long during inspiration & short during expiration; found in peripheral lung fields
156
Q

What are some adventitious breath sounds?

A
  • vesicular diminished: hear more w/ elderly
  • fine crackles: fire burning
  • course crackles: rolling strands of hair b/w fingers near ear
  • rhonchi or sonorous wheeze: snoring
  • wheezes or sibilant wheeze: musical
  • stridor: hear w/out microscope
  • pleural friction rub: walking through snow
157
Q

what adventitious sound is very alarming and seen in pediatric clients w/ croup?

A

stridor

158
Q

What are 3 voice sounds or tests of consolidation?

A
  • bronchophony: clarity of “99” sign of fluid of mass, muffled “99” w/ clear lungs
  • egophony: patient says eee and stays eee w/ clear lungs, “aye” w/ fluid or mass
  • whispered pectoriloquy: patient whispers “1,2,3” and listen to chest, clear lungs muffled, fluid or mass whisper is loud and clear
159
Q

What 7 things should you inspect for w/ anterior thorax?

A
  • shape & configuration
  • position of sternum
  • slope of ribs
  • sternal retractions
  • observe quality/pattern of respiration
  • inspect intercostal spaces for retraction or bulging
  • observe for use of accessory muscles
160
Q

What 5 things should we palpate for in anterior thorax?

A
  • tenderness, sensation, surface masses
  • tenderness at costochondral junctions of ribs
  • crepitus
  • fremitus
  • anterior chest expansion
161
Q

For fremitus what is diminished vibrations a sign of? decreased fremitus?

A
  • diminished vibrations: obstruction of tracheobronchial tree
  • decreased fremitus: COPD due to air trapping
162
Q

What is atelectasis?

A

collapsed lung

163
Q

What is pleural effusion?

A

fluid surrounding lung

164
Q

What is pneumothorax?

A

air b/w lungs & chest wall resulting in lung collapse

165
Q

What is hemothorax?

A

blood in thoracic cavity

166
Q

How do we diagnose pneumothorax & hemothorax? treat?

A

diagnose: chest x-ray, arterial blood gases
treatment: chest tube

167
Q

What are some symptoms of pneumothorax & hemothorax? causes?

A

symptoms: dyspnea, anxiety, tachycardia, pleural pain, asymmetrical expansion, decreased breath sounds
causes: ruptured bleb, thoracentesis, trauma, secondary infection

168
Q

What is pulmonary embolus?

A

clot in lungs

169
Q

What does a pulmonary embolism usually start out as?

A

deep vein thrombosis

170
Q

What is tuberculosis?

A

bacteria spread via droplet

171
Q

What are some symptoms of tuberculosis?

A
  • fatigue
  • malaise
  • anorexia
  • weight loss
  • chronic cough (productive)
  • night sweats
  • hemoptysis
  • pleuritic chest pain
  • low grade temp (in afternoon)
172
Q

What is treatment for tuberculosis? diagnosis?

A

treatment: TB medications, decreased activity, isolation
diagnosis: TB skin test, chest x-ray, sputum studies

173
Q

When would we call 911 w/ asthma?

A

if symptoms do not respond to usually treatment in 30 minutes or they cannot breath

174
Q

What is asthma?

A

chronic inflammation & narrowed airways

175
Q

What is pneumonia?

A

infection inflames alveoli (fluid or pus)

176
Q

How do we diagnose pneumonia?

A
  • chest x-ray
  • ABG
  • sputum culture
177
Q

What is bronchitis?

A

increased mucus in airways (inflammation)

178
Q

What is chronic bronchitis?

A

productive cough for 3 months or more in at least 2 consecutive yrs

179
Q

What are some features of bronchitis?

A
  • overweight & cyanotic
  • elevated hemoglobin
  • peripheral edema
  • rhonchi & wheezing
180
Q

What is emphysema (COPD)?

A

permanently enlarged air sacs, no elastin

181
Q

What are 4 features of emphysema?

A
  • older and thin
  • severe dyspnea
  • quite chest
  • w/ x-ray have hyperinflation w/ flattened diaphragms
182
Q

What is COPD?

A

chronic airflow limitation due to emphysema and chronic bronchitis

183
Q

What are 12 features of COPD?

A
  • easily fatigues
  • frequent respiratory infections
  • use accessory muscles to breath
  • orthopneic
  • wheezing
  • pursed lip breathing
  • chronic cough
  • barrel chest
  • dyspnea
  • prolonged expiratory time
  • clubbing
  • thin appearance
184
Q

What are 7 older adult consideration?

A
  • pain at costochondral junction of the ribs
  • experience dyspnea w/ activities related to aging changes of lungs
  • ability to cough effectively may be difficult due to easy fatigue
  • kyphosis is common
  • decreased thoracic expansion due to calcification of costal cartilages & loss of accessory musculature
  • sternum/rubs may be more prominent due to loss of subcutaneous tissue
185
Q

What is the leading cause of cancer related death?

A

lung cancer

186
Q

What are 5 risk factors of lung cancer?

A
  • smoking
  • genetic disposition
  • exposure to toxins
  • workplace pollutants
  • poor diet
187
Q

What are 3 ways to decrease risk for lung cancer?

A
  • stop smoking
  • check for occupational or home exposure to asbestos or radon
  • seek care for prolonged cough or pain in chest area
188
Q

What are 4 common errors in auscultation of thorax?

A
  • crackling sounds from chest hair
  • diminished breath sounds caused by muscle contraction from cold environment
  • cracked or ma fitted diaphragm
  • rubber tubing rubs together
189
Q

what are 4 respiratory symptoms that have other etiologies?

A
  • cough -> CHF, side effect from medication
  • chest pain -> angina, musculoskeletal pain
  • kussmaul respiration -> ketoacidosis (diabetes)
  • bradypnea or apnea -> drug overdose
190
Q

What is the anatomy of the abdomen?

A

abdomen extends from diaphragm to the symphysis pubis

191
Q

How do we divide up the anatomy?

A

divided into 4 quadrants putting a vertical and horizontal line at the umbilicus

192
Q

What are some muscle group in the abdomen from outermost to innermost?

A
  • rectus abdominus
  • external oblique
  • internal oblique
  • transverse
193
Q

What is located in RUQ, RLQ, LLQ, LUQ?

A
  • RLQ: appendix, cecum, small intestine
  • RUQ: liver, gallbladder
  • LLQ: small intestine
  • LUQ: stomach, spleen
194
Q

Where is the spleen located, function, and size?

A

located: 9th to 11th rib lateral to L MAL
size: 7 cm
function: purifying blood

195
Q

If spleen is enlarged should we palpate it?

A

no, do not want to risk rupture

196
Q

Where are kidneys located?

A

retroperitoneal at costovertebral angle - right kidney hangs lower than left kidney

197
Q

What are the accessory organs of the alimentary system and their functions?

A
  • liver: provides large proteins for blood and detoxifies toxins in body
  • gallbladder: produce bile which helps absorb fatty foods
  • pancreas: produce enzymes that aid in digestion and absorption
198
Q

What are the main organs of the alimentary system and the functions?

A

organs: esophagus, stomach, small intestine, large intestine, rectum, anal canal
functions: digest food, absorb nutrients, electrolytes & water, and eliminate solid waste

199
Q

What are 3 urinary tract organs?

A
  • kidneys
  • ureters
  • bladder
200
Q

What are 3 things we should consider with an aging adult with the abdominal system?

A
  • salvation decreases leading to dry mouth and decreased sense of taste
  • esophageal emptying & gastric acid secretion are delayed
  • constipation
201
Q

What are 5 factors leading to constipation in aging adult?

A
  • decreased activity
  • inadequate water intake
  • low fiber diet
  • medication side effect
  • ambulation difficulty leading to holding it
202
Q

What 11 things should we ask abt when collecting subjective data for an abdominal assessment?

A
  • appetite changes
  • dysphagia - difficulty swallowing
  • food intolerance
  • abdominal pain
  • nausea or vomiting
  • bowel habit changes
  • medications
  • past medical history
  • family history
  • alcohol, drug, tobacco use
  • nutritional assessment
203
Q

What are three main causes of pain in GI tract?

A
  • distension: gas, obstruction
  • ischemia: loss of blood flow
  • inflammation: peritonitis, appendicitis, cholecystitis
204
Q

What are 3 qualities of abdominal pain?

A
  • visceral: from the organs - dull, poorly localized
  • parietal: inflammation of peritoneum- sharp, precise location, worse w/ movement
  • referred: from another place
205
Q

If a patient has tenderness, what order should we examine in?

A

examine this area last

206
Q

what do the different colors of stool mean?

A
  • black: bleeding high in GI tract
  • red: bleeding low in GI tract
  • grey (or clay colored): gall bladder disease
  • be aware that medication can also change stool color
207
Q

What is the order of assessment for the abdomen?

A
  1. inspection
  2. auscultation
  3. percussion
  4. palpation
    - go least intrusive to most intrusive
208
Q

What 5 things should you do for preparation for the assessment of the abdomen?

A
  • empty bladder
  • warm room
  • supine with knees bent
  • expose abdomen
  • bright lighting
209
Q

What 6 things should we look for during an inspection of the abdomen?

A
  • contour: scaphoid, flat, rounded, protuberant
  • umbilicus: mid-line, inverted, everted
  • skin: lesions, striae, scars
  • vascular pattern: faint and symmetrical if visible
  • pulsations or movements: abdominal aortic pulse visible, peristalsis not normally visible
  • hernias: umbilical, incisional, epigastric
210
Q

If belly button turns from inverted to everted what is this a sign of?

A
  • increased intra-abdominal pressure (mass, ascites)
211
Q

What are the four abdominal contours?

A
  • flat: normal finding
  • rounded: normal finding
  • scaphoid: abdomen sunken; sign of malnourishment
  • protuberant: abdomen distended; from obesity, pregnancy, obstruction, ascites
212
Q

When would you see an aortic pulsation?

A
  • visible in the epigastrium of very thin people
  • if vigorous, wide, exaggerated pulsations this is a sing of abdominal aortic anuerysm
213
Q

what are some causes of localized abdominal distension? generalized?

A
  • localized: discrete mass, organ enlargement
  • generalized: feces, fetus, flatus, fluid
214
Q

What are some common causes of abdominal distension?

A
  • obesity
  • pregnancy
  • irritable bowel syndrome
  • constipation
  • fibroids
  • enlarged bladder
215
Q

What is a hernia?

A

weakness of abdominal wall

216
Q

What are 3 types of hernias?

A
  • incarcerated: hernia contents are irreducible (cannot be pushed in) but not obstructed or strangulated
  • obstructed: irreducible hernia presenting w/ intestinal obstruction
  • strangulated: life threatening; when blood supply to the contents is jeopardized in an irreducible hernia
217
Q

How should you listen to bowel sounds?

A

begin in RLQ and go clockwise

218
Q

What are 4 bowel sounds?

A
  • active: normal (5-30 per minute)
  • hypoactive: less than 5 per minute due to post-op, peritonitis, late obstruction
  • absent: none in 5 minutes
  • hyperactive: almost constant due to hunger (borborygmus), gastroenteritis, diarrhea, early obstruction
219
Q

What are 2 abnormal sounds to hear when auscultating the abdomen?

A
  • bruits: assess in aorta, left and right renal arteries, left and right iliac, and femoral arteries
  • peritoneal friction rub: grating sound of friction created by inflammation of organ in contact w/ peritoneal lining
220
Q

What are percussion sounds you should hear in abdomen?

A
  • general: tympany
  • liver: dullness
  • spleen: tympany, if hear dullness sign of spleen enlargement
221
Q

How to percuss for liver span?

A
  • begin in RLQ at MCL and percuss upward and note change from tympany to dullness
  • start at upper chest on R MCL and percuss downward and note difference
  • should be about 6-12 cm in size from about 5th ICS to costal margin
222
Q

What is the scratch test for liver border?

A

scratch from RLQ upward and when scratching sound becomes magnified you reached liver

223
Q

How to assess for splenic dullness?

A
  • have patient breath out and percuss last ICS to L AAL
  • should be tympanic
  • have patient take deep breath and percuss again and should remain tympanic
224
Q

What organs do you use fist percussion for and where?

A
  • kidney at costovertebral angle
  • liver/gallbladder at R costal margin
225
Q

What are two tests for ascites?

A
  • shifting dullness test: percuss while patient supine and will turn to dullness on side, then have patient lie on side and percuss up; if difference in the point changes then sign of ascites
  • fluid wave test: have patient place hand at midline of abdomen and place hand on one side and then tap wall on other side; if feel fluid shift then sign of ascites
226
Q

Light vs deep palpation of abdomen?

A
  • light: 1-2 cm; detect superficial masses, large masses, tenderness, rigidity
  • deep: 5-8 cm; note location, size, consistency, mobility of any masses, enlargement of organs and tenderness
227
Q

What are two ways to palpate the liver?

A
  • bimanually
  • hook technique
228
Q

What are 7 normally palpable structures?

A
  • sigmoid colon: LLQ firm narrow
  • cecum: RLQ soft, wide
  • liver: RUQ at costal margin
  • lower portion of rt. kidney: RUQ deep
  • aorta: pulsations of upper abdomen
  • distended bladder/pregnant uterus
  • sacral vertebral prominence: kids and slender adults
229
Q

What 5 things are normally not palpable?

A
  • liver
  • gall bladder
  • spleen
  • duodenum
  • pancreas
230
Q

When palpating aorta what is its common width?

A

2.5 to 4 cm wide

231
Q

What are two signs of rebound tenderness?

A
  • Rovsing’s sign: pain in RLQ during pressure in LLQ - positive sign of appendicitis
  • Blumberg’s sign: painful w/ release of pressure at McBurney point - positive sign of appendicitis
232
Q

What is murphy’s sign?

A
  • palpate liver and have patient take deep breath
  • if painful and causes patient to stop inspiration, positive sign and indicates cholecystitis
233
Q

What is the illiopsoas muscle test?

A
  • lift R leg straight up, flexing at hip
  • have examiner push down on right though while patient tries to hold it up
  • if painful positive sign of appendicitis
234
Q

What are 3 abnormal abdominal findings?

A
  • gas: curved, hypoactive/absent bowel sounds in ileus; hyperactive bowel sounds heard in early bowel obstruction
  • ascites: curved, everted umbilicus, bulging flanks, taut/glistening skin
  • tumor: localized distension, dull over mass, may feel borders
235
Q

What are 6 signs of intestinal obstruction?

A
  • vomiting
  • absence of stool or gas
  • hyperactive early bowel sounds
  • hypoactive/silent late
  • fever
  • pain
236
Q

What is appendicitis pain like?

A
  • begins as dull, steady pain in periumbilical area and progresses over 4-6 hours & localizes over RLQ
  • if sudden pain relief may indicate rupture of appendix
237
Q

When is the peak incidence of appendicitis?

A

10-12 yrs

238
Q

What are some dietary habits that can reduce gallbladder disease?

A
  • increase fruits, veggies, nuts, beans, high fiber, whole grains
  • avoid fats and greasy foods
239
Q

What is dyspepsia?

A

indigestion, r/t peptic ulcers or drugs such as ASA or NSAIDS

240
Q

What is inflammatory bowel disease vs inflammatory bowel syndrome?

A

disease: ulcerative colitis or Crohn’s disease, intestines are inflamed and recurring cramping and diarrhea
syndrome: disorder of entire digestive tract that causes recurring abdominal pain and constipation or diarrhea

241
Q

What are ulcers?

A

lining of stomach or duodenum has been eaten away by stomach acid or digestive juices

242
Q

What is gastritis?

A

inflammation of stomach lining caused by infection, alcohol, stress, injury, drugs, immune system

243
Q

What is gastroesophageal reflux disease (GERD)?

A

stomach acid and enzymes flow backward from stomach into esophagus, causing inflammation and pain in the esophagus

244
Q

What is functional pain?

A

chronic or recurring pain w/ no identified disorder - related to stress and anxiety

245
Q

What are some symptoms that require immediate evaluation of abdomen?

A
  • high fever
  • loss of appetite/weight
  • pain that awaken the patient
  • blood in stool or urine
  • jaundice
  • ascites
246
Q

What is the location of the female breast and what is its function?

A
  • location: anterior to the pectoralis major and serratus anterior muscles, which supports and shape breasts; between second and sixth ribs
  • function: produce milk
247
Q

What is the composition of breast tissue?

A
  • glandular tissue: 15-20 lobes radiating from nipple that contain the acini (alveoli) cells that produce the milk
  • suspensory (cooper’s) ligaments: fibrous bands that support breast
  • adipose tissue: bulk of breast
248
Q

What are 4 anatomy parts of the breast?

A
  • areola: pigmented circle of wrinkled skin
  • Montgomery’s glands (areolar glands): tiny sebaceous glands on the areola
  • axillary tail (tail of spence): extends superolaterally into axilla
  • mammary ridge (milk line): supernumerary nipples or breast tissue may be present along the ridge
249
Q

What breast quadrant is the most common site of cancer?

A

upper outermost quadrant

250
Q

What are common sites of metastasis for breast cancer?

A
  • brain
  • lymph nodes
  • lung
  • liver
  • skin
  • chest wall
  • bone
251
Q

When will breast cancer be visible on mammogram? on self exam?

A

mammogram: 8 yrs
self exam: 10 yrs

252
Q

What is a part of the breast lymphatic system and drainage and their locations?

A
  • central axillary nodes: reach w/ fingers into apex of axilla
  • pectoral nodes/anterior axillary: palpate in anterior axillary fold
  • subscapular nodes/posterior axillary: palpate in posterior axillary fold
  • lateral nodes/brachial: upper inner aspect of arm
  • supraclavicular: above clavicle
  • subclavicular: below clavicle
253
Q

Tanner’s stages vs thelarche?

A
  • tanner’s stages: scale for stages of sexual development in puberty for males and females
  • thelarche: breast development in females; begins during preadolescent phase and precedes onset of menarche by abt 2 yrs
254
Q

What past health history should you ask about relating to breast assessment?

A
  • trauma, hx of breast disease, previous breast surgeries
  • age of onset of menses
  • age of menopause
  • given birth? age at 1st birth?
255
Q

What are some lifestyle & health practices relating to breasts?

A
  • taking hormones, contraceptives, antipsychotics -> can cause breast engorgement
  • live/work around radiation, benzene, asbestos
  • high fat diet -> risk of breast cancer
  • alcohol use -> 2 drinks/day increases cancer risk
  • tobacco use -> risk of breast cancer
  • caffeine -> aggravates fibrocystic disease
  • regular exercise
  • performing regular BSE in 202
  • any previous breast imaging
256
Q

What position should the client be in during breast exam?

A

sitting upright facing examiner

257
Q

What 2 things does a clinical breast exam consist of?

A
  1. inspection of breast and axillae
  2. palpation of breast and axillae
258
Q

How should you check for retraction and dimpling of breasts?

A

have client raise arms over head, press against hips, press hands together, & lean forward from waist

259
Q

What position should client be in during palpation of breasts?

A

laying supine

260
Q

What is the strip method for palpating breast?

A

lay supine with arm over head and use 3 fingers to palpate every inch

261
Q

When palpating the axillae what are normal findings?

A
  • no rash or infection
  • no palpable nodes or one to two small, discrete, nontender, movable nodes in central area
262
Q

What can be found in a male breast?

A

gynecomastia: smooth, firm, movable disc of glandular tissue
- due to testosterone deficiency, obesity, hormone imbalances, leukemia, and drug abuse

263
Q

What are 3 things to be aware of relating to infants and children and breasts?

A
  • breast tissue can be swollen b/c of hypoestrogenism of pregnancy
  • infants produce thin discharge called “witch’s milk” ; subsides as infant’s body eliminates maternal hormones
  • growth of breasts is not necessarily steady or symmetrical
264
Q

What are 4 expected changes in aging female breasts?

A
  • decrease in size
  • decrease in firmness
  • axillary hair decreases
  • glandular tissue decreases, whereas fatty tissue increases
265
Q

When should you start self breast examination and when should you perform?

A
  • start every month after age 18
  • perform on 10th day after beginning of menstrual period
266
Q

When do clinical breast exams start?

A

age 20 - every 3 yrs
after 40 - annually

267
Q

What are the 5 steps of a self breast exam?

A
  1. examine breasts in shower
  2. examine breast in mirror w/ arms down, up, and on hips
  3. stand and press your fingers on breast, working around the breast in a circular direction
  4. lie down and repeat step 3
  5. squeeze nipples to check for discharge. Check under the nipple last
268
Q

What are 9 abnormalities on inspection of breast?

A
  • Peau d’orange
  • paget disease
  • retracted nipple
  • dimpling
  • retracted breast tissue
  • mastitis
  • mastectomy
  • fibroadenomas
  • benign breast disease
269
Q

What can cause retraction and dimpling?

A
  • aging
  • duct estasia
  • breast cancer
270
Q

What are 5 characteristics of mastitis?

A
  • inflammation of breast
  • usually in single quadrant
  • red, swollen, tender, hard, warm
  • headache, malaise, fever, chills, flu like symptoms
  • usually occurs in lactating mom with a plugged duct
271
Q

What is a mastectomy?

A

removal of breast, nipple, areola and sentinel lymph node or nodes

272
Q

What is the most common cancer among women?

A

breast cancer

273
Q

What are 3 risk factors for breast cancer?

A
  • inherited mutation of BRCA1 and BRCA2 genes
  • inadequate care
  • alcohol/western diet
274
Q

What are 3 types of masses in the breast?

A
  • gross cyst: 30-60; diminished after menopause; round in shape, tender
  • fibroadenoma: puberty to menopause, round in shape, nontender
  • carcinoma: most common after menopause, irregular in shape, nontender
275
Q

What is (fibrocystic) benign breast disease?

A
  • fibrocystic = lumpy breasts
  • fluctuates w/ hormonal changes throughout the month
276
Q

What are the 3 steps of male breast examination?

A
  • inspect the chest wall
  • inspect the breasts and nipples
  • palpate breasts and nipples

Health Assessment (3 decks)

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