Exam 2 Flashcards
(109 cards)
1
Q
respir. assessment parts
A
inspection, palpation, percussion, auscultation
2
Q
lung reference lines- anterior
A
anter. axillary line (R and L)
midclavicular line (R and L)
midsternal line
3
Q
lung reference lines- posterior
A
scapular line (L and R) vertebral or mid-spinal line
4
Q
lung reference lines- lateral
A
anter. axillary line (near pectoral fold)
mid-axillary line
poster. axillary line (inside latis. dorsi)
5
Q
anterior thoracic landmarks- sternum
A
suprasternal notch- v at top of sternum
sternum
manubriosternal angle- trachea birfurcation anteriorly (opposite 2nd rib)
costal angle- under xphoid process (norm= < or equal to 90 degrees)
6
Q
posterior thoracic landmarks
A
superior border scapula- 2/3rd rib infer. border scapula 10th rib (normal respir) 12th rib (deep respir) tracheal bifurcation (4-5ribs)- can listen heart sounds
7
Q
lung borders- anterior
A
above the clavicle (apex) to 6th rib
8
Q
lung borders- lateral and purpose
A
high axilla to 8th
can assess all 3 R lung lobes in one position
9
Q
lung borders- posterior
A
T-1 to T-10 or T-12
10=normal respir
12= deep respir
10
Q
low SA 02 manifestations
A
sleepy/ confused
11
Q
normal breathing rate v inc and dec
A
eupnea, unlabored 12-20
trachypnea- >20
bradypnea- <10 or 12
12
Q
apnea
A
without respir
13
Q
nasal flaring common in what populations
A
infants and kids
14
Q
labored respir signs
A
cyanosis, lvl of conciousness, nasal flaring, pursed lips, position, ICS retractions/ bulging, super clavicular retraction
15
Q
rib angle of insertion ant and post
A
ant- 90 to the sternum
post-45 to spine
16
Q
norm configuration/ transverse values
A
1:2 or 5:7
laternal v front/back
17
Q
COPD-Emphysema manifestations
A
access. muscle use
pursed lips, ICS, labored respir, hypertrophied musc, weight loss
18
Q
dis. linked to hyperresonance
A
COPD-emphy
pneumothorax
19
Q
purpose percussion
A
5-7cm
determine density underlying tissue
20
Q
where is resonance heard
A
periph lungs
21
Q
dullness heard
A
over liver and heart
22
Q
tympany heard
A
stomach
23
Q
flatness heard where in thoracic area
A
over clav and scapula
24
Q
bronchial breath sounds
A
E>I
anterior only, normal over trach
abnorm= anywhere else bc consolidation
25
bronchovesicular breath sounds
```
E=I
norm over major airways
rib 2 anter
rib 4/5 post
if heard anywhere else= abnorm bc fluid
```
26
vesicular breath sounds
I>E
27
crackles
discontin
fulid in alveoli
bc heart failure and pneumonia
28
wheezing
contin
high pitched
obstructed air flow - asthma
29
rhonchi
low pitched wheezing
continuous
thick secretions
30
stridor
continu
| upper airway obstruction
31
areas tactile frem more intense
trach and major airways
32
sounds heard w/ pneumonia
bac infection
| crackles
33
pneumonia manifestations
tachy, dyspnea, nasal flaring, febrile, cough, fever, fatigue
34
inc breath sounds def
bronchial or bronchovesicular heard in abnorm locations
| occur w/ consolidation
35
diminished breath sound causes
obesity, hyperinflat, air/fluid in pleural space, foreign body
36
pneumothorax sounds
diminished/absent
37
pneumothorax manifestations
dyspnea, tachy, dec o2 sat, cyanos, inc respir, dec bp, unequal chest expansion, dec tactile frem, trach deviation, hyperreson.
38
emphysema sounds
hyperreson.
| diminished
39
emphysema patho results
dec tact frem, barrel chest, ICS, access. muc use, tripod posit, trach, inc heart rate, dyspnea,
40
asthma sounds
wheezing
41
asthma manifestations
SOB, dyspn, chest tightness, ICS, access. muscle use
42
cardiac assessment- PND
paroxysmal nocturnal dyspnea
SOB when laying down/ sleeping due to heart failure
laying dwn inc vol intrathoracic blood
heart cannot accom inc load/blood vol
43
chest pain causes
cardiac, GI, musculoskeletal, repspiratory
44
location of heart in relation to sternum (%)
2/3 to L of sternal border
| 1/3 under sternum
45
heart landmark- anteriorly
precordium
| inc area heart overlays and great vessels
46
chest pain- diff btw sex- women
wmn- inc SOB, more fatigue, flu-like sympt (nausea/vomiting)
| shoulder and back pain
47
nocturia
inc urination at night
| fluid shifts from legs to core (inc blood to heart= inc kidney perfusion)
48
risk for black, native and hispanic
inc for cardia/cerebralvascular (stroke)
49
risk for cardiac problems w/ age
inc
| greater in men until women hit menopause
50
risk for cardiac problems assoc w/ diabetes
2x risk coron. artery dis
| inc lvl cholesterol and LDL
51
HTN is risk for what cardiac condition
main contributor to heart dis/ stroke
52
smoking risk
2-4x inc risk dev. cornonary a disease
53
orthopnea/ PND
diff breathing laying on back (supine)
54
sympt associated w/ chest pain +locations
locations- substernal, can radiate down arm and to jaw
| sympt- sweating, nausea, vomiting, SOB, fatigue, feeling of indigestion, "elephant on chest"
55
concerns for family hx w/ cardiac problems
male hx cardiac dis before 55
| wmn hx cardiac dis before 65
56
atrioventricular valves
| semi-lunar valves
R- tricuspid and pulmonic
| L- mitral and aortic
57
flow of conduction through heart
SA node, av node, L atria, L/R ventr. bundle branches, Purkinje fibers
58
electrical events v mechanical
electrical before mech and L sided heart action before R
59
heart ICS location
2nd-5th
60
diastole v systole
diastole- vent filling, AV valves open,
| systole- AV closed, SL valves open, contraction/ ejecting blood
61
pre- ventricular systole
atrial kick
| ejects last 25-30% blood
62
S1 and S2
s1- systole- av v closed, beginning ventricular systole
Mitral before tricuspid (L before R), heard loudest at apex
s2- semi lunar closed, aortic before pulmonic, end of systole, begin. of diastole, loundest at base
63
apex location- heart
5th intercostal space mid-clavicular line over mitral area
64
base location- heart
top part of heart
| 2nd ICS to R/L sternum
65
S2- physiological (normal) split
aortic close before pulmon
heard as two sounds
present during inspir/ dec w/ expir and sitting
delay in R value closure, inc blood return to R side heart
shortened LV systole
lub- dub- lub- T-dub
heard best in pulmonic valve area
66
S3
```
lub- duppa- lub- duppa
after S2
early diastolic sound (during filling)
best heard at apex (5th ICS)
norm in children, young adults, pregnancy
abnorm w/ heart failure
```
67
S4
```
late diastolic, w/ atrial contraction/kick
before S1
dalub- dup- dalub- dup
norm- occasionally in adults
heard best at apex (5ICS)
```
68
murmurs- systolic
between s1 and s2
| early
69
murmurs normal v abnorm
normal- pregnancy, children, after exercise
| abnorm- valve incompet (backwards flow, vent hypertrophy, non-rigid valve, inc high flow)
70
murmurs- diastolic
between S2 and S1
| late
71
apical pulse v apical impulse
pulse- ausc for @ 5ICS @MCL (felt in 50% adults)
| impulse- seen 5ICS @MCL
72
thrill
palap murmur
abnorm!
just bc no thrill doesn't mean no murmur
loud turbulence of blood flow
73
lifts/heaves
observable lifts of entire heart
abnorm
hypertrophy of heart
74
aortic valve area
close= S2 sound
heard best at base
2nd ICS R of sternal border
75
pulmonic valve area- what sound/best heard
close= S2 sound
heard best at base
2nd ICS L of sternal border
76
Erb's point valve area
3ICS L of sternal border
| *common place to hear mumurs
77
tricuspid valve area
4/5 ICS L of sternal border
| close= S1 sound
78
mitral valve area
apex of heart
5 ICS L of sternal border in MCL
close= S1 sound
79
heart Valve area assessment process
go over all spots w/ diagphram and back again w/ bell
supine
turn pat. onto left side- listen apex (mitral area) w/ bell
sitting up/ leaning forward/exhale- go over spots again
80
diaphragm sounds
high pitched s1-s2
81
bell sounds
low pitched s3, s4 and murmurs
82
orthostatic Hypotension- common ass w/
BP/ pulse supine, sitting, standing 30sec - min apart
slight dec is normal!
drop SBP > 20mmHg and/or pulse inc 20bpm
common in prolonged bed rest, older age, hypovolemic, antihtn meds, history syncope/ LOC
83
arterial system
pumps blood to musc
thick walls, high P
pulse created by P wave from each heart beat
oxygenated blood
84
pulse sites
abdominal aorta, carotid, temporal, radial, brachial, ulnar, femoral, popliteal, dorsal pedialis, posterior tibial
85
venous system
high elastic (accom changes in blood vol), thin walls, dexygenated blood (except pulm v), no valves in jugular veins, low P, drain blood from tissues to heart
86
deep venous system incl
90% blood carrying
| femoral/ popliteal
87
factors for blood flow in venous system
musc P through contraction, intraluminal valves, inspiration dec thoracic P and inc abdomin P
88
axillary nodes location
high in axilla
89
epitrochlear node location
in grove btw/ bicep and tricep (inner elbow)
90
inguinal nodes- upper and lower
upper- diagonal angle btw thigh and pelvis
| lower- "femoral lymph nodes"
91
leg pain/ cramps indicate- cause
arterial circ. problems
"claudiation" inadeq blood flow (/ 02) to tissues
can be intermitent- inc w/ exercise, dec w/ rest
cause= periph. artery dis (atheroscler and arterialscler)
92
risks w/ prolonged standing/ sitting/ bedrest
venous problems, pooling, clots
93
edema in peripher vasc- v or a? and risk for what complication
venous
| if painful, red and warm = clot (most commonly DVT/VTE)
94
thrombophlebitis
inflamm of vein w/ clot
95
dec hair distribution, cyanosis, clubbing, dec cap refill, cool extremities, musc atrophy bc
arterial
96
edema, dec leg pain w/ elevation
venous
97
bruits
```
abnorm sound (whooshing) heard w/ steth. over artery
related to arterial circ
```
98
carotid assessment
use bell
| lower aspect of neck
99
allen's test
```
occlude radial/ulnar arteries
squeeze hand multiple times till pallor present
release radial- hand should return pink
occulde b again
release ulnar- hand should return pink
```
100
calf tenderness- Homan's sign
if negative= no tenderness
| to assess have pat move foot in Dorsal and plantar motions, ask if pain is present
101
normal changes in elderly- cardiac
dec hair distrib, inc thickness nails, think skin
| pulse should remain normal
102
varicose veins
enlrgment superficial v
sympt- aching/ swelling
low chance of dev PE
103
superficial thrombophlebitis- sign and treatment
clots/ inflamm of superficial v
tender, red, warm, firm
treatment- moist heat and pain control
104
DVT or Venous Thromboembolism VTE- common in and sympt
risk for PE
common w/ bedrest, dehyd, orthopedic surgery, hypercoaguable blood, cancer, after baby delivery
sympt- swelling, Red( not always), pain, tenderness
105
pitting edema
press against bony prom.
if doesn't pit- due to lymphatic dis
venous circ problems
106
jugular distention purpose
general estimate venous P
indicates R atrial P
inc bulging = inc P
107
jugular disten assessment
supine (distention is normal, no valve btw superior vena cava and r atrium)
45°- vein shouldn't be greater than 3-4cm above clav
90°- vein should not be visible
108
arterial abnormalities
dec pulse, dec cap refil, cyanosis, cold extremities, no edema, shinky skin, dec hair, nail thickening (e/x elderly), claudication, pain w/ elevation, hanging legs alleviates pain
109
venous abnormalities
edema, brown pigmentation, varicosities, elevation makes pain better, standing makes pain worse, thickened skin, edema
