Exam 2: Heart & Lungs Assessment Flashcards
(137 cards)
1
Q
Technique and sequence of physical assessment for heart and lungs
A
Inspection
Palpation
Percussion
Auscultation
2
Q
When assessing for heart and lungs, also consider diagnostics such as
A
X-rays, MRIs, CT scan, EKGs, etc.
3
Q
Pulmonary assessment subjective data
A
- Cough, sputum, SOB, pain
- History or respiratory diseases (Asthma, Croup, cystic fibrosis)
- Self care (immunizations, influenza, TB test)
- Environmental exposure
- Habits (smoking)
- Injuries
4
Q
Pulmonary assessment objective data: anterior/posterier
A
Inspect…
- facial expression
- LOC (Level of consciousness)
- ease of breathing
- Skin color and nail beds
- use of accessory muscles
- respiratory rate
- Sternal formation
- – Pectus carinatum
- –Pectus excavatum
- Shape and configuration
- —Downward sloping of ribs
- —muscle and skeletal structures
- —-posture
- AP diameter of chest 2:1
- kyphosis/scoliosis/lordosis
5
Q
inspection includes
A
Visual examination
6
Q
Palpation includes
A
Using hands to feel
7
Q
Percussion includes
A
Light tapping to assess underlying structures
8
Q
Auscultation includes
A
listening to sounds produced by body
9
Q
Pectus carinatum
A
sternal production
10
Q
Pectus excavatum
A
sternal concavity
11
Q
AP diameter of chest —-> anterior posterior diameter is
A
- Approximately 1/2 of transverse diameter or 1:2 ratio
- rounding from chronic COPD can cause a barrel chest look
12
Q
pulmonary assessment objective: palpate posterior
A
- Symmetric expansion
- Assess for tenderness with percussion over kidneys: costal vertebral angle
13
Q
how to do to symmetric expansion
A
Thumbs along spinal processes
2 inch apart @ 10th rib
palms resting lightly on lateral chest
tell patient to take several deep breaths
note bilateral outward movement of thumbs
—- thumbs should life symmetrically
14
Q
Costal vertebral angle tenderness indicates a need for
A
renal assessment
15
Q
does costal vertebral angle assess respiratory?
A
No! since we are already behind conducting pulmonary assessment, a renal assessment is good
16
Q
When auscultating lungs, individuals should breathe through
A
their mouth
17
Q
When auscultating lungs, start at
A
top to bottom comparing sides, then compare laterally
18
Q
Normal lung sounds
A
- vesicular
- Bronchovesicular
- Bronchial
19
Q
vesicular lung sound
A
Soft, breezy, low pitched
20
Q
Bronchovesicular lung sound
A
Blowing, medium pitch/intensity
21
Q
Bronchial lung sound
A
Loud high pitched
22
Q
Where to hear vesicular lung sounds
A
small airways: periphery of lung
23
Q
Where can you hear bronchial lung sounds
A
Trachea: heard only over the trachea
24
Q
Where to hear Bronchovesicular lung sound
A
Large airways: Between scapulae, over bronchioles lateral to sternum
25
Abnormal sounds
```
Atelectasis
Crackles
Wheezes
Rhonchi
Stridor
Pleural Friction Rub
Absent
```
26
Atelectasis
Collapsed alveoli: small area or large
| Will most likely not hear, but inspiration !!
27
Minor atelectasis may not be detected
early
28
Major atelectasis is when
entire lobe/lung collapses
29
Crackles
popping open of deflated alveoli on INSPIRATION
30
Where in the lungs does fluid usually collect
Lower lobes
31
Can crackle sound be cleared by a cough?
Nope!
32
Fine crackles sound similar to
the sound of a wood fireplace
33
Coarse crackles
Velcro separating/ cellophane crumpled
34
Wheeze
High velocity airflow through narrowed/obstructed airways with many causes
35
Where can you hear a wheeze?
Heard in all lung fields
36
Can coughing mitigate wheeze?
Nope, there is nothing to cough or move
37
Wheeze sounds like
High pitches, continuous musical sound/squeaking
38
When can you hear a wheeze?
Inspiration AND/OR expiration
| --usually louder on expiration
39
Rhonchi
Spasm, fluid/mucus in airways = turbulence
40
Where can you hear rhonchi
Mostly over trachea and bronchi with mucus present
41
Can rhonchi be cleared with a cough
yes, clear after coughing usually, BUT not always
42
Rhonchi sounds like
Loud, low pitched, rumbling, continuous coarse sounds, snore
43
When can you hear rhonchi
inspiration and/or expiration
44
Stridor
Air moving over partially obstructed airway/larynx
45
stridor can become
emergent
46
Stridor can be caused by
Inhaled object, infection, throat swelling, laryngospasm
| --- frequent in children
47
you can only hear bronchial sounds
anteriorly
48
Where can you hear stridor
Through, it's loud and do not need stethoscope
49
When can you hear stridor
High pitch musical sound heard on INSPIRATION
50
Pleural friction rub
Inflamed pleura rubbing against raw visceral pleural
51
When can you hear pleural friction rub
Dry, rubbing or grating on inspiration AND expiration
52
where can you hear pleural friction rub
Hear over anterior lateral lung fields
53
What does pleural friction rub sound like
Rubbing leather together, walking
54
Absent lung
Pneumothorax (collapsed lung)
55
Absent lung =
No air movement in the identified area
56
Subjective data for cardiac assessment
```
Smoking/alcohol/caffeine
Prescribed medication/OTC
History of Cardiac diseases
family medical HX
report discomfort : OLDCART
cardiac procedures
Reporting palpitations, fatigue, cough, dyspnea
peripheral symptoms: leg pain, cramp, edema, cyanosis, nocturia
dizziness, SOB, orthopnea
Lifestyle
```
57
When can you hear atelectasis
Inspiration
58
Objective anterior cardiac assessment
Inspect
- Skin: oxygenation/lesions
- Heave/lift at apical pulse
- ----hypertrophy of ventricle
Palpate -valves
- Aortic, pulmonic, tricuspid, mitral
- Apical pulse (PMI) - mitral
- -- Location, size, amplitude, duration
- --- 5th intercostal space
- -- may need to roll or learn to left to help increase amplitude
59
Objective auscultate of heart (APETM)
```
Aortic valve
Pulmonic valve
Erb's point
Tricuspid Valve
Mitral Valve
```
60
Aortic valve
2nd right intercostal
61
Pulmonic valve
2nd left intercostal space
62
Erb's point
3rd intercostal space
63
Is era's point a valve?
Nope
64
Tricuspid valve
4th or 5th left intercostal
65
Mitral valve
5th intercostal space
- midclavicular line
- at base of breast tissue, move bra out of way if present
66
When auscultating heart, start
at base and move in Z to apex
67
When auscultating heart, listen with
both the diaphragm and the bell of stethoscope
68
When auscultating the valves of the heart, you listen
to not the ACTUAL anatomical locations of the valve, but where the valve sound is heard best
69
S1: "lub" is louder at
apex
70
In QRS, S1 represents
carotid pulsation and the "R" wave
71
S1 is the closure of
AV valves
72
S2 "dub" is louder
At base
73
S2 "dub" is the closure of
semilunar valves
74
When assessing neck vessels, inspect
For obvious pulsation/bulging
75
When palpating the carotid artery, massaging vigorously can cause
Syncope
76
When palpating carotid arteries, can you do both?
No! Only one side at a time to prevent obstructed blood flow to brain
77
When auscultating carotid arteries use the ___ of a stethoscope
Bell and have patient hold breath
78
Normal carotid arteries sound is
no sounds
79
Carotid artery sound: Bruit
Blowing, swishing sound (narrowing_)
80
Carotid bruit
Narrowed blood vessel: arteriosclerosis
- Creates turbulence
- Blowing/swishing
81
Assessing for Jugular venous distention
Place patient in supine position (bulge is normal when flat)
Raise torso to 45 degrees
82
after raising horse to 45 degrees, if JV is still bulging
There is JVD which means venous and rich atrium pressure is elevated
-- heart failure, fluid volume overload/hypervolemia
83
When assessing peripheral arteries, assess
ELASTICITY
STRENGTH
EQUALITY
84
Peripheral arteries can be graded on 4 point scale
```
4- bounding
3- full and brisk
2- NORMAL
1- weak
0- absent
```
85
Light pressure is on the
Bell
86
Firm pressure is
Diaphragm
87
Modifiable risk factors for CV disease
```
Hyperlipidemia
Hypertension
excessive weight
physical inactivity
smoking
psychological stress
diabetes
```
88
Non-modifiable factors
family history
| genetics
89
Lab values to assess cardiac system
- Complete blood count
- Lipids
- Serum electrolytes
- BNP: elevated in heart failure
- Creatine kinase
- Troponin/myoglobin
90
Values listed for complete blood count
numerous components
91
Values listed for lipids
cholesterol
triglycerides
HDL
LDL
92
HDL =
good
93
LDL = bad
94
Values listed for serum electrolytes
C-reactive protein: inflammation
| Peaks 18+ hours
95
Values listed for Creatine Kinase
Heart muscle injury: Inexpensive
Elevated in 4+ hours after injury
Can pick up skeletal muscle injury
96
Values listed for troponin/myoglobin
evidence of cardiac damage
| elevated in 3-4 hours
97
Murmurs
A blowing swishing sound from turbulent blood flow in the heart or great vessels
--- you will feel a thrill when palpating
98
murmurs are often abnormal or normal?
Abnormal, however, some people live with murmurs without symptoms
99
Timing of murmurs
Systolic and diastolic murmurs without symptoms
100
Loudness of murmurs are graded
1-6, soft to loud
101
Murmur pitch
high, medium, low
102
Developmental considerations of infants for cardiac and pulmonary assessment
- Smaller diaphragm/bell
- Higher heart rates
- ---- Harder to count and evaluate for murmurs
103
Feeling turbulence is known as
feeling a thrill
104
Developmental considerations of children for cardiac and pulmonary assessment
- Extra cardiac signs of heart diseases
- -clubbing of fingers
- -- cyanosis: fingers, lips, etc.
- Activity level
- Weight gain: Fluid retention, immobility due to low activity tolerance
105
You can feel a ____
| or hear a _____
Feel a thrill, hear a bruit
106
Developmental considerations of pregnant women for cardiac and pulmonary assessment
- Pulse increased 10-15 BPM
- heart displaced to upper left and rotates
- PMI is higher
- Increased blood volume
- Systolic murmurs - 90% disappear after delivery
107
Changes with aging
- Harder to hear sound with increased AP diameter
- cardiac valves degenerate: Especially mitral and aortic---- murmurs
- conduction: pacemaker cells decrease in number ---- dysrhythmias, ectopic bears
- left ventricle: size increases and more fibrotic --- decrease cardiac output
- Aorta and large vessels: Thicken ---- increase systolic BP
- baroreceptors: Become less sensitive ---- orthostatic hypotension
108
Right side heart failure
Function of R ventricle or increased pulmonary vascular resistance
109
Function of R ventricle or increased pulmonary vascular resistance can cause
- Peripheral congestion/backup
- --Hepatomegaly
- --splenomegaly
- --dependent edema
- -- weight gain
- Distended neck vein
- -- JVD
110
Left side heart failure
Function of L ventricle
- cardiac output
- -- fatigue
- -- dizziness
- -- confusion
- Pulmonary congestion
- -- crackles
- -- SOB
- -- Dyspnea
- -- Breathlessness
111
The right side of the heart receives
From the periphery
112
If right side of heart fails,
The blood backs up into where it was coming from
113
The left heart receives from the
lungs
114
if the left side fails
the blood backs up into the lungs
| -- ALSO circulates to everything, so everything is getting LESS oxygen and nutrients
115
Factors affecting Oxygenation:
Alterations in respiratory function
- respiratory
- -- Hypo/Hyperventilatoin
- -- Anoxia
116
Anoxia
Absence of oxygen
117
Physiological factors affecting oxygenation
Decreases O2 carrying capacity
- hypovolemia/decreased circulating blood volume
- oxygen concentration
- --airway obstruction
- --decreased environmental oxygen
- --hypoventilation
- increased metabolic rate
- decreased O2 carrying capacity
Chest wall movement
- pregnancy
- obesity
- musculoskeletal alterations in thoracic region
- trauma
- neuromuscular
- central nervous system
118
decreased O2 carrying capacity:
Low hemoglobin/anemia
119
Increased metabolic rate:
Increases oxygen demand
120
Hypoxia
Inadequate oxygenation of the TISSUE
121
Hypoxemia
Inadequate oxygenation of the BLOOD
122
Is hypoxia measurable
Nope, but comes as a result of hypoxemia
123
Is hypoxemia measurable
YES!
- Pulse oximetry
- arterial blood assess
- other respiratory tests
124
First signs of hypoxemia
Restlessness and confusion
125
Factors affecting oxygenation
Alterations in cardiac function
Lifestyle factors
Environmental factors
126
Examples of alterations in cardiac function
Conduction
Altered cardiac output
Valves
Myocardial ischemia: Blood flow to heart is insufficient
127
Myocardial ischemia
Blood flow to heart is insufficient
128
Lifestyle factors affecting oxygenation
```
nutrition
exercise
smoking
substance abuse
stress
```
129
Developmental considerations for infants: Pulmonary
- Count respiratory rate 1 full minute
- irregular with some apnea normal
- crackles are common in newborns
- distress
- ----- nasal flaring
- ----- substernal and intercostal retractions
130
Developmental considerations for elderly: Pulmonary
- Increased AP diameter (especially COPD)
- kyphosis
- Less mobile thorax
- fatigue easily during auscultation (pace your assessment)
- fragile bones (broken ribs or spine)
131
Clubbing of nails
building of tissues at the nail bas
132
Clubbing of nails is caused by
Insufficient oxygenation at the periphery
| pulmonary OR cardiac
133
Most common causes of clubbing of nails
Emphysema and congenital heart disease are the most common causes
134
How to calculate smoking habits: Pack years
years smoked * # packs smoked/day = ___ pack years
135
pulmonary/oxygenation NANDA nursing diagnosis
```
Impaired gas exchange
fatigue
ineffective airway clearance
ineffective breathing pattern
activity tolerance
risk for acute confusion
decreases cardiac output
actor pain
risk fo infection
```
136
interventions for pulmonary/oxygenation
Airway: Coughing. suctioning, physiotherapy maintenance
Hydration: Humidifiers, fluid intake orally, through GI tracts or IV
Nebulizers: breathing treatments w/ medications added as well as humidity
Cough/deep breathing
Pursed-lip breathing: Helps leep alveoli open
Noninvasive ventilation
Invasive mechanical ventilation
ambulation/positioning
chest tubes
oxygen therapies
137
Are crackles common in infants?
yes due to the fact that lungs have not developed
