exam 3

Question 1

medical conditions/ assessments for protein deficiency?

Answer 1

lab tests, Kwashiorkor: a disease marked by severe protein malnutrition and bilateral extremity swelling
marasmus: a severe form of malnutrition that occurs when the body doesn’t have enough calories, protein, carbohydrates, or fats to function normally

Question 2

physical exam findings of a client with adequate nutrition ?

Answer 2

evident by a persons physical appearance, weight, measurements, BMI 18.5-24.9

Question 3

symptoms of dyspnea:

Answer 3

difficulty breathing, difficulty in facial expression, distressed, retraction, flaring of nose, labored breathing

Question 4

most important technique when auscultating lung sounds

Answer 4

compare sounds between symmetrical lung fields on each side of the chest, moving systematically from the apex to the base while asking the patient to take deep breaths through their mouth, sitting up

Question 5

important factors to observe and document when assessing the adult anterior chest

Answer 5

increases systolic, arteries get hard, on left side of heart, but diastolic stays the same

Question 6

voice sound tests

Answer 6

bronchophony: pt repeats 99, soft, muffled, and indistinct, abnormal if 99 sounds distinct
egophony: listen while pt says “eeee”, should hear “eee” abnormal if you hear “aaaa”
whispered pectoriquoly: pt whispers “1,2,3” as you listen, it should be faint, muffled, almost inaudible, abnormal would be if sound was very clear

Question 7

Guidelines to correctly listen to breath sounds

Answer 7

have to assess inspection, palpation, percussion, auscultation

Question 8

Expected findings in the normal adult lung—tactile fremitus and resonant percussion

Answer 8

tactile fremitus: palpable vibration (99 test)
resonant percussion: normal percussion of lungs sounds

Question 9

Bronchial, vesicular, bronchovesicular breath sounds

Answer 9

bronchial: loud, harsh, high-pitched breath sounds that are usually heard over the trachea or at the right apex of the lungs
vesicular: soft, low-pitched sounds that are heard when a person breathes in and out, and are a sign of normal lung function
bronchovesicular: medium-pitched sounds that are heard in the lungs when a person breathes in and out, posterior chest between the scapulae and in the center part of the anterior chest

Question 10

how many lobes do the lungs have?

Answer 10

right lung: shorter because of liver , three lobes
left lung: narrower because of heart bulging to left, two lobes

Question 11

pleura:

Answer 11

a thin layer of tissue that lines the inside of the chest cavity and covers the lungs

Question 12

History taking for respiratory ailments

Answer 12

pertinent past medical history (e.g. asthma/COPD), inhaler use, smoking history, occupational exposures, and even childhood illnesses

Question 13

Assessing voice sounds during a respiratory assessment

Answer 13

in tactile fremitus, soft, muffled, and indistinct; you can hear sound through stethoscope but cannot distinguish exactly what is being said

Question 14

Symptoms associated with orthopnea and what may cause the symptoms

Answer 14

orthopnea: difficulty breathing laying down
causes: heart failure, COPD, pulmonary hypertension, obesity, pneumonia, stress

Question 15

Adventitious breath sounds—definition and the types of sounds that may be auscultated

Answer 15

stridor: high pitch inspiration crowing sound caused by upper airway obstruction louder over the neck than the chest wall
crackle: abnormal discontinuous adventicious lung sound heard on inspiration
wheeze: high pitch musical squeaking adventicious lung sound also used with low pitched adventicious sounds

Question 16

barrel chest assessment findings

Answer 16

AP diameter, greater than 1-2, COPD

Question 17

reasons why someone has crackles, wheezes:

Answer 17

fluid gets in lungs

Question 18

diastole

Answer 18

hearts filling phase, bottom #

Question 19

systole

Answer 19

hearts pumping phase, top #

Question 20

Action that produces S1 sound

Answer 20

Occurs with closure of AV valves—signals beginning of systole

Question 21

Correct technique for palpating the carotid arteries

Answer 21

Palpate only one carotid artery at a time to avoid compromising arterial blood to brain, feel contour and amplitude of pulse, normal strength 2+, findings should be same bilaterally

Question 22

Correct sequence for auscultating heart sounds

Answer 22

1. Second right interspace: aortic valve area
2. Second left interspace: pulmonic valve area
3. Left lower sternal border: tricuspid valve area
4. Fifth interspace at around left midclavicular line: mitral valve area
   APE to man

Question 23

Diastole and the S2 heart sound

Answer 23

heart relaxes, occurs with closure of semilunar valves—signals end of systole, S2 loudest at base

Question 24

Electrical sequence of the cardiac cycle

Answer 24

start in SA node then AV, bundle of his, bundle branches, Purkinje fibers

Question 25

Cardiovascular changes NOT expected in the aging adult

Answer 25

resting heart rate — the number of heartbeats per minute at rest — does not change significantly with normal aging

Question 26

Anatomy of the heart—heart wall, chambers, and valves

Answer 26

heart wall: precordium, note any heave or thrill chambers: the right and left atria, and the right and left ventricles valves: aortic valve, mitral valve, tricuspid valve, and pulmonary valve

Question 27

Blood flow through the heart

Answer 27

superior cena cava, inferior cena cava, Right Atrium, tricuspid valve,Right Ventricle, Pulmonary Artery, Lungs, Pulmonary Vein, Left Atrium, mitral valve, Left Ventricle, aortic valve, aorta, body

Question 28

Blowing/whooshing sound in the aortic and pulmonic anatomical regions

Answer 28

murmurs, they are the result of vibrations caused by turbulent blood flow patterns

Question 29

what valves are in AV valves and SL valves:

Answer 29

AV: tricuspid (right side), mitral (left side) SL: pulmonic (right), aortic (left)

Question 30

First sounds that should be identified when auscultating the heart

Answer 30

S1 and S2

Question 31

Anatomical location of the auscultating the pulmonic valve

Answer 31

second left intercostal space near the upper sternal border

Question 32

signs and symptoms of varicose veins

Answer 32

create incompetent valves leading to increased venous pressure, which further dilates the vein, bulging bluish veins, discomfort, swelling in legs

Question 33

Anatomical location of the dorsalis pedis pulse

Answer 33

a pulse in the foot that can be felt by pressing fingertips into the dorsum of the forefoot near the ankle, Normally it is just lateral to and parallel with extensor tendon of big toe

Question 34

Arterial insufficiency

Answer 34

stops the flow of blood, pallor when leg raised 

Question 35

Risk factors that contribute to DVT

Answer 35

standing for a long time, prolonged bedrest, hypercoagulation, obesity, pregnancy, heart failure, kidney disease

Question 36

Lymphedema precautions

Answer 36

avoid getting BP on same arm with it because it could cut off circulation

Question 37

Peripheral vascular disease with associated pain in lower extremities

Answer 37

peripheral artery disease (PAD), a chronic condition that occurs when blockages in the arteries reduce blood flow to the legs, claudication is pain in the legs or arms that occurs while walking or using the arms

Question 38

Popliteal pulse

Answer 38

the soft spot in the back of the knee, behind the kneecap, anchor your thumbs on knee, and curl your fingers around into popliteal fossa

Question 39

Assessment of peripheral pulses

Answer 39

a clinical tool that involves palpating the blood moving away from the heart through the extremities, femoral, posterior tibial, dorsalis pedis, and sometimes the popliteal arteries

Question 40

Assessment of extremity edema

Answer 40

performing a pitting test and measuring the circumference of the extremity

Question 41

Anatomical locations of the ulnar and radial pulses

Answer 41

ulna is on the pinkie side of the wrist, and radial is on the thumb side

Question 42

Timing to determine absence of bowel sounds

Answer 42

5 mins each quad

Question 43

Purpose of fluid shifting dullness test

Answer 43

finding ascites (abnormal accumulation of serous fluid within the peritoneal cavity, associated wih heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer)

Question 44

Normal findings when palpating abdomen

Answer 44

Abdomen soft to touch with no masses, swelling, pain, and rigidity, no tenderness, symmetric

Question 45

Sequence of abdominal assessment and reasoning

Answer 45

inspect, auscultation, percussion, palpation, can cause peristalsis if palpate before auscultate

Question 46

Costovertebral angle tenderness

Answer 46

meaning kidney enlarged, this is where you assess the back and the angle between ribs, you "punch" to see if any tenderness

Question 47

Know anatomical locations of organs in the abdomen

Question 48

Sequence of auscultating the abdomen

Answer 48

rlq, ruq, luq, llq, use diaphrgam

Question 49

Anatomical location for auscultating the abdominal aorta

Answer 49

about two-thirds of the way down the abdomen, between the xiphoid (epigastrium) and the umbilicus, epigastric region

Question 50

Definition of hepatomegaly

Answer 50

abnormal enlargement of liver

Question 51

Palpation of an enlarged spleen—precautions when enlarged

Answer 51

Normally not palpable and must be enlarged 3 times its normal size to be felt, friable and can rupture easily during palpation—therefore it should not be palpated due to danger of rupture and significant blood loss