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NURS 335 > Quiz 3 > Flashcards

Quiz 3 Flashcards

(45 cards)

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1
Q

Right Middle Lung (RML) Position

A

Extends from fourth rib at the sternal border to the fifth rib at the midaxillary line
- RML can only be auscultated anteriorly**

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2
Q

Lung Facts (RML, RUL, RLL, LLL, LUL)

A

-RLL and LLL are approx same size
- Right Lung is about 2.5 cm higher than the left because liver displaces right lung
- Left lung is narrower than right because of heart

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3
Q

Lung Apex and Base Location

A

Apex:
Anteriorly = Extends about 2-4cm above the inner third of the clavicle
Posteriorly = Near C7

Base:
Anteriorly = Rests on the diaphragm at the sixth rib MCL and the eighth rib midaxillary line
Posteriorly = Near T10

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4
Q

Respiratory Urgent Assessments

A
  • Res Rate
  • Pulse
  • BP
  • SpO2
  • Auscultate lungs
  • Administer O2/inhaler
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5
Q

Pectus excavatum & Pectus Carinatum

A

Sternal deviations that limit respiratory excursion

EXCAVATUM = Funnel Chest (can compress heart and cause murmurs)

CARINATUM = Pigeon Chest (Sternum is displaced anteriorly)

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6
Q

Flail Chest

A

When multiple ribs are fractured, paradoxical movements of chest may occur

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7
Q

Crepitus

A

Air entering lungs escapes into the subcutaneous tissue
- Creates a bubble wrap/rice crispy sound under skin

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8
Q

Kyphoscoliosis

A

Kyphosis = thoracic spine curves forward which reduces inspiratory lung volumes

Scoliosis = lateral S shaped curvature of spine causes unequal shoulders, scapulae and hips

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9
Q

Expected Findings of Posterior Chest

A
  • Spinous process of vertebrae are midline
  • Chest wall is cone shaped, symm and oval
  • Transverse/AP ratio is between 1:2 & 5:7
  • Thorax is nontender, without lesions, lumps, masses or crepitus
  • Thumbs move apart 5-10cm during inhalation
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10
Q

Tactile Fremitus

A
  • Tested when concern exists about obstruction or consolidation of lung
    tissue
  • Avoid scapula
  • Patient voices “99”
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11
Q

Rhonchal Fremitus

A

Coarse vibration produced by passage if air through or around thick exudates in the airways
Eg) pneumonia

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12
Q

Pleural Friction Fremitus

A

From inflamed pleural surfaces rubbing together and causing a grating sensation synchronous with respirations and more commonly felt in inspiration

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13
Q

Diaphragmatic Excursion

A
  • Done when concern for chest expansion
  • Helps estimate how much the diaphragm moves between inhalation and exhalation

Pt deeply exhales and holds it as you percuss in the ICSs down the scapular line until sound goes from resonant to dull (last resonant sound marks the location of lung tissue on deep expiration)
Repeat with pt holding a deep inhale (percuss same resonant spot, it should still be resonant), then percuss down to previously dull spot which should now be resonant because lungs moving down with diaphragm
Difference should be 1-2 rib spaces/3-5cm

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14
Q

Auscultation of Lungs

A

MOST IMPORTANT PHYSICAL EXAMINATION FOR ASSESSING AIR FLOW THROUGH RESPIRATORY PASSAGES AND ALVEOLI

Larger Airways = louder and coarser
Smaller Airways = softer and finer

Expected Findings:
- Expiration longer than inspiration
- Vesicular without crackles, wheezes or rhonchi

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15
Q

Vesicular Sounds

A
  • Soft, low-pitched
  • Whispering undertones
  • Found over fine airways near the site of air exchange
  • Inspiration > Expiration
  • “jaws”
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16
Q

Bronchovesicular Sounds

A

Found over major bronchi that have fewer alveoli (between scapula
- Intermediate pitch, intensity and quality
- Inspiration = Expiration

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17
Q

Bronchial Sounds

A
  • Loud, high-pitched
  • Coarse or tubular
  • Found over the trachea and larynx (manubrium)
  • Inspiration < Expiration
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18
Q

Tracheal Sounds

A
  • Very Loud and harsh
  • Harsh quality
  • Inspiration = Expiration
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19
Q

Adventitious Sounds

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A
  • Layered on top of underlying breath sounds

Crackles:
- Fluid in airways or alveoli
- Sounds like hairs rubbing together or velcro opening
Course = Lower, slower
Fine = Higher, quicker/closer together sounding

Wheezes:
- More musical
- Fluttering of narrowed airway walls (asthma or bronchitus)

Rhonchi:
- “course wheezes or gurgles”
- lower pitched and louder sounds resulting from secretions moving around during inhalation or exhalation
- Usually accompany pneumonia
“Underwater scuba diver”

Pleural Friction Rub:
- “walking on snow” sound
- Loud coarse and low pitched grating

Stridor:
- Loud high pitched crowing or honking sound louder in upper airway
“Seal sound”

20
Q

Egophony

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A

“ee” sounds like “A”
- Found w/ increased consolidation or compression (just like Bronchophony & Whispered Pectoriloquy)

21
Q

Bronchophony

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A

“99” is easily understood and louder in dense areas
- Sounds as if pt were talking directly into steth

22
Q

Systole

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A
  • Ventricles contract
  • Closed mitral and tricuspid valves prevent regurgitation
  • Aortic and pulmonic valves are open
23
Q

Diastole

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A
  • Twice as long as systole
  • Aortic and Pulmonic valves closed
  • Mitral and Tricuspid valves open*
24
Q

Urgent Assessment of Cardiac Event

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A
  • Acute coronary syndrome
  • Acute severe heart failure
  • Hypertensive crisis
  • Cardiac tamponade
  • Unstable cardiac arrhythmias
  • Cardiogenic shock
  • Systemic or pulmonary embolism
  • Dissecting aortic aneurysm

Symptoms:
- Chest pain
- Back pain
- Shortness of breath
- Too high or too low BP
- Inadequate tissue perfusion

25
Estimating JVP
- Expected findings = up to 3cm above sternal angle
26
Jugular Venous Distention (JVD)
Assoc w/ fluid volume overload, right-sided congestive heart failure, constructive pericarditis, tricuspid stenosis, and superior vena cava obstruction - Neck veins appear full and level of pulsation is >3cm above sternal angle
27
Hepatojugular Reflux Inspection/Palpation
- Apply gentle pressure on liver for 30-60sec and look for rise of 3cm or more in JVP Expected Findings: - Pulsation will rise briefly and then return to initial level Heart failure common cause of unexpected findings
28
Carotid Arteries Inspection/Auscultation/Palpation Etc
Inspection: - Check for double stroke seen in S1 and S2 - Contour is smooth with rapid upstroke and slower downstroke Auscultation: - Auscultate BEFORE palpation to detect carotid narrowing from atherosclerosis - Place BELL lightly over each carotid artery while pt holds breath - NO sounds or bruits heard Palpation: -One at a time - Palpate strength of pulse and grade it - Typical = 2+ on scale of 0-4 and equal bilaterally
29
Bruit Vs Murmur
Bruit: - higher-pitched - More superficial - Heard only over affected vessel Murmur: - Originate in heart or great vessels - Louder over upper precordium - Softer near the neck - Radiate to carotid arteries
30
Inspection of the Precordium
Expected Findings: - Maximal Impulses (PMI) of apex at 5th intercostal space are absent or located at the 5th left medial to the MCL with no lifts or heaves
31
Palpation of the Precordium
- Use the palmar surface of the hand when palpating for sensations related to the heart - Beginning at the apex of the heart - The PMI is in the 5th left ICS medial to the MCL when present - No pulsation are palpated in other areas
32
Percussion of Precordium
Chest X-ray has mostly replaced percussion of precordium - Left border of the the heart is percussed from the apex in the 4th to 5th left ICS medial to the MCL
33
Auscultation of Heart
MOST IMPORTANT TECHNIQUE of Cardiovascular examination - Most important landmark is the sternal angle at the junction of the manubrium with the body of the sternum
34
5 Auscultation Locations
Aortic: - 2nd ICS @ Right sternal Border Pulmonic: - 2nd ICS @ Left Sternal Border Erb: - 3rd ICS (right below Pulmonic) - Valves are usually equally audible Tricuspid: - 4th ICS sternal border Mitral: - 5th ICS midclavicular
35
Split Heart Sound
Valves close at slightly different times creating two discernible components of the same sound
36
Expected Findings - Heart Sounds
Use diaphragm - Listen to apical for S1, S2, heart rhythm and HR SINUS ARRHYTHMIA: Expected variation
37
S1 vs S2
S1: - Louder at apex (mitral tricuspid) - "Lub" - Correlates w/ carotid pulse S2: - Louder at base (Aortic Pulmonic) - Correlates with beginning of diastole - "Dub"
38
S3 & S4
S3: - Occurs during early rapid diastolic filing IMMEDIATELY AFTER S2 - Quiet, low-pitched and often difficult to hear - "Kentucky" S4: - Heard late in diastole IMMEDIATELY BEFORE S1 - "Tennessee"
39
Six P's
Pain (acute/severe) Pallor (Mottled skin) Pulselessness Poikilothermia (aka Polar = cold to touch) Paresthesia (burning, tingling or numbness) Paralysis
40
Peripheral Vascular and Lymphatic S&S
- Six P's - Edema of arms, hands, calves, legs and feet - Edema w/ redness or tenderness - Hair loss from feet or legs - Fatigue or muscle cramping in lower extremities w/ ambulation
41
Allen Test
-Assess the patency of collateral circulation of the hands - Pt makes fist, occlude radial and ulnar arteries of one hand simultaneously, pt opens hand (should be blanched), release pressure, colour should return within 2-5sec
42
Trendelenburg Test
Pt w/ Varicose Veins: - Evaluates the saphenous vein valves and retrograde filling of the superficial veins - Pt supine, elevate the leg 90 degrees for 15sec, apply tourniquet to the upper thigh, assist pt w/ standing and inspect for venous filling, release tourniquet after 30sec Saphenous Veins fill from the bottom up while the tourniquet is on
43
Checking for Pitting Edema
Press firmly w/ the thumb for 5sec or more over DORSUM of each foot, over each MEDIAL MALLEOLUS, and over SHINS
44
Pitting Edema Grading
1+ = Slight pitting, 2mm, Disappears rapidly 2+ = Deeper pitting, 4mm, 10-15sec 3+ = Visible swelling of extremity, 6mm, >1min 4+ = Grossly swollen extremity, 8mm, up to 2-3min
45

NURS 335 (4 decks)

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