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242 Cards in this Set
- Front
- Back
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What is contained in the anterior and posterior chest?
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Mediastinum and pleural cavities |
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What is positioned in the middle of the chest, contained the heart, aortic arch, superior vena cava, lower esophagus, and the lower trachea? |
Mediastinum |
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Which pleural cavity has 3 lobes? |
Right lung |
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Which pleural cavity has 2 lobes? |
Left |
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What is asked when taking a history about related to the respiratory system? |
Present health status Past medical and family history Occupational history Home environment Travel Cough, with or without sputum Shortness of breath Chest pain with breathing? |
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What family history questions are asked in relation to the respiratory system? |
Any COPD, asthma, emphysema, or what type of respiratory disease? |
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If a patient is short of breath what further questions are asked? |
When? Short exertion? When sleeping? Need to prop with pillows? Affect ADL's? Gradual or sudden? |
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What chronic illnesses need to be assessed with respiratory problems? |
COPD Asthma Emphysema Bronchitis Heart disease Kidney disease |
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What questions are asked if a patient is using oxygen? |
How much? When is it used? Continuous? At night? |
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What are important home environment questions to asked when assessing the respiratory system? |
Anyone smoke in the household? Do you have a wood stove? Allergic to dust or cats? |
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How is packs per years determines? |
#ppd x years |
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What past medical diagnosis are assessed in the respiratory system? |
TB Chest pain Asthma COPD, emphysema, bronchitis Cancer - specifically lung Lung or chest injury or surgery |
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What types of respiratory problems are travelers exposed to? |
Avian flu, SARS - China/Asia Histoplasmosis - Southeast/Midwest |
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What occupational hazards are looked at when assessing the respiratory system? |
Chemical exposure Asbestos Mines Farming |
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What questions are asked when a patient has a cough? |
When? Morning? After meals? Evenings? Wet/Dry? Productive? |
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If a patient has a productive cough, what questions about the sputum are asked? |
Color Consistency Amount Large/small? Associated symptoms? SOB? Pain? |
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If sputum is whit, scant, and thin...what is a possible diagnosis? |
COPD |
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What color will sputum be if the patient has an infection or pneumonia? |
Green or yellow |
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If sputum is red, what is suspected? |
TB or tumor |
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What might be happening if a patient has gradual shortness of breath? |
Worsening heart failure |
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What is defined as difficulty breathing when lying down? |
Orthopnea |
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What occurs only at night and commonly awakens the patient, and they have to sit up to breathe? |
Paroxysmal Nocturnal Dyspnea |
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What associated symptoms are when a patient has chest pain when breathing? |
Sweating
Radiation of pain Type Crushing, dull, sharp Intensity on scale of 0-10 |
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What aggravating or alleviating measures are asked when a patient has chest pain when breathing? |
Associated with an injury? Hurts only when you breathe? Any self treatments? Tums? Inhaler |
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What techniques are used during assessment of respiratory system? |
Inspection Palpation Percussion Auscultation |
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What is assessed in the respiratory system during inspection? |
General appearance Breathing effort Oxygenation Chest wall configuration |
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What is assessed with general appearance with a patient with a respiratory illness? |
Posture Tripod position Anxiety, restlessness SOB Skin, lips, and nail color or clubbing |
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What is assumed when a patient has nail clubbing? |
Chronic hypoxia |
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How is normal rate and quality of respirations documented? |
Effortless, smooth, even |
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What is adequate oxygenation? |
92% or above |
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How is normal chest expansion documented? |
Symmetrical |
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How is normal breathing patterns documented? |
Even, unlabored, smooth pattern |
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If intercostal muscles are retracted in children, what is assumed? |
Respiratory distress |
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What is a normal adult respiratory rate? |
12-20 |
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What is tachypnea? |
Increased respiratory rate Greater than 20 Rate remains smooth and even |
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What is an increased respiratory rate and depth? |
Hyperpnea or hyperventilation |
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What is bradypnea? |
Respiratory rate less than 12 |
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What is the definition for no respirations? |
Apnea |
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What are abnormal findings with muscles during respiration? |
Use of accessory muscles
Retractions Bulges Nasal flaring |
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What is a sign of respiratory distress infants? |
Nasal flaring
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What are normal findings in muscles during respirations?
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Diaphragm, intercostals, abdominal Symmetrical expansion, effortless muscles |
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What type of breathing pattern is hyperventilation, very fast, deep and labored respirations? |
Kussmaul |
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When is Kussmaul's breathing pattern seen? |
Ketoacidosis |
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What type of breathing patterns are described as long periods of apnea with short bursts of deep, labored breathing? |
Cheyne-Stokes |
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What type of breathing pattern will be seen with brain damage, death, or drug overdose? |
Cheyne-Stokes |
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What is Biot's breathing pattern?
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Irregularly spaced intervals of apnea, breathing with a disorganized and irregular pattern, depth, and rate? |
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When is Biot's breathing pattern seen? |
Intracranial pressure Brain damage |
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What is an abnormal chest wall configuration? |
Barrel chest |
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When is ok to have a barrel chest? |
Some men have a barrel chest and that is ok |
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What is the normal costal angle in chest wall configuration? |
less than 90 degrees |
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What is normal AP diameter? |
1:2 |
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What is the costal angle and AP diameter in someone with a barrel chest? |
Greater than 90 degrees AP 1:1 |
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What type of chest wall configuration will be seen with emphysema? |
Barrel chest |
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What is assessed during chest palpation? |
Trachea midline and flexible |
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What bony landmarks are assess in the anterior chest palpation? |
Sternum, ribs, clavicle |
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What bony landmarks are assess during posterior chest palpation? |
Vertebrae Scapula |
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How is tactile fremitus assessed? |
Palpation with vibration Client says loudly "99" Assessed with ulnar or palmar surface of hand Palpate bilaterally posterior chest |
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What is questioned when a patient has decreased or absent fermitus? |
Obstruction or transmission of vibration due to excessive fat/muscle pleural effusion emphysema pneumothorax bronchial obstruction |
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What is questioned with increased fremitus? |
Lung tissue compressed of solidified due to Pneumonia Atelectasis Tumor |
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What should be done if difference is felt when assessing tactile fremitus? |
Obtain CXR |
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How many areas are assessed during chest percussion? |
Ten areas on posterior chest, side to side, and apex to base |
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What tone should be heard during chest percussion? |
Resonance |
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How is chest percussion performed? |
With middle finger |
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Why is the diaphragm percussed during a chest assessment? |
To estimate lung expansion and position |
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When is diaphragmatic expansion performed? |
When client has shallow breathing |
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What technique is used in diaphragmatic expansion? |
Make patient take a deep breath and let it all out Percuss from T7-8 downward until sound changed from resonant to dull Mark when client exhales completely and when they inhale deeply |
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What is the normal difference in diaphragmatic expansion? |
3-5 CM |
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What is heard when tissue is percussed in diaphragmatic expansion? |
Dull sound |
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When is chest auscultation done best? |
Patient sits upright, breathes deeply and slowly through mouth |
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Which lung may be higher when assessing diaphragmatic expansion? |
Left |
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Is diaphragm or bell used during chest auscultation? |
Diaphragm |
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How many areas are auscultated on the posterior chest? |
10 |
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How many areas are auscultated on the anterior chest? |
8 |
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How many areas are auscultated in the lateral area of the chest? |
3-4 |
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When is the lateral area of the chest auscultated? |
If hear anything in lower anterior or posterior area |
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How is patient positioned to auscultated the lateral area of chest? |
Lift arm up |
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What normal breath sounds are low-pitched and soft? |
Peripheral lung fields |
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Where are vesicular sounds heard? |
Over most of the lung fields |
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Describe bronchial sounds.
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High-pitched and loud |
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Where are bronchial sounds heard? |
Trachea and large bronchi |
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How is a medium pitch breath sound described? |
Bronchovesicular |
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Where are bronchovesicular sounds normal heard? |
Bronchial bifurcation Below clavicles Between scapula |
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When are bronchial breath sounds normally heard? |
On expiration |
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When are bronchovesicular breath sounds normally heard? |
Equally on inspiration and expiration |
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When are vesicular breath sounds normally heard?
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Inspiration |
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What are signs of respiratory distress? |
Asymmetry of chest wall and movement Cyanosis or pallor Adventitious sounds Restlessness, anxiety, confusion Use of accessory muscles Nasal flaring Increased respiration Abnormal location |
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What is heard and seen with distant breath sounds? |
Soft, difficult to hear Shallow breathing |
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What is a possible diagnosis when breath sounds are distant? |
Chest wall mass |
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What should you ask the patient to do if they have distant breath sounds? |
Ask patient to breathe deeper |
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What are adventitious breath sounds? |
Crackles or rales Wheezes Rhonchi Pleural friction rub |
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How is a pleural friction rub assessed? |
Have patient hold breath to determine if cardiac or pulmonary problem |
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When are crackles best heard? |
Inspiration |
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Are crackles cleared by cough? |
No
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What is the happening when crackles are heard? |
Air is passing through excess secretions or opening collapsed alveoli |
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How are crackles described? |
Soft or harsh, crackling, popping, discontinous sounds |
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If airway is small how will crackles sound? |
Fine - high pitched |
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How are medium crackles described? |
Moist |
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What type of lung sound is low-pitched, bubbling, gurgling and indicates large airways? |
Course crackles |
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What diagnosis may be determined by crackles? |
Pneumonia CHF Pulmonary edema |
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When are wheezes commonly heard? |
Expiration |
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How are wheezes described? |
High-pitched, musical sound |
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When causes wheezing lung sounds? |
Narrowed airways - asthma |
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Wheat are low-pitched, rumbling, or snoring sound? |
Rhonchi |
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Where is rhonchi normally heard? |
Over larger airways
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What is rhonchi caused by? |
Airway obstruction from secretions |
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Is rhonchi cleared by coughing? |
Yes |
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What is important to know about children with rhonchi? |
May be harder to clear with coughing |
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What breath sound is described as harsh, creaking, or grating sound? |
Pleural friction rub |
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When is pleural friction rub best heard? |
Inspiration and expiration |
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What is happening when you hear a pleural friction rub? |
Inflammation of pleural surfaces that are rubbing together |
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What causes a pleural friction rub? |
Virus or injury |
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What vocal sound is heard when a patient says "99'? |
Bronchophony |
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How should "99" sound in a normal patient? |
Muffled |
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How does "99" sound abnormally? |
Loudly and clearly |
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What is a possible diagnosis when bronchophony is abnormal? |
Consolidation |
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What vocal sound is assess with a patient says "E E E"?
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Egophony |
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What is heard with abnormal Egophony? |
"A A A" |
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What does a client do when you are assessing whispered pectoriloquy? |
Client whispers "1 2 3" |
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How should whispered pectoriloquy normally sound? |
Muffled |
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How is whispered pectoriloquy heard when it is abnormal? |
Clearly
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What diagnostic tests are done in a respiratory assessment? |
Chest x-ray Pulmonary function studies Bronchoscopy Biopsy Gram stains, washings ABG's Lung perfusion studies |
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What diagnostic test for the respiratory system is the gold standard? |
CXR |
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Why are lung perfusion studies performed? |
VQ scan to rule out pulmonary embolism |
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What are normal findings in the respiratory system in older adults? |
Increased AP diameter (1:1)
Kyphosis Decreased chest wall expansion Drier mucous membranes |
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What are the 2 chambers of the the heart? |
Atrium Ventricle |
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How many chambers does the heart have? |
4 |
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What is the leading cause of death in the US? |
Coronary artery disease |
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Coronary artery disease affects 1 in how many women? |
3 |
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Why have death rates in coronary artery disease decreased since the 70's? |
Smoking decreased |
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Describe how deoxygenated blood flows? |
Returns to the right atrium via the superior vena cava and inferior vena cava |
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Describe blood flow from right atrium. |
Empties into the right ventricle through the tricuspid valve and is ejected from the right ventricle through the pulmonic artery, where blood travels to lung and is oxygenated |
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Describe blood after it is ejected from the left ventricle. |
Ejected through the aortic valve into the aorta and throughout the body |
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Where does blood travel to after it enters the lungs? |
Comes back to the heart through the pulmonary veins and fills the left atrium which empties into the left ventricle. |
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Where is heart failure usually caused? |
Left ventricle because more powerful |
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What type of history is taken during a cardiac assessment? |
Present health status Past medical and family history Chest pain SOB Cough Fatigue Fainting Edema Leg pain Exercise |
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What type of medications should be specifically asked about during a cardiac assessment? |
OTC Illegal Caffeine Alcohol |
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How is diet assessed during a cardiac assessment? |
24 hour recall |
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What is asked about the present health status during a cardiac assessment? |
Chronic illnesses Medications OTC drugs Illegal drugs/caffeine/alcohol Exercise Diet Stress/coping Smoking history |
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What family members history is important during a cardiac assessment? |
Parents Grandparents Sons Daughters Sisters Brothers |
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What is considered a young age for heart attack or disease? |
<50 years old |
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What are important past cardiac medical history diagnosis? |
Congenital heart disease
Rheumatic fever Heart murmur |
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What past lab is important during assessment of cardiac history? |
Lipid levels |
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Why is important to ask about most recent EKG? |
Was it done because of screening or cause |
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What is asked when a patient is having chest pain? |
Where - have them point What - quality of pain, 0-10, what were doing when happening When - does it occur Alleviating/aggravating factors Does it radiate Associated symptoms - SOB, sweating |
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Where is chest pain when a woman is having a heart attack? |
Radiates to back, abdomen, and can have fatigue |
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What are symptoms of an acute MI? |
Unrelenting pain, sweating, impending doom, shortness of breath |
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What are symptoms of angina? |
Rest or Nitro and pain subsides |
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What type of chest pain is precodial or restrosternal in location, radiates to arm, usually left but possibly right, or to jaw or back. |
Cardiac chest pain |
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What are the associated symptoms with cardiac chest pain? |
N/V SOB Diaphoresis Pressure Impending doom |
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What type of chest pain occurs with breathing and pain does not radiate and causes patient to have shallow breathing? |
Pulmonary chest pain |
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Does Nitro relieve pulmonary chest pain? |
No
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How is chostochronditis described? |
Pain upon movement with deep breathing or coughing. Pain radiates |
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Describe symptoms of GERD. |
Burning sensation in center or epigastric of chest |
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How is GERD relieved? |
Antacids May also be relieved by Nitro |
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What type of tenderness may be felt with chostochrondritis? |
Pinpoint |
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What should be assessed when a patient complains of fatigue and fainting? |
When did start or worsen Diet Medication - specifically iron Associated symptoms Alleviating factors Aggravating factors Loss of consiousness |
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What should be obtained when a patient complains of fainting or fatigue? |
Labs |
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What questions are asked when a patient has shortness of breath in a cardiac assessment? |
How long When does it occur? Day/night? Interfere with ADL's or sleep Alleviating or aggravating factors |
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What would a patient say that would be a sign of heart failure? |
Cannot lay down because lungs feel like they fill up with fluid |
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What is a big reason for intermittent claudication? |
Smoking |
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When is edema unusual? |
When still there in the morning |
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When is a small amount of leg edema normal? |
In older adults |
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What are question asked when a patient has leg edema and/or pain during a cardiac assessment? |
Where located - bilateral or unilateral When did it start Associated symptoms Alleviating symptoms Aggravating symptoms |
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What techniques are used during a physical exam of the cardiac system? |
Inspection Palpation Auscultation |
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What type of chest wall inspection is described as an abnormal forceful movement of chest wall, usually at the apex? |
Heave |
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What is damaged when a heave is noticed on inspection?
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Muscle completely damaged - usually equals death |
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What is described as a forward thrust of the chest wall but that is not as dramatic as a heave? |
Lift |
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What is described as a small area of the chest wall, usually apical, sterno-clavicular, epigastric? |
Pulsation |
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Where is a retraction seen on the chest wall? |
Sternal, muscles of chest wall, apical space
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What general appearance is done during inspection in the cardiac system? |
Skin color Nails Breathing effort Expression/posture JVD |
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When should JVD be seen? |
Lying down |
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What is described as a fine vibration due to turbulent blood flow? |
Thrill |
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How is a thrill assessed? |
Use of palm on sternum and apex of heart |
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What grade is a thrill? |
4 or above |
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Where is the point of maximum impulse? |
Apex of heart 5th intercostal space Left midclavicular line |
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What is determined when palpating pulses? |
Rate Rhythm Contour |
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Which pulses are checked and described by the rate, rhythm, and contour? |
Brachial Radial |
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Where is pulse palpated for amplitude? |
Temporal artery Carotid Dorsalis pedis Post tibial Femoral Popliteal |
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What are skin and nail assess for during a cardiac assessment? |
Turgor Color Edema Clubbing Temperature Capillary refill Moisture Skin intergrity |
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Where is 3+ pulse normal? |
Carotid |
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How is normal contour described? |
Smooth |
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Is pitting edema subjective or objective? |
Subjective |
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Describe 4+ pitting edema. |
Takes longer than 30 seconds to rebound |
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Describe these auscultation sites |
1. Aortic 2. Pulmonic 3. Erb's 4. Tricuspid 5. Mitral |
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Do you listen with diaphragm or bell during a cardiac assessment? |
Both |
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Normal S1 and S2 are heard because |
Closure of valves |
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S3 and S4 are described as |
Extra sounds |
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What causes a split S1 sound? |
Valves no closing at the same time Mitral valve closes first then tricuspid |
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Where is split S1 heard best? |
Tricuspid area |
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S1 is described as what sound?
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"Lub" |
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Which heart sound is heard at the beginning of systole? |
S1 |
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Which valve is heard because of the close of mitral and tricuspid valves? |
S1 |
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Where is S1 heard loudest at? |
Apex (1st floor) |
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What is the S2 heart sound described as? |
"Dub" |
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What heart sound is heard at the beginning of diastole? |
S2 |
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Which heart sound coincides with the carotid pulse? |
S1 |
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What valves are closing that makes the S2 sound? |
Aortic and pulmonic valves |
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Where is S2 heard the loudest? |
Aortic and pulmonic areas (2nd floor) |
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Where is a split S2 sound heard best? |
Pulmonic or Erb's point |
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Which heart sound is described as in early diastole? |
S3 |
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What sound is heard with an S3 heart sound? |
Low pitched
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Where is S3 heard best? |
Mitral area with patient lying on left side |
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When is it normal to hear an S3? |
People less than 30 years old, pregnant women, children |
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What is S3 an indicator for? |
Heart failure |
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Where is S3 usually found |
left side also known as floppy ventricle |
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Which heart sound is heard because of atrial contraction against stiff ventricle? |
S4 |
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Which ventricle is caused by rapid, large volume ventricular filling? |
S3 |
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How does an S4 heart sound usually sound? |
soft and low-pitched
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When will a hear sound best be heard? |
at end of diastole |
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Which heart sound is described as a ventricular gallop? |
S3 |
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When is it normal to hear an S4 heart sound? |
less than 30 year old or child |
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Where is the S4 heart sound heard best? |
Mitral area with patient lying on left side |
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What does an S4 heart sound indicate? |
Ventricular hypertrophy |
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Which heart sound is described as an atrial gallop? |
S4 |
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What heart sound is a result of turbulent blood flow? |
Murmur |
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What is assessed when describing a murmur? |
Timing Duration Pitch Quality Location |
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What can murmurs be caused by? |
Infection of valves Stenosis of valves Blood clot |
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How would a continuous murmur be described? |
From S1 to S2 or S2 to S1 |
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Describe quality of a murmur? |
Blowing Harsh Musical Rumbling Soft |
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How is Grade 1 intensity described? |
Barely audible |
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What grade is an audible heard with stethoscope above chest, with a visible thrill? |
Grade 6 |
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What grade is described as clearly heard? |
Grade 3 |
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Describe Grade 2 intensity. |
Quiet |
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Which intensity grade is loud with a thrill? |
Grade 4 |
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Describe grade 5. |
Easily heard, strong thrill |
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How is pitch described? |
Low Medium High |
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How is location of heart sound described? |
Describe by which ausculatory site the sound is heard the loudest |
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What is assessed when looking at jugular venous pressure?
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Pulsations Strength Amplitude Distension |
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How is jugular venous distention assessed? |
Lower head of bed to 45 degrees |
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Is JVD normal? |
NO |
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What 2 methods can be used to measure jugular venous pressure? |
Hemodynamic monitoring Ruler and tongue blade |
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What does a carotid bruits indicate? |
Occlusion in carotid arteries |
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What part of the stethoscope is used to assess carotid arteries? |
Bell |
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What is described as murmur of carotid artery that is partially blocked? |
Bruit |
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What is a normal finding in older adults during a cardiac assessment? |
Cardiac out decreases by 30-40% Myocardium becomes rigid: S4, soft systolic murmur |
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What are symptoms of a myocardial infarction? |
SOB, Chest or abdominal pain Radiation Unrelieved by NTG Change in position does not help |
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What are common problems and heart conditions? |
Myocardial infarction Angina pectoris Heart failure Hypertension |
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What are symptoms of angina pectoris? |
Temporary Same as MI Relieved by NTG |
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What is the criteria for clearing a blockage? |
Must be 70% blocked |
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What type of angina is relieved by rest or Nitro, has no other symptoms or radiation, occurs on exertion, and only lasts a few minutes? |
Stable angina |
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What type of angina is described as associated with N/V, SOB, or radiation of pain, occurs at rest, and lasts more than a few minutes? |
Unstable |
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What are the cardinal signs of heart failure? |
Dyspnea Rales or crackles upon auscultation S3, S4 Systolic murmur Increased JVP or JVD |
