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134 Cards in this Set

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Briefly describe the physiology of respiration.
The physiology of respiration is the transport of oxygen from the outside air to the cells within tissues and the transport of carbon dioxide in the opposite direction.
Name the 4 major functions of the respiratory system.
1. supplying oxygen to the body for energy production
2. removing carbon dioxide as a waste product of energy reactions
3. maintaining homeostasis of arterial blood
4. maintaining heat exchange
Name the surface landmarks to locate the apex of the lungs.
Posterior: C7-T1
Anterior: 3-4cm above inner third of clavicles
Name the surface landmarks to locate the base of the lungs.
Posterior: T10-T12 (with inspiration)
Anterior: 6th rib MCL
Name the surface landmarks to locate the lateral part of the lungs.
Apex of axilla to 7th-8th rib MAL
Name the surface landmarks to locate the tracheal bifurcation.
Posterior: T4-T5
Anterior: Angle of Louis
Name the surface landmarks to locate the right lung oblique fissure.
T3 to 5th rib MAL and 6th rib MCL
Name the surface landmarks to locate the right lung horizontal fissure.
5th rib MAL to 4th rib at R sternal border
Name the surface landmarks to locate the left lung oblique fissure.
T3 to 6th rib MCL
The base of scapulae corresponds with what ribs?
7th and 8th rib
What is the sequence of your respiratory assessment?
1. Inspect
2. Palpate
3. Percuss
4. Auscultate
Why is it critical you move systematically during respiratory assessment?
It allows you to compare side to side.
COPD
Chronic Obstructive Pulmonary Disease. It is the presence of airflow obstruction caused by chronic bronchitis or emphysema.
Emphysema
destruction of elastin and collagen, the supporting structures of the lung which leads to capillaries around alveolar walls and the alveolar walls are destroyed.
Bronchitis
excessive production of mucus, chronic inflammation and narrowing of airways. Their alveolar structures and capillaries are fairly normal.
What is the fourth leading cause of death in the US?
COPD
What are normal findings for the anterior-posterior diameter and transverse for a healthy adult?
AP<T or 1:2 ratio
What are normal findings for the anterior-posterior diameter and transverse for elderly and children under 6 years old?
AP=T
What is a normal finding for the angle of the ribs?
45 degrees downward
How do we explain normal breathing?
regular and unlabored
When inspecting during respiratory what are normal findings for the nails?
-Slightly curved
-Nail bed angle 160 degrees or less
-Pink or dark brown in color
When inspecting during respiratory what are normal findings for the lips?
Pink
What mm are assess during inspection of the respiratory system?
symmetrical movement of trapezius, SCM, scalenus
What are normal findings for the supraclavicular and intercostal spaces in the respiratory system?
no retractions and no buldges
What does a barrel chest refer to?
AP=T with pulmonary disease
Pectus Excavatum
deviated in-between chest
Pectus Carinatum
sticks outward in-between chest
Dyspnea
shortness of breath
Orthopnea
shortness of breath while laying down
Tripod Position
leaning forward on arms to assist with breathing
What are abnormal findings for the nails in a respiratory assessment?
-Clubbing: nail base greater than 180 degrees
-Nails Thicken
-Assoc with CV/resp disease
What are abnormal findings for the lips in a respiratory assessment?
cyanotic
What are the abnormal findings for skin in the respiratory assessment?
cyanosis
pallor
What are the abnormal findings for accessory mm in respiratory assessment?
hypertrophied SCM, scalenus, or trapezius
Pursed Lip Breathing
Using the resistance of your lips to breath. It helps keep the alveoli open longer.
What are abnormal findings in the supraclavicular and intercostal spaces during respiratory assessment?
retractions suggest obstruction of resp tract
What is it called if you hear wheezing during inspiration without a stethoscope?
Stridor (obstruction)
If sputum is white and clear what would this possibly indicate?
cold/bronchitis
If sputum is yellow and green what would this possibly indicate?
bacterial infection
If sputum is pink and frothy what would this possibly indicate?
fluid in the pleural cavity
If a cough is continuous what may this indicate?
respiratory infection
If a cough is in the evening what may this indicate?
exposure to irritant at work
If a cough is at night time what may this indicate?
sinusitis
If a cough is in the morning time what may this indicate?
chronic bronchial infection
Why are we concerned if a patient has a spinal deficit?
It is going to place abnormal pressures on the respiratory system and make it difficult to breathe.
Scoliosis
lateral deviation
Kyphosis
humpback
Lordosis
swayback
What are normal findings when palpating during the respiratory system assessment?
-no m/l/t
-skin is warm and dry
What sounds will you hear over lung tissue?
Resonance
What is the Diaphragmatic Excursion used to assess?
Where the diaphragm is located.
What is the technique for the Diaphragmatic Excursion?
Posterior side only. Have patient take deep breath and hold while you quickly percuss down back until you reach dull sound. Mark this location. Have patient take another deep breath and hold it. You percuss from previous point down until you hear dull sounds. Mark this spot. You measure between these two spots. You are locating the diaphragm.
What are normal findings for the Diaphragmatic Excursion test?
Normal is 3-5cm in between the spots you mark on the back.
What is the technique for the Thoracic Expansion?
Place thumbs 3-5cm apart on chest (anteriorly along costal margin) or T9-T10 (posteriorly). Then ask patient to breathe deeply and observe separation of thumbs.
What is the normal findings for Thoracic Expansion?
3-5cm in between thumbs.
What is the technique for the Tactile Fremitus?
Patient repeats the word "99" while the practitioner systematically palpates the thorax from apex to base.
What is normal findings for the Tactile Fremitus?
mild fremitus and symmetrical but R>L
When would you see decreased fremitus?
Pneumothorax (lung collapse)

This is because there is an obstruction that creates a barrier between wall and lung.
When would you see increased fremitus?
Pneumonia

This is because of compression/consolidation of tissue.
What type of sounds would you hear with Pneumothorax
Hyperresonant
What sound would you hear over the heart?
dullness
What sound would you hear over bone and mm?
flatness
What sound would you hear over the abdomen?
tympany
What sound may you hear over children lung tissue?
hyperresonant
Where will you hear vesicular breath sounds?
ausculated over majority of lung tissue (anterior & posterior)
Where will you hear bronchovesicular breath sounds?
ausculated over bronchi. first second intercostal spaces (anterior) and in between scapulae (posterior).
Where will you hear bronchial breath sounds?
ausculate over the trachea.
Name five types of abnormal breathing sounds.
1. crackles
2. rhonchi
3. wheezes
4. friction rub
5. absent sounds
Describe the technique to assess vocal resonance.
Ask your patient to repeat a word or number while you ausculate through stethoscope in same areas as you would for general ausculation.
What are normal findings for the vocal resonance?
spoken voice should be soft and muffled.
What are abnormal findings for vocal resonance?
spoken voice sounds loud and clear
What is the pitch and amplitude of vesicular breath sounds?
low and soft
What is the pitch and amplitude of bronchovesicular breath sounds?
intermediate
What is the pitch and amplitude of bronchial breath sounds?
loud and high
List clinical findings of a patient who arrives with Pneumothorax.
You will inspect anxiousness, shortness of breath (SOB), deviated trachea, and expansion on one side would be decreased. Percussion over the air in pleural space would sound hyperresonant. Breath sounds would most likely be absent. There would also be a decreased fremitus due to the lung collapse.
List clinical findings of a patient who arrives with Pneumonia.
A patient with Lobar Pneumonia would have terrible coughing, unequal expansion, and could be tripoding to help breathe.They will have much shorter diaphragmatic excursion and increases fremitus. When doing percussion you will hear more dull sounds. You could also hear crackles and wheezes.
What does the Doppler do?
Provides amplification of blood flow through an artery.
How do we assess the Peripheral Vascular System?
-Inspect Skin
-Hair Distribution
-Venous Pattern
-l/m/t
-Assess Peripheral Pulses & BP
-Nails for Capillary Return
How long should it take for normal color to return after blanching?
N=1-2 seconds
Name the major structures of the heart.
- R and L Atriums
- R and L Ventricles
- AV Valves (tricuspid & bicuspid)
-Semilunar Valves (pulmonic & aortic)
Name the great vessels of the heart.
-Superior & Inferior Vena Cava
-Pulmonary Arteries
-Pulmonary Veins
-Aorta
Name the layers of the heart wall.
Myocardium
Endocardium
Pericardium
What is the location of the heart?
-Thoracic Cavity
-Behind Sternum
-Base: 2nd-3rd rib
-Apex: 5th-6th rib MCL
What is deoxygenated blood route?
-Blood from upper body returns from superior vena cava
-Blood from lower body returns from inferior vena cava
-Both dump into the R atrium
-Through the tricuspid valve and into R ventricle
-Through pulmonic valve and out pulmonary arteries to the lungs to get oxygen and dump carbon dioxide.
What is the route for oxygenated blood through the heart?
-Blood returns from lungs through the pulmonary veins.
-Then into the L atrium and through the bicuspid valve.
-Blood dumps into L ventricle.
-Then blood goes through aortic valve and into the aorta.
-Finally oxygenated blood to the systemic circulation.
What is the technique for jugular vein assessment?
Use tangential light with head of bed 20-45 degrees. Use Angle of Louis as landmark and use ruler to measure. Measure vertical distance between sternal angle and highest level of jugular pulsation.
What are normal findings for the jugular vein assessment?
N= 2cm or less
What does the jugular venous pressure indicate?
The hearts right side activity and pressure.
What is JVD (jugular venous distention) indicate?
right sided heart failure
Clinical findings of left sided heart failure.
-Dyspnea
-Cough producing frothy mucus
-Fluid accumulation in lungs
-Fatigue
-Pulmonary Edema
Clinical findings of a patient with right sided heart failure.
-Enlarged Liver
-Cyanosis
-Enlarged Jugular Veins
-Elevated Venous Return
-Edema (ankles & feet)
-Fatigue
-Dyspnea
Describe the risk factors for heart disease.
-Diet (high in fat & cholesterol)
-Smoking
-Heavy drinking
-Obesity
-Physical inactivity
-HTN
-DM (diabetes mellitus)
-Age
-Heredity
Explain Split S1 and the Etiology:
-The AV valves are opening at different times.
-Rare (may be normal or disease)
Etiology: ventricular pressure higher on L and depolarization faster on L
Explain Split S2:
-More blood return to R Atrium
-R ventricle increases SV (delays pulmonic valve close)
-L ventricle decreases SV (early aortic valve close)
Split S2 Etiology:
More to the right , less to the left. Delayed pulmonic valve closure and early aortic valve closure. **You can create this by many deep breaths**
What diseases may Split S2 be associated with?
Atrial Septal Defect
Right Ventricular Failure
Is the Split S2 sound heard on inspiration, expiration, or both?
Only inspiration.
The S1 sound indicates the closing of what?
The AV Valves (tricuspid & bicuspid)
The S2 sound indicates the closing of what?
The Semilunar Valves (aortic & pulmonic)
Where is the S1 sound heard the loudest?
Apex of the heart
Where is the S2 sound heard the loudest?
The base of the heart.
The S1 sound indicates the beginning of what?
ventricular systole
The S2 sound indicates the beginning of what?
ventricular diastole
Where is the Bicuspid Valve best heard?
5th ICS (L) MCL
Where is the Tricuspid Valve best heard?
4th ICS (L) SB
Where is the Pulmonic and Aortic Valve best heard?
3 ICS (L) SB
Where is the Pulmonic Valve best heard?
2 ICS (L) SB
Where is the Aortic Valve best heard?
2 ICS (R) SB
What are the head-to-toe systemic effects important to the cardiac assessment?
-Skin (edema, color, temp)
-VS (BP & pulse)
-Nails (color & clubbing)
-Respiratory System (dyspnea, cough)
Explain S3 heart sound:
-Early diastole
-Hear right after S2
-Sound of blood hitting cardiac mm
Are we concerned about S3 sounds?
We are not concerned about the S3 unless we can hear it with a stethoscope. Abnormal over age 40.
Explain S4 heart sound:
-Late diastole
-Hear right before S1 (atrial kick)
-Inflow of blood vibrates the structures and valves
What is Pericardial Rub?
inflammation of pericardial sac and viseral surfaces
Where is the Pericardial rub best heard?
At the apex of the heart.
What are murmurs?
Blowing, swishing sounds caused by turbulent blood flow through the heart.
Name the three types of murmurs.
1. Innocent
2. Functional
3. Pathologic
When may you hear an innocent murmur?
In children and young adults
When may you hear a functional murmur?
After exercising or during pregnancy.
When may you hear a pathologic murmur
When there are structural abnormalities.
What is the difference between bruit and murmur?
murmurs are heard in the heart and bruits are heard in peripheral vessels or outside of the heart.
What are causes of murmurs?
-increased blood flow (exercise)
-defective valves
-abnormal opening in heart
What is the percentage of people over 85 with a murmur?
50%
What will a Grade I murmur sound like?
very soft
What will a Grade VI murmur sound like?
audible with stethoscope barely on chest
What is a retraction in the heart?
pulling in of tissue on precordium related to position or activity of the heart
Is SI retraction normal anywhere?
Yes only at apical impulse.
What are lifts and heaves of the heart?
sustained forceful thrust of ventricle during systole
When are lifts and heaves normal?
Never
Where is the Apical Pulse located?
4th-5th ICS (L) MCL
If you have trouble finding the Apical Pulse what could you do?
Ask pt. to lie on left side to bring it closer to the skin
Have pt exhale and hold breath
What does a thrill indicate?
turbulent blood flow
How do you assess thrills?
What will it sound like?
Palpation only. Sounds like kitten purring.
How do we assess for pitting edema?
Use a scale 1+ to 4+. 4+ indicates the worst pitting
How do we assess the carotid arteries?
-Inspect & Palpate
-Should be bounding
-Ausculate for middle aged to elderly for bruits.