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126 Cards in this Set
- Front
- Back
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Thoracic Cage |
contains sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles, and cartilage |
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Thoracic Cavity |
mediastinum, pleural cavity, lungs (apex/base) |
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where is the top and bottom of lung tissue |
The top spreads above our clavicles and down to the diaphragm. (no tissue below the 6th rib) |
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Apices |
plural for apex |
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Lobes of the Lung |
5 lobes - Right upper, middle, and lower lobe and left upper and lower lobe |
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What lung lobe can we not see posteriorly |
Right Middle Lobe |
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Pleural Membranes |
Parietal pleura, Visceral pleura, and pleural space/cavity |
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Parietal Pleura |
lines the chest wall |
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Visceral Pleura |
lines the lungs |
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Pleural Cavity/Space |
keeps lungs from creating friction |
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Pleurisy |
friction of lungs/irritation, associated with pain when taking a deep breath. Can hear the rubbing |
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Structure of the Respiratory System |
Trachea, bronchi, bronchioles, alveolar sacs, alveoli |
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Trachea |
rings of cartilage built up and conveys air into the lungs |
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Bronchi |
major air passage of lungs that takes air from windpipe |
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Bronchioles |
minuet branches in which air travels to the lungs |
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Alveolar Sacs |
dialatation of alveoli to hold oxygen |
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Alveoli |
small cavity of lungs |
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Atelectasis |
when alveoli collapse |
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Barrel Chest |
refers to an increase in the anterior posterior diameter of the chest wall resembling the shape of a barrel, most often associated with emphysema. There are two main causes of the barrel chest phenomenon in emphysema |
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Hypertrophy of Neck |
using accessory muscles to breathe better |
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Landmarks on Anterior Chest |
Suprasternal Notch, Sternum, Sternal Angle, Ribs/intercostals, and Costal Angle |
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Landmarks of Posterior Chest |
Vertebra Prominens (C7), Spinous process (T1=First Rib). T3 separates the upper and lower lobe, Inferior border of scapula is 8th rib, and the 12th rib |
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Suprasternal Notch |
"U-Shaped", bones that make a U-Shape on the top of the rib cage |
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Sternum |
Breastbone |
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Sternal Angle |
Angle of Louis - continuous with 2nd rib, should be able to feel this in the middle of the 2nd ribs |
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Costal Angle |
@ Xiphoid Process - 90 degrees, at the end of the breast bone |
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Dyspnea |
Difficulty breathing |
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Insomnia |
Difficulty sleeping |
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Angina |
Chest pain |
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cough and sputum |
look for color and consistency |
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Types of Inspection - Respiratory |
nasal flaring, color, nails, configuration of chest (chest deformities), accessory muscles, positioning |
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Inspection - Respiratory |
Things we can see and observe without touching the patient - creeping |
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Types of Palpation - Respiratory |
tenderness, crepitus, tactile fremitus, expansion |
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Tenderness - Respiratory |
Should not have any tenderness to chest |
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Crepitus |
crunching sound - subcutaneous air |
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Tactile Fremitus |
you feel fremitus - have the patient say "Blue Moon" - You feel the vibrations, they're stronger up high |
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Chest Expansion |
hands on the patients back/front at the base of the lungs, when the patient inhales, both hands should move symetrically |
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Types of Percussion - Respiratory |
Resonance, flat, hyper-resonance, and dull |
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Resonance |
Sound should continue - good to hear |
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Flat |
like when percussing a bone - no resonance |
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Hyper- Resonance |
continuous sounds that go past the normal - echo sounding |
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Dull |
Dense |
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Types of Auscultation - Respiratory |
Normal, Adventitious, voice sounds |
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Normal Auscultation - Respiratory |
tracheal, bronchial, bronchiovesicular, and vesicular |
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Adventitious/Abnormal Auscultation - Respiratory |
rales, rhonchi, wheeze, stridor |
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Rales |
crackles |
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Rhonchi |
gurgles/rattling |
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wheeze |
high-pitched continuous |
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Stridor |
loud, high-pitched crowing - can hear without a stethoscope |
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Pleural Friction Rub |
low pitch grating/rubbing |
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Where does aspirated food go |
to the right upper lung |
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Normal Assessment Findings - Respiratory |
symmetric chest shape, anterior-posterior diameter less than the transverse diameter (1:2), normal chest shape w/out deformities, no muscle retractions when breathing, quiet - unlabored respirations, reg rate/rhythm of 12-20, skin color matching the rest of the body's color |
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Normal Breath Sounds - Tracheal |
Over Trachea I<E |
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Normal Breath Sounds - Bronchial |
Over Bronchus E>I |
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Normal Breath Sounds - Bronchiovesicular |
Over major bronchi I=E |
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Normal Breath Sounds - Vesicular |
Over Terminal Bronchi I>E |
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Types of Voice Sounds |
Bronchophony, Egophony, Whispered Pectoriloquy |
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Bronchophony |
Have patients say "ninety-nine" - if you hear this perfectly, this is bad |
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Egophony |
Have patient say "E" - If you hear this as "A", this is bad |
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Whispered Pectoriloquy |
Have patient whisper "1-2-3" - If this is heard clearly, that is bad |
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Normal Voice Sounds |
Everything we hear for the tests should be a little muffled - clear sounding is a bad indication |
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Abnormal Respiratory Sounds |
Eupnea, Tachypnea, Bradypnea, Hyperventilation, Hypoventilation, and Cheyne-Stokes |
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Eupnea |
Good breath sounds |
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Tachypnea |
Increased breaths |
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Bradypnea |
Decreased breaths |
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Hyperventilation |
Increased or rapid breathing |
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Hypoventilation |
Decreased or slowed breathing |
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Cheyne - Stokes |
Sick-like breathing pattern found with patients that are dying |
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Orthopnea |
Difficulty breathing while lying flat |
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Landmarks - Cardiovascular |
Precordium, base of heart, and apex of the heart |
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Precordium |
clavicle to xiphoid, overlying heart and great vessels |
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Base of Heart |
located at the 2nd intercostal space |
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Apex of Heart |
located at 5th intercostal space |
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What are the left and right atriums |
Receiving chambers |
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What are the left and right ventricles |
Pump the blood out of the heart |
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What does the right side of the heart do |
Transports unoxygenated blood to the lungs |
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What does the left side of the heart do |
transports oxygenated blood to the systemic circulation |
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What do the 4 heart valves facilitate |
unidirectional movement of the blood through the heart and prevents backflow |
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AV Valves |
Atrio-Ventricular Valves - Tricuspid & Mitral (Bicuspid) |
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SL Valves |
Semilunar Valves - Pulmonic & Aortic |
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Neck Vessel Structures |
Carotid Arteries and Jugular Veins |
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Carotid Arteries |
supply oxygenated blood to the head and neck - located between the trachea and SCM |
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Jugular Veins |
Returns unoxygenated blood to the heart - Jugular Vein distention reveals info about right side of heart |
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Why wouldn't we palpate both carotid arteries at the same time |
your patient could potentially pass out because of the cut off of blood flow |
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Types of Inspection - Cardiovascular |
General Appearance, Jugular Veins, carotid arteries, hand/fingers, and chest |
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Type of Palpation - Cardiovascular |
Pulsation, heave, vibratory sensation (thrill), Carotid Pulses, Apical Impulse |
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Heave |
a lift you can feel on the chest |
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Vibratory Sensation (Thrill) |
like a cat purring |
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Types of Percussion - Cardiovascular |
Cardiac Border - dull percussion tone over the border of the heart - we don't really do this anymore because we have tests we can do |
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Types of Auscultation - Cardiovascular |
Carotid Arteries, Apical Pulse at the five listening points |
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5 Listening Points of the Heart |
APETM - All Physician's Enjoy Taking Money Aortic, Pulmonic, Erb's, Tricuspid, & Mitral |
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What listening points are on the left of the sternum and the right of the sternum |
Left Side - Pulmonic, Erb's, Tricuspid, & Mitral Right Side - Aortic (only one!) |
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What should we hear at the APET listening sites |
Lub-Dub and move to next site |
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What are we listening for at the Mitral site |
we're listening for one whole minute while counting the heart rate (BPM) and assessing the rhythm (regular/irregular) |
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S1 Normal Heart Sounds |
closure of the AV valves (lub) - heard loudest at the apex, listen at tricuspid & mitral points |
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S2 Normal Heart Sounds |
Closure of semilunar valves (dub) - heard loudest at the base, listen at the pulmonic and aortic points |
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S3 & S4 Heart Sounds |
If heard, they are considered "extra" heart sounds - could be murmur or heart defect |
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Perfusion |
arterial tissue perfusion |
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chest pain - what do we do |
OLDCART/ICE to find out exactly where the chest pain is |
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Risk factors - Cardiovascular |
Age, Lifestyle, and activity |
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Bruit |
turbulent blood flow - hear a whooshing sound |
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Murmur |
heard from valve dysfunction |
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how do we get apical pulse |
by auscultating |
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how do we get apical impulse |
by palpating |
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what do arteries transport |
transport oxygen and blood via the heart to the organs and tissue capillaries (perfusion) |
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how do arteries work |
has smooth muscle layer that contracts and relaxes in response to changes in blood volume |
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what does the arterial pulse reflect |
the pumping of the heart during systole |
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what do veins transport |
unoxygenated blood from capillaries to the right side of the heart |
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how do veins work |
thinner walls make veins more distensible; can accumulate large amounts of fluid |
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what do one way valves in veins do |
creates a one way flow of blood that allows it to flow against gravity and back to the heart |
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Function of Lymph System |
retrieve excess fluid from tissue spaces and returns to the bloodstream. |
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what can be the cause of lymphedema |
damage to the lymph system or the removal of lymph nodes |
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what do lymph nodes filter |
filter out micro-organisms (like bacteria), and foreign substances like toxins |
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where are the superficial lymph nodes located |
head/neck, axillary, epitrochlear (elbow), & Inguinal |
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Inspection of arterial insufficiency |
skin is pale/shiny, hair loss distribution, distal/dry ulcer |
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Palpation of arterial insufficiency |
absent/diminished pulse, cool temp, no edema |
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Inspection Venous Insufficiency |
swollen leg, darkened hyperpigmentation at ankle, ulcers on leg and ankle |
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Palpation Venous Insufficiency |
moderate to severe pitting edema, palpable pulse (depending on edema), hard skin/normal temp |
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what works best to relieve venous insufficiency |
elevation and compression |
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what are the 5 P's |
Pain, pulse, pallor, parasthesia, & paralysis |
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Homan's Test |
an assessment for DVT - pt pushes foot down against hand and if pain is felt, it could dislodge the DVT and cause it to become a pulmonary embolism |
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what is important to know about Homan's Test |
***We no longer practice this*** |
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Allen Test |
cut off blood supply at the wrist by pressing on the 2 arteries - hand should turn white - let go of one artery at the time and check the refill rate |
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what does the Allen Test check |
the patency of the radial and ulnar arteries |
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CMS Checks |
Circulation, Motion, Sensation |
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how do we compare limbs |
always bilaterally |
