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336 Cards in this Set
- Front
- Back
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pressure wave in artery; only felt where close to skin over bone
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pulse
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pulse palpated in front of ear
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temporal artery pulse
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pulse palpated in groove between sternomastoid muscle and trachea
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carotid artery pulse
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pulse in bicept-tricept furrow;surfaces in elbow medial
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brachial artery pulse
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pulse medial to radius at wrist
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radial pulse
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pulse same relation to ulna; deeper and difficult to feel
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ulnar artery pulse
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pulse: major artery to leg; passes under inguinal ligament
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femoral artery pulse
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pulse: lower thigh; posterior
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popliteal artery pulse
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pulse top of foot
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dorsalis pedis
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pulse:back of leg - dorsal to ankle bone
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posterior tibial pulse
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deficient supply of oxygenated arterial blood to a tissue by obstruction of blood vessel
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ischemia
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run along deep arteries; conduct more venous return from legs called femoral and popliteal
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deep veins
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veins that are the great and small saphenous
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superficial veins
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vein - inside leg, starts medial side of dorsum of foot.
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great saphenous
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vein: outside leg; starts lateral side of dorsum of foot,
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small saphenous
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connecting veins join two sets. One-way valves. Route blood from superficial into deep veins
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perforators
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veins have ability to stretch
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capacitance vessels
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Dilated and tortuous (varicose) veins create ___________-where lumen is so wide the valve cusps cannot approximate this increases venous pressure further dilating the vein. Caused by genetics, obesity and pregnancy
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Incompetent valves
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duct empties into right subclavian. drains the right side of head, neck, arm, thorax, lung and pleura, heart and liver
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right lymphatic duct
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duct that drains rest of body; empties into left subclavian vein
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thoracic duct
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These are functions of ________
1) conserve fluid and plasma proteins that leak out of capillaries 2) part of immune system that defends body against disease 3) absorb lipids from intestinal tract |
lymphatic system
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process of ________ system
1) detects and eliminates foreign pathogens (abnormal and mutant) by phagocytosis |
process of immune system
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small oval clumps of lymphatic tissue along vessels. They filter out fluid before it’s returned to bloodstream and filter microorganisms if enlarges: occurs with infection, malignancies, or inflammation
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lymph nodes
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nodes that drain head and neck
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cervical nodes
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nodes that drain breast and upper arm
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axillary nodes
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nodes in antecubital fossa; drain hand and lower arm
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eiptrochlear node
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nodes in groin; drain lower extremities, external genitalia, and anterior abdominal wall
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inguinal nodes
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an organ located in left upper quadrant of abdomen; 4 functions:
1) destroy old red blood cells 2) produce antibodies 3) store red blood cells 4) filter microorganisms from blood |
spleen
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(glands) (palatine, adenoid, lingual) respond to inflammation
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tonsils
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(gland) flat, pink-gray gland located in superior mediastinum behind sternum in front of aorta. develops T lymphs in children; serves no function in adults.
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thymus
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blood vessels become rigid with age. Produces rise in systolic blood pressure
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arteriosclerosis
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deposits of fatty plaques on intima of arteries
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atherosclerosis
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# of blocks walked or stairs climbed to produce pain
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Claudication distance
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associated with impotence (Leriche’s syndrome)
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Aortoiliac occlusion
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bilateral in arms or legs caused by systemic problems (heart failure) unilateral with local obstruction or inflammation
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edema
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check with hands near level of heart, index of peripheral perfusion and cardiac output.
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capillary refill
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What kind of pulse:
hyperkinetic states (exercise, anxiety, fever, anemia and hyperthyroidism |
full, bounding pulse
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What kind of pulse:
with shock and peripheral arterial disease |
weak, thready pulse
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(enlarged node)
occurs with infection of hand or forearm |
enlarged epitrochlear node
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test that evaluates adequacy of collateral circulation prior to cannulating radial artery; simple useful test subject to error. If pallor persists or sluggish return to color: suggests occlusion of collateral arterial flow. Avoid radial cannulation until adequate circulation
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modified Allen test
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what causes skin to be:
thin, shiny atrophic skin, thick-ridged nails, hair loss, ulcers, gangrene |
malnutrition
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what causes skin to be:
malnutrition, pallor, coolness |
arterial insufficiency
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lymphedema-asymmetry 1-3cm
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mild
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lymphedema-3-5cm
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moderate
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lymphedema-more than 5cm
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severe
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what kind of ulcers-bacterial invasion of poorly drained tissues
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venous ulcers
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ulcers on tips of toes, metatarsal heads, lateral malleoli
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arterial deficit
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calf pain when flexing knee and compressing calf muscle against tibia
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Homans sign
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bruit occurs with turbulent blood flow check if pulse is weak
popliteal pulse-normal if difficult to localize. |
femoral arteries
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what causes: elevational pallor, delayed venous filling
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arterial insufficiency
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what causes dependent rubor(deep blue-red color) motor loss
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severe arterial insufficiency
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what causes loss of vasomotor tone and pooling of blood in veins
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chronic hypoxia
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sensory loss especially with diabetes
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arterial deficit
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which test:
use Doppler stethoscope determine systolic pressure in posterior tibia or dorsalis pedis artery. divide figure by systolic of brachial artery: |
Ankle-Brachial index (ABI)
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episodes of abrupt progressive tricolor change of fingers due to cold, vibration, or stress. lasts minutes to hours bilaterally
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Raynaud's Phenomenon
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removal or damage of lymph nodes with breast surgery/cancer can impede drainage of lymph. Protein-rich lymph builds in interstitial spaces. unilateral swelling, nonpitting brawny edema, threat to body image and reminder of cancer
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Lymphedema
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buildup of fatty plaques (atherosclerosis) and hardening of arterial wall (arteriosclerosis). Deep muscle pain, coolness, pallor, dependent rubor, diminished pulses, trophic skin, systolic bruits, xanthoma formation, distal gangrene
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Arteriosclerosis-Ischemic ulcer
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episodes of abrupt progressive tricolor change of fingers due to cold, vibration, or stress. lasts minutes to hours bilaterally
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Raynaud's Phenomenon
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after acute deep vein thrombosis or chronic incompetent valves : aching pain in calf, worse at end of day and prolonged standing or sitting
Firm brawny edema, coarse thickened skin, normal pulse, petechiae, brown pigment discoloration, dermatitis. Causes increase venous pressure Ulcers occur, uneven edges |
Venous (stasis) ulcer
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incompetent valves permit reflux of blood, Unremitting hydrostatic pressuse makes worse aching, heaviness in calf, ease fatigue, night leg/foot cramps, dilated tortuous veins
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superficial varicose veins
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deep vein occluded by thrombus causes inflammation, blocked venous return, cyanosis, and edema. Causes:bed rest, history of variscose veins, trauma, infection, cancer. in young women used or oral estrogen contraceptives. Sudden onset of intense sharp deep muscle pain, increases warmth, swelling, redness, dependent cyanosis mild or absent, tended to palpation. Requires emergency referral
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Deep Vein Thrombophlebitis
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causes by atherosclerosis. reduces blood flow. risk factors: obesity, cigarette smoking, hypertension, diabetes melliltus, elevated serum cholesterol, sedentary lifestyle, family history of hyperlipidema
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Occlusions
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sac formed in artery wall/ weakens middle of vessel wall. effect of blood pressure creates balloon enlargement.
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aneurysms
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Each pulse has 2 strong systolic peaks, with dip in between. Best assessed at carotid. Assoc. with: Aortic valve stenosis plus regurgitation
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Pulsus Bisferiens
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Beats have weaker amplitude with inspiration, stronger with expiration. Best determined with blood pressure measurement; reading decreases >10 mmHG during inspiration & increases with expiration
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Pulsus Paradoxus
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rhythm is regular, force varies with alternating beats of large and small amplitude. Assoc. with heart failure
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Pulsus Alternans
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rhythm is couples, every other beat comes early normal beat followed by premature beat. Force of beat is decreased due to shortened cardiac filling time
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pulsus bigeminus
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greater than normal force collapses suddenly : Assoc. with aortic valve regurgitation; patent ductus arteriosus
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Water-Hammer (Corrigan's) Pulse 3+
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Easily palpable, pounds under fingertips. Assoc. with hyperkinetic states (exercise, anxiety, fear, anemia, hyperthyroidism
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full, bounding pulse 3+
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Hard to palpate, may fade in and out Assoc. with: decrease cardiac output; arterial disease; aortic valve stenosis
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Weak thready pulse 1+
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Borders – sternum, 12 pairs of ribs, vertebrae, and the diaphragm
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thoracic cage
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points at which the ribs join their cataliges/not palpable
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costochondral junction
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u-shaped depression above the sternum in between clavicles
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suprasternal notch
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“breastbone” 3parts: manubrium, body, xiphoid process
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sternum
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“angle of Louis” articulation of the manubrium & body of the sternum. Helps localize a respiratory finding horizontally
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manubriosternal angle
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Rt & Lt costal margins form an angle at the xiphoid process. 90° of less. Angle increases when rib cage is chronically overinflated : Emphysema
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costal angle
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Posterior thoracic landmarks
flex head, feel bony spur protruding at the base of the neck. ↑ C7 ↓ T1 |
vertebra prominens
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Posterior thoracic landmarks
align with same number ribs till T4. After T4 angle down from vertebral body And overlie the vertebral body & rib below |
spinous processes
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Posterior thoracic landmarks
located symmetrically in each hemithorax. Lower tip at seventh/eighth rib |
inferior border of scalpula
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Posterior thoracic landmarks
midway between spine & person’s side. Free tip. |
twelfth rib
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middle section of thoracic cavity contain: esophagus, trachea, heart, great vessels
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mediastinum defined
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Rt & Lt on either side of mediastinum. Contains Lungs
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pleural cavities
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paired but not symmetrical. Rt lung shorter than left w/3 lobes. Lt lung narrower w/2 lobes Stack in diagonal sloping segments & separated by fissures that un obliquely
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lung lobes
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oblique crosses fifth rib in midaxillary line & terminates at six rib midclavicular line. Horizontal fissure of Rt extends from fifth rib in Rt midaxillary line to 3rd intercostals space
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anterior chest
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almost all lower lobe. ↑ Lobes T1-T3/4. ↓ Lobes down to T10-expiration T-12-inspiration
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posterior
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from the apex of the axilla down to the 7th/8th rib.
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lateral
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envelope between lungs and chest wall.
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pleurae
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lines the outside of the lungs. Dipping down into fissures
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visceral pleurae
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lining the inside of the chest wall & diaphragm
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parietal pleura
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potential space filled with a few milliliters of lubricating fluid. Has vacuum of negative pressure Holds lungs tightly against the chest wall
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pleural cavity
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lies anterior to the esophagus 10 to 11cm long. Begins at cricoid cartilage to just below sternal
Angle into Lt & Rt main bronchi |
trachea
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begins T4/T5 and branch’s into Rt(shorter,wider, more vertical) & Lt.
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bronchi
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transport gases between environment and lung parenchyma(Dead space)
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trachea & bronchial tree
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space that is filled with air but is not available
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dead space
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functional respiratory unit consists of bronchioles, alveolar ducts & sacs, and alveoli. gas exchange across respiratory membrane in alveolar duct & millions of alveoli.
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function of acinus
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1. Supplying O2 to the body for energy productin. 2. Removing CO2 as waste product. 3. Maintaining Homeostasis (acid-base balance). 4. Maintaining heat exchange(less important)
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functions of respiration
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slow,shallow,breathing causes CO2 build up
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hypoventilation
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rapid,deep breathing causes CO2 to be blown off
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hyperventilation
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increase of carbon dioxide in the blood (normal stimulus to breathe)
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hypercapnia
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decrease of oxygen in the blood. Increases respirations. Less effective than hypercapnia
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hypoxemia
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chest size increases. Negative pressure in relation to atmosphere. Diaphragm contracts.
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inspiration
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chest recoils. Passive. Positive pressure within alveoli and air flows out. Diaphragm relaxes.
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expiration
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line that goes straight down the middle along the sternum
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midsternal line
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line that bisects the center of each clavicle at a point halfway
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midclavicular line
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line that extends through the inferior angle of the scapula when the arms are at the sides of the body
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scapular line
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midspinal line
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vertebral line
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line that extends down from the anterior axillary fold where the pectoralis major muscle inserts
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anterior axillary
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line that continues down from the posterior axillary fold where the latissimus dorsi muscle inserts
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posterior axillary
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line that runs down from the apex of the axilla and lies between and parallet to the other two
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mid axillary
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cough:
throughout the day: acute illness (e.g. respiratory infection) |
continuous cough
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cough:
may reflect exposure to irritants at work |
afternoon/evening cough
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cough:
postnasal drip, sinusitis |
night cough
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cough:
chronic bronchial inflammation of smokers |
early morning cough
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hx. of productive cough for 3 months of the year for 2 years in a row
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chronic bronchitis
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coughing up blood
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hemoptysis
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What color mucus:
colds, bronchitis, viral infections |
white/clear mucus
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What color mucus:
bacterial infections |
yellow/green mucus
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What color mucus:
TB, pneumococcal pneumonia |
rust color mucus
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What color mucus:
pulmonary edema, some sympathomimetic medications have side-effect |
pink/frothy mucous
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what symptom is assoc. with this disease:
mycoplasma pneumonia |
hacking cough
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what symptom is assoc. with this disease:
early heart failure |
dry cough
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what symptom is assoc. with this disease:
croup, colds, bronchititis |
barking cough
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what symptom is assoc. with this disease:
pneumonia |
congested
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SOB (stands for)
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shortness of breath
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difficulty breathing when supine
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orthopnea
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awakening from sleep with SOB. Need to be upright to achieve comfort. Diaporesis/Cyanosis
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paroxysmal nocturnal dyspnea
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associated with specific allergen, extreme cold, anxiety
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asthma attacks
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who is at risk for grain inhalation, pesticide inhalation
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farmers
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this area has risk of histoplasmosis(fungal lung infection non-contagious) exposure
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rural midwest
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this area has risk of Coccidiodomycosis (fungal lung infection contagious).
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southwest/Mexico
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marked by inflammation and scarring in forms of nodular lesions in the upper lobes of the lungs.stone cutters, miners.
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potters scillcosis
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2 lung irritants
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asbestos, radon
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carbon monoxide causes:
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dizziness, headache, fatigue
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sulfur dioxide causes
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cough, congestion
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what age group is less efficient respiratory system (decreased vital capacity,less surface area)less torlerance
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older adults
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if pt complains of localized sharp pain consider:
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fractured rib or muscle injury
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transverse is 1:2 to 5:7
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anteroposterior diameter
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Anteroposterior = transverse diameter. Chronic Emphysema from hyperinflation of lungs >90
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barrel chest
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COPD (chronic obstructive pulmonary disease) from forced respirations causes this disease:
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hypertropied neck muscles
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tripod position. Leverage so rectus abdominis, intercostals & neck muscles can aid in expiration
Purse lips. Rectus abdominus&internal intercostals muscle used to force expiration |
COPD
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atelectasis/pneumonia. Thoracic trauma (facture ribs) or with phemothorax
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unequal chest expansion
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Pain accompanies deep breathing
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inflamed pleurae
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palpable vibration. Sound generated from larynx through bronchi&parenchyma to chest wall
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tactile fremitus
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anything obstructs transmission vibrations(obstructed bronchus, pleural effusion, thickening Pneumothorax, or emphysema
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Decreased fremitus
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compression or consolidation of lung tissue(lobar pneumonia). Only present when bronchus is Patent. Note:small areas of early pneumonia do not affect fremitus
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Increased fremitus
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palpable with thick bronchial secretions
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Rhonchal fremitus
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palpable with inflammation of the pleura
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Pleural friction fremitus
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coarse crackling sensation palpable over the skin surface. Air escaping into subcutaneous tissue Occurs in subcutaneous emphysema or thoracic injury/surgery
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Crepitus
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percuss interspace, side to side comparison down lung region. 5cm intervals.avoid ribs/scapulae Predominant lung sound. Cardiac dullness along border.
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percuss lung fields
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low-pitched, clear,hollow sounds in healthy tissue.sounds different in different body types
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resonance
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lower-pitched booming sound. To much air present. Emphysema or pneumothorax
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hypersonance
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soft,muffled thud. Abnormal density in lungs. Pneumonia,pleural effusion, atelectasis,tumor
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dull note
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percuss to map out the lung border in expiration and inspiration. Equal bilaterally 3-5cm/7-8cm
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diaphragmatic excursion
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high level of deafness & absence of excursion(also with atelectasis of lower lobes)
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pleural effusion
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breathing on, bumping stethoscope,Pt. Shivering. Hair.rustling of paper gowns
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extraneous noises
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High pitch, Loud, During inspiration < expiration. Harsh, hollow tubular (trachea/larynx)
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bronchial breath sound
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moderate pitch, moderately loud. During inspiration=expiration. Quality mixed.(over bronchi)
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bronchovesicular
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Low pitch,soft. During inspiration > expiration.Rustling like sound of wind in trees (lung fields
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vesicular
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decreased/absent breath sounds. Secretions, mucus plug, foreign body
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bronchial tree obstruction
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decrease. Loss of elasiticity in lung fibers.↓force of inspired air. Hyperinflation,inhaled, little noise
Hypertrophy of abdominal muscles |
emphysema
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pleurisy,pleural thickening, air(pneumothorax) or fluid(pleural effusion) in the pleural space
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transmission obstruction
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no air is moving in or out. Ominous sign
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silent chest
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occur when consolidation (pneumonia) or compression(fluid in intrapleural space)dense lung High pitched,louder,prolonged expiratory phase. Pause between inspiration/expiration
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increased breath sounds
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sounds that are not normally heard in the lungs.moving air colliding w/secretions. Popping open
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adventitious sounds
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not pathologic.short,popping,crackling sound like fine crackles but do not last a few breaths
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atelectatic crackles
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causes of what kind of crackles in lungs:
pneumonia, heart failure, intersititial fibrosis |
late inspiratory crackles
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causes of what kind of crackles in lungs:
obstructive disease. Chronic bronchitis,asthma, emphysema |
early inspiratory crackles
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causes of what kind of crackles in lungs:
(PICs) fine,sitting to supine.supine to supine legs elevated. Associated with MI |
posturally induced crackles
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Loud,low pitch,bubbling,gurgling w/early inspiration maybe expiration.suctioning helps Pulmonary edema,PN,pulmonary fibrosis, terminally ill
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crackles - coarse
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superficial sound,coarse/low pitched.grating quality(two pieces of leather rubbing). Sounds like crackles but close to ear sounds louder if you push stethoscope hard. Pleuritis, Pain
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pleural friction rub
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high pitched,musical squeaking,polyphonic.expiration.Diffuse obstruction,Asthma/emphysma
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wheeze high-pitched (sibilant)
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low-pitched;monophonic single note, musical snoring, moaning sounds.expiration. bronchitis. Obstruction from tumor
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Wheese –low-pitched (sonorous rhonchi)
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high-pitched, monophonic inspiratory, crowing sound, louder in neck. Croup. Foreign inhalation
obstructed airway(maybe life threatening) Emergency! |
stridor
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listen to chest wall,sound should be soft,muffled, and indistinct. Pathology enhance transmision
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normal voice sounds
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abnormal transmission of sounds from the lungs or bronchi.
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bronchophony
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is an increased resonance of voice sounds
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Egophony
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an increased loudness of whispering listening using a stethoscope on a patient's back.
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Whispered pectoriloquy
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what causes excessive drowsiness/anxiety,restlessness, irritability
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cerebral hypoxia
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clubbing of distal phalanx
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chronic respiratory disease
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what causes: (Nevi) liver disease, portal hypertension
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chest cutaneous angiomas
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lung is obstructed or collapsed(PN).when guarding postoperative incisional pain. Pleurisy pain.
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unequal chest expansion
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obstruction, increased inspiratory effort.
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lung retraction
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trapped air, forced expiration associated with emphysema or asthma
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bulging
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rapid shallow breathing >24 per minute. Fever,fear,exercise,respiratory insufficiency,PN alkalosis,pleurisy, lesions on the pons
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tachypenea
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↑rate & depth. Exertion,fear,anxiety. Diabetic ketoacidosis (kussmaul’s respirations) hepatic coma, salicylate overdose.lesions of midbrain,alter blood gas concentration. Blow off CO2
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hyperventilation
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slow breathing. Less than 10 per/min. drug-induced depression of respiratory center in medulla ↑in intracranial pressure, diabetic coma
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bradypnea
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irregular shallow pattern, overdose narcotics, prolong bedrest, conscious splinting from pain
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Hypoventilation
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cycle respirations wax/wane in regular pattern. Alternating cycle. Heart failure,renal failure Meningitis, drug overdose,increased intracranial pressure. Normal aging person/infant
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Cheyne-Stokes
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pattern irregular. Head trauma, heat stroke, spinal meningitis, encephalitis.
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Biot's respiration
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normal inspiration&prolonged expiration to overcome airway resistance.
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chronic obstructive breathing
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punctuate normal breathing.purposeful to expand alveoli.frequent-emotional dysfunction
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sigh
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atelectasis, pneumonia, and postoperative guarding
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lag expansion
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palpable grating sensation
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pleural friction fremitus
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second it takes the person to exhale from total lung capacity to residual volume. Screen for airflow obstruction.
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forced expiratory time
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6 seconds or longer occurs with obstructive lung disease
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forced expiration
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non-invasive to assess arterial oxygen saturation (SpO2) Normal-97%-98%. Hemoglobin level Acid-base balance and ventilatory status
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pulse oximeter
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safe,simple,inexpensive,clinical measure of functional status. Measure for pulmonary rehabilatation. Stop walk is SpO2 below 85%-88%.
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6 minute distance walk
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equal anteroposterior-to-transverse.ribs horizontal instead of normal downward slope Chronic emphysema/asthma from hyperinflation of lungs
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barrel chest
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sunken sternum&adjacent cartilages.congenital/not symptomatic.
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pectus excavatum
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forward protrusion of sternum, ribs sloping back. No tx. Pigeon breast. Less common.
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pectus carinatum
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a lateral S-shaped curvature of the thoracic&lumbar spine.vertebrae rotation.reduces lung Volume.impaired cardiopulmonary function.
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scoliosis
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exaggerated posterior curvature of the thoracic spine (humpback). Back pain.impairs cardio-pulmonary function
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kyphosis
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conditions that increase density of lung tissue (PN) conducting medium for vibrations
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increased tactile fremitus
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obstruction of vibrations.pleural effusion,thickening,pneumothorax,emphysema.
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decreased tactile fremitus
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vibration felt when inhaled air passes through thick secretions
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rhonchal fremitus
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produced from reduction of lubricating fluid. Sounds like 2 pieces of leather rubbing
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pleural friction fremitus
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cough,↑resp. rate&pulse.cyanosis.decreased chest espansion.tracheal shift to affected side Tactile fremitus decreased/absent.dull.breath sounds decreased.
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atelectasis (collapse)
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infection in parenchyma.edematous/porous.alveoli w/bacteria.↓surface area. ↑resp.rate Chest expansion ↓.dull over lobar PN. Breath sounds louder.voice sounds increased clarity Crackles, fine to medium
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lobar pneumonia
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excessive mucus secretion.inlfammation.hacking,rasping cough,dyspnea,fatigue,cyanosis
Clubbing. Resonant. Prolonged expiration. Crackles over deflated areas –prolonged expiration |
bronchitis
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destruction elastin,collagen.permenent enlargement of air sacs.cigarette smoking.barrel chest SOB,respiratory distress,tachypnea,decreased tactile fremetus&chest expansion.hyperresonant Decreased diaphrmatic excursion. ↓breath sounds.muffled heart sounds.
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emphysema
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allergic,airway resistance.wheezing,dyspnea,chest tightness. ↑resp.rate cyanosis.↓tactile Fremitus. Resonant, breath sounds ↓ voice sounds. Bilateral wheezing on expiration
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asthma (reactive airway)
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excess fluid in intrapleural space.↑resp.dyspnea.dry cough.abd.distension. ↓tactile fremitus Dull to flat. No diaphragmatic excursion on affected side. Sounds ↓. Bronchophony.egophony Whisperd pectoriloquy. No adventitious sounds.
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pleural effusion
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pulmonary congestion. Air sacs deflated.capillaries engorged. SOB,↑resp.rate. orthopnea,
Paroxysmal nocturnal dyspnea.edema,pallor.skin moist.resonant.S3gallop. crackles at base |
congestive heart failure
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free air in pleural space.spontaneous,traumatic,tension. Unequal chest . bulging in interspaces tactile fremitus ↓,tracheal shift to opposite side(unaffected side). Chest expansion↓. BP↓ hyperrsonant, ↓diaphragmatic excursion. Sounds ↓. No adventitious sounds
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pneumothorax
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virulent form of PN. Protozoal infection associated w/AIDS. Cysts. Anxiety,SOB,malaise dry
Non productive cough. ↓chest expansion. Dull over areas of diffuse infiltrate. Maybe diminished, crackles maybe |
pneumocystis
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macrophages engulf bacilli but do not kill,Tubercle forms around bacilli. Scar tissue forms Lesions calcifies. Necrosis, cavitation, caseous lung tissue. Lesion erodes into bronchus forming Air-filled cavity. 1rst asymptomatic, anorexia, fatigability, low fevers,sigh sweats. Skin moist
Dull over any effusion. Crakles ↑lobes |
TB
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undissolved materials. DVT . saddle embolus in bifurcation of pulmonary arteries leads to Death. CP. Restless,anxiety,mental status changes,hemoptysis. Alkalosis. Diaphoresis Hypotension, accentuated pulmonic component S2 heart sound. Crackles,wheezes
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pulmonary embolism
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trauma, gastric acid aspiration, shock sepsis. Damage alveolar capillary membrane.edema,alveoli collapsed. Restlessness,productive cough,frothy sputum, retraction intercostals spaces & sternum. Alkalosis. Diffuse pulmonary infiltrates crackles, rhonchi
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ARDS (acute respiratory distress syndrome)
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the area on the anterior chest overlaying the heart and great vessels.
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pericordium
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a tough, fibrous, double-walled sac that surrounds and protects the heart.
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pericardium
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the muscular wall of the heart; it does the pumping.
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myocardium
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the thin layer of endothelial tissue that lines the inner surface chambers and valves.
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endocardium
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the rhythmic movement of blood through the heart.
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cardiac cycle
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the ventricles relax and fill with blood
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diastole
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the heart’s contraction.
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systole
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the first passive filling of blood pouring rapidly into the ventricles.
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Protodiastolic (early) filling
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the active filling phase. The atria contracts and pushes the last amount of blood into the ventricles. 25% of stroke volume.
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Presystole or atrial systole
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a contraction against a closed system that works to build pressure inside the ventricles to a high level.
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Isometric contraction
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when all four valves are closed and the ventricles relax.
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Isometric or isovolumic relaxation
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occurs with closure of the AV valves and thus signals the beginning of systole. It is heard over the precordium, but it is usually loudest at the apex.
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First heart sound (S1)
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occurs with closure of the semilunar valves and signals the end of systole.
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Second heart sound (S2)
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Only in some cases. Ventricle fillings create vibrations that can be heard over the chest.
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Third heart sound (S3)
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occurs at the end of diastole, at presystole, when the ventricle is resistant to filling.
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Fourth heart sound (S4)
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in some conditions, blood circulating through the cardiac chambers and valves create turbulent blood flow and collision currents. May be due to congenital defects and acquired valvular defects.
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Murmurs
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equals the volume of blood in each systole times the number of beats per minute. CO=SV x R
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Cardiac output
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the venous return that builds during diastole.
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preload
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the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure.
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afterload
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irregularity of the heartbeat.
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arrhythmia
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qualify exactly (e.g. DOE after walking two blocks).
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dyspnea on exertion (DOE)
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occurs with myocardial infarction or low cardiac output states as a result of decreased tissue profusion.
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cyanosis or pallor
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dependent when caused by heart failure.
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edema
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recumbency at night promotes fluid reabsorption and excretion; this occurs with heart failure in the person who is ambulatory during the day.
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nocturia
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elevated cholesterol, elevated BP, blood sugar levels above 130 mg/dL, obesity, cigarette smoking, and low activity level.
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risk factors for CAD
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a palpable vibration. It signifies turbulent blood flow and accompanies loud murmurs.
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thrill
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due to increased ventricular volume or wall thickness; it occurs with hypertension, CAD, heart failure, and cardiomyopathy.
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cardiac enlargement
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an isolated beat is early, or a pattern occurs in which every third or fourth beat sounds early.
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premature beat
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no pattern to the sound of the ventricles; beats come rapidly and at random intervals.
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irregularly irregular
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signals a weak contraction of the ventricles; it occurs with atrial fibrillation, premature beats, and heart failure.
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pulse deficit
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unaffected by respiration; the split is always there.
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fixed split
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the opposite of what you would expect; the sounds fuse to one side in inspiration and the split is heard in expiration.
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paradoxical split
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occurs with heart failure and volume overload.
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pathologic S3
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occurs with CAD.
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Pathologic S4
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calcified mitral valve impedes forward flow of blood into left ventricle during diastole.
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Mitral stenosis
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(mitral insufficiency) incompetent mitral valve allows regurgitation of blood back into left atrium during systole.
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mitral regurgitation
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occurs near term or when the mother is lactating; it is due to increased blood flow through the internal mammary artery.
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Mammary soufflé
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a sudden drop in blood pressure when rising to sit or stand.
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Orthostatic hypotension
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occurs with right ventricular hypertrophy, as found in pulmonic valve disease, pulmonic hypertension, and chronic lung disease.
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Lift
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persistence of the channel joining left pulmonary artery to aorta. Normal to the fetus and usually closes spontaneously within hours of birth.
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Patent Ductus Arteriosus (PDA)
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abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large increase I pulmonary blood flow.
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Atrial Septal Defect (ASD)
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Abnormal opening in septum between the ventricles, usually subaortic area. The size and exact position vary considerably.
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Ventricular Septal Defect (VSD)
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calcification of pulmonic valve restricts forward flow of blood.
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Pulmonic Stenosis
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calcification of aortic valve cusps restricts forward flow of blood during systole; LV hypertrophy develops.
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Aortic Stenosis
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backflow of blood through incompetent tricuspid valve into RA.
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Tricuspid regurgitation
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calcification of tricuspid valve impedes forward flow into RV during diastole.
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Tricuspid Stenosis
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stream of blood regurgitates back through incompetent aortic valve into LV during diastole.
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Aortic regurgitation
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backflow of blood through incompetent pulmonic valve, from pulmonary artery to RV.
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Pulmonic regurgitation
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abnormal mid-diastole heart sound heard when both the pathologic S3 and S4 are present.
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Summation gallop
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temporary loss of consciousness due to decreased cerebral blood flow (fainting), caused by ventricular asystole, pronounced bradycardia, or ventricular fibrillation.
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Syncope
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abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large increase I pulmonary blood flow.
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Atrial Septal Defect (ASD)
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Abnormal opening in septum between the ventricles, usually subaortic area. The size and exact position vary considerably.
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Ventricular Septal Defect (VSD)
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calcification of pulmonic valve restricts forward flow of blood.
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Pulmonic Stenosis
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calcification of aortic valve cusps restricts forward flow of blood during systole; LV hypertrophy develops.
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Aortic Stenosis
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backflow of blood through incompetent tricuspid valve into RA.
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Tricuspid regurgitation
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calcification of tricuspid valve impedes forward flow into RV during diastole.
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Tricuspid Stenosis
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stream of blood regurgitates back through incompetent aortic valve into LV during diastole.
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Aortic regurgitation
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backflow of blood through incompetent pulmonic valve, from pulmonary artery to RV.
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Pulmonic regurgitation
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abnormal mid-diastole heart sound heard when both the pathologic S3 and S4 are present.
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Summation gallop
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temporary loss of consciousness due to decreased cerebral blood flow (fainting), caused by ventricular asystole, pronounced bradycardia, or ventricular fibrillation.
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Syncope
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uncomfortable awareness of rapid or irregular heart rate.
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Palpitation
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high-pitched scratchy extracardiac sound heard when the precordium is inflamed.
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Pericardial friction rub
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normal variation in S2 heard as two separate components during inspiration.
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Physiologic splitting
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rapid heart rate, >100 beats per minute in the adult.
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Tachycardia
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right AV valve separating the right atria and ventricle.
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Tricuspid valve
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right ventricle hypertrophy and heart failure due to pulmonary hypertension.
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Cor pulmonale
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traditional auscultatory area inn the 3rd left intercostal space.
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Erb’s point
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technique of moving the stethoscope incrementally across the precordium through the auscultatory areas while listening to the heart sounds.
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Inching
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increase in thickness of myocardial wall that occurs when the heart pumps against chronic outflow obstruction. E.g. aortic stenosis
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Left ventricle hypertrophy (LVH
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imaginary vertical line bisecting the middle of the clavicle in each hemithorax.
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MCL (midclavicular line)
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severe narrowing of the descending aorta, a congenital heart defect.
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Coarctation of aorta
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slow heart rate, <50 beats per minute in the adult.
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Bradycardia
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broader area of heart’s outline located at the 3rd right and left intercostal space.
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Base of the heart
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acute chest pain that occurs when myocardial demand exceeds its oxygen supply.
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Angina pectoris
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the left semilunar valve separating the left ventricle and the aorta.
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Aortic valve
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tip of the heart pointing down toward the 5th left intercostal space.
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Apex of the heart
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(point of maximal impulse, PMI) pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th left intercostal space in the
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Apical impulse
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the heart’s pumping phase.
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systole
|
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the heart's filling phase
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Diastole
|
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Lie anterior to the pectoralis major and serratus anterior muscles.
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breasts
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The superior lateral corner of the breast tissue, projects up and laterally into the axilla.
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Tail of Spence
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Just below the center of the breast. It is rough, round, and usually protrubant; its surface looks wrinkled and indented with tiny milk duct openings.
|
nipple
|
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Surrounds the nipple for a 1-2 cm radius. Contain small sebaceous glands, called Montgomery’s glands.
|
areola
|
|
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Contains 15 to 20 lobes radiating from the nipple, and these are composed of lobules.
|
Glandular tissue
|
|
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Are fibrous bands extending vertically from the surface to attach on chest wall muscles.
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Coopers ligaments
|
|
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High up in the middle of the axilla, over the ribs and serratus anterior muscle. These receive lymph from the other three groups of nodes.
|
Central axillary nodes
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Along the lateral edge of the pectoralis major muscle, just inside the anterior axillary fold
|
Pectoral (anterior) nodes
|
|
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Along the lateral edge of the scapula, deep in the posterior axillary fold.
|
Subscapular (posterior) nodes
|
|
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Along the humerus, inside the upper arm.
|
Lateral nodes
|
|
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Extra nipple
|
Supernumerary nipple
|
|
|
Five stages of breast development
|
Tanner staging
|
|
|
Only a small elevated nipple
|
Stage 1 preadolescent
|
|
|
A small mound of breast and nipple developes; areola widens
|
Stage 2 breast bud stage
|
|
|
The breast and areola enlarge; the nipple is flush with the breast surface.
|
Stage 3
|
|
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The areola and nipple form a secondary mound over the breast.
|
Stage 4
|
|
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Only the nipple protrudes; the areola is flush with the breast contour (the areols may continue as a secondary mound in some normal women)
|
Stage 5 mature breast
|
|
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Beginning of menstruation
|
Menarche
|
|
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Thick, yellow fluid which is the precursor for milk, containing the same amount of protein and lactose but practically no fat.
|
Colostrum
|
|
|
During adolescence, it is common for breast tissue to temporarily enlarge. This condition is usually unilateral and temporary.
|
Gynecomastia
|
|
|
Occurs with trauma, inflammation, infection, and benign breast disease.
|
Gynecomastia
|
|
|
Occurs with trauma, inflammation, infection, and benign breast disease.
|
Mastalgia
|
|
|
Note medications that may cause clear nipple discharge; oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, calcium
|
Galactorrhea
|
|
|
Cancer causes fibrosis, which contracts the suspensory ligaments. The dimple may be apparent at rest, with compression, or with lifting of the arms.
|
Dimpling
|
|
|
Lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pig-skin or orange-peel look. This condition suggests cancer.
|
Edema (peau d’Orange)
|
|
|
Asymmetry, distortion, or decreased mobility with elevated arm maneuver. As cancer becomes invasive, the fibrosis fixes the breast to the underlying pectoral muscles.
|
Fixation
|
|
|
An underlying cancer causes fibrosis in the mammary ducts, which pulls the nipple angle towards it.
|
Deviation in nipple pointing
|
|
|
Multiple tender masses. Six diagnostic categories exist.
1. Swelling and tenderness 2. Mastalgia (sever pain) 3. Nodularity 4. Dominant lumps 5. Nipple discharge 6. Infections and inflammations. |
Benign brest disease (formerly fibrocystis breast disease)
|
|
|
Solitary unilateral nontender mass. Often painless, although the person may have pain. Most common in upper outer quadrant. Usually found in women 30 to 80 years of age; increased risk in ages 40 to 44 and in women older than 50 years.
|
Cancer
|
|
|
Solitary nontender mass. Benign breast disease. Solid, firm, rubbery, elastic. Round, oval, and lobulated; 1 to 5 cm. freely movable, slippery. Most common between 15 and 30 years of age but can occur up to 55 years.
|
Fibroadenoma
|
|
|
Pastelike matter in subareolar ductsproduces sticky, purulent discharge that may be white, gray, brown, green, or bloody.itching, burning, or drawing pain occurs around nipple.
|
Mammary duct ectasia
|
|
|
Bloddy nipple discharge that is unilateral and from a single duct requires further investigation.
|
Carcinoma
|
|
|
Serous or serosanguineous discharge, which is spontaneous, unilateral, or from a single duct. Consists of tiny tumors, 2 to 3 mm. affect women 40 to 60 years of age, most are benign.
|
Intraductal papilloma
|
|
|
Early lesion has unilateral, clear, yellow discharge and dry, scaling crusts, friable at nipple apex. Spreads outward to areola with eryhematous halo on areola and crusted, eczematous, retracted nipple.
|
Pagets disease (intraductal carcinoma)
|
|
|
One milk duct is clogged. Fairly common and not serious. One section of the breast is tender and may be reddened.
|
Plugged duct
|
|
|
Uncommon; an inflammatory mass before abcess formation. Usually occurs in single quadrant. Area is red, swollen, tender, very hot, and hard. Woman has headache, malaise, fever, chills and sweating, increased pulse, flu like symptoms.
|
Mastisis
|
|
|
Fewer than 1% of breast cancer occurs in men. The lesion is hard, irregular, nontender mass, most often directly under the areola, fixed to the area, and may have nipple retraction.
|
Carcinoma
|
|
|
Location—use breast as a clock face and describe in distance of Cm’s from nipple
Size—judge in CM’s Width x Length x Thickness Shape—oval, round, lobulated, indistinct Consistency—soft, firm, hard Movable—freely movable or fixed. Distinctness—solitary or multiple Nipple—displaced or retracted Note skin over lump—erythematous, dimpled, retracted Tenderness—tender to palpation Lymphadenopathy—any regional node palpable |
Characteristics to note for lumps or mass
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Best time to conduct ____ is right after the menstrual period, or the 4th through 7th day of the menstrual cycle, when the breast are smallest and least congested. Advise the pregnant or menopausal woman who is not having menstrual periods to select a familiar date to examine her breasts each month, for example, her birth date or the day the rent is due.
|
BSE (breast self examination)
|
