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32 Cards in this Set
- Front
- Back
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Anatomical position of Heart
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From the right sternal border and across to the left-mid-clavicular line, between the 2nd and 5th intercostal space.
It can be found by finding the supersternal notch, and then working down to the angle of loui - which meets up with the 2nd rib, the second intercostal space will be directly below this rib. |
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Anatomical position of the Lungs
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They are situated in thoracic cavity, in the middle lie the trachea, esophagus and beginnings of the bronchial tree. The lungs lie either side of the mediastinum within the pleural cavities.
The apex is about 3cm above the inner third of the mid-clavicular-line and the anterior base sits on the 6th rib. Laterally, the lungs reach from the apex of the axilla down to the 7th, 8th rib and posteriorly C7 marks the apex, and T10 corresponds to the base, and on deep inspiration expands to T12. |
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Lung Structure
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Right lung has 3 lobes and is slightly shorter than the left due to the underlying liver.
Left lung is slightly narrower due the heart and only has 2 lobes. The fissures of each lung lie diagonally across the lungs |
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Inspection of cardiovascular system
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Health History
Skin of precordium visible pulsations JVP ( indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease). |
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Inspection of respiratory system
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Health history
Skin - pale Breathing pattern - purse lipped breathing Posture/position - tripod position Resp Rate Symmetry of movement Respiratory mechanics - what muscles are being used during normal ventilation |
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Abdominal Inspection
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Health History
Skin Position - guarding symmetry/contour nutritional status |
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Neurological Inspection
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Health History
Conscious state coordination motor function speech balance orientation mental state alertness muscle atrophy |
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Cardiovascular palpation
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Apical pulse
Carotid artery - feeds blood to brain (only palpate one side at a time) all pulse sites capillary refill temperature of skin thrills (vibrations) |
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Respiratory palpation
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symmetric chest expansion (think- butterfly hands)
Tactile Fremitus "99" "Bluemoon" |
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Abdominal AUSCULTATION
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start in RLQ and work your way up and around umbilicus region and back down the left side.
Normal bowel sounds - 5 to 30 times per minute Absent bowel sounds - no sounds for over 5 minutes Abnormal sounds: Hypoactive sounds - reduced/hard to hear Hyperactive sounds - very active/loud Borborgymous - loud and physical sensation of stomach churning |
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Neurological FUNCTIONAL ASSESSMENT
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testing/looking for:
Motor skills - gross and fine motor movements Sensory skills Romberg test - eyes closed/balance/posture Finger-to-nose test Reflex arc |
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Reflex arc - what is it? and what different types are there?
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Involuntary basic defense mechanism
-allows quick reaction to painful or damaging stimuli/situations and aims to oppose original stimulus 4 types: Deep tendon - Patella reflex superficial - abdominal reflex visceral - (response of an organ to stimuli) the contraction of peristalsis in the GI tract Pathologic - babinkski - rub soul of foot |
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Cardiovascular percussion
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Fluid filled organ = Dullness,
it can be useful to percuss cardiac border (precordium). However difficult as it sits under the thoracic cage |
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Respiratory percussion
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main note over lungs - resonance
normal diaphragmatic excursion: 3-5cm (measures contraction of the diaphragm. It is performed by asking the patient to exhale and hold it. The provider then percusses down their back in the intercostal margins (bone will be dull), starting below the scapula, until sounds change from resonant to dull (lungs are resonant, solid organs should be dull). That is where the provider marks the spot. Then the patient takes a deep breath in and holds it as the provider percusses down again, marking the spot where the sound changes from resonant to dull again. Then the provider will measure the distance between the two spots. Repeat on the other side, is usually higher up on the right side. If it is less than 3–5 cm the patient may have a pneumonia or a pneumothorax in which a chest x-ray is diagnostic for either. |
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abdominal percussion
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Tympany over hollow organs (GI tract)
Start RLQ Dullness over solid viscera or distended hollow viscera (Liver + full bladder) liverspan (vertically 6-12cm) percuss down R-mid-clavicular line and listen for -resonance(lungs) -Dullness(liver) -Tympany(GItract) |
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costovertebral angle tenderness
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indicates inflammation of Kidneys
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What is Ascites? and what assessment techniques can be used in this instance?
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Ascites is the accumulation of fluid in the peritoneum, the abdomen can expand up to 20litres.
Assessment tools: - fluid wave - patient puts hand down midline, RN taps either side and observes fluid movement. - shifting dullness - percuss fluid line and then ask patient to change position to see movement of fluid in the peritoneum. |
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Cranial nerve assessment
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neuro torches
reflex hammers tuning fork lightly touch face sterognosis - recognition of familiar object sharp vs blunt GCS |
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Cardiovascular Auscultation
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be mindful of valve locations:
S1 "lub" : closure of Atrioventricular valves auscultate at the 5th intercostal space Tricuspid AV: Sternal border Bicuspid: mid-clavicular S2 "dub" closure of semilunar valves auscultate at the 2nd intercostal space Aorta on right, Pulmonic trunk on left |
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adventitious sounds of the heart during auscultation
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Mumur: turbulence in flow due to incompent valves and hence impacts cardiac output
Split S2: "lub-ta-dub" valves close at different times creating an extra sound - impacts on intrathoracic pressure of pulmonic trunk. S3 & S4: Rare, abnormal sounds (additional to S1 & S2) - heart failure. Pericardial Rub: High-pitched (think balloon) caused by inflammation. Bruit: washing sound in carotids. |
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Respiratory Auscultation
normal sounds |
normal sounds:
-Bronchial: hollow tubular sounds - over trachea. -Bronchovesicular: moderate sounds - where trachea meets lungs. -Vesicular: wind in the trees - lungs. |
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Abnormal sounds in respiratory auscultation
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Vocal sounds: if pathology suspected, vibrations and sound will be amplified.
Rales: crackles Rhonchi: wheeze - asthma - trapped air in aveoli whistling out of restricted bronchioles Pleural friction rub: inflammation of pleura No sounds: Pneumothorax Stridor: wheezing on inspiration (obstruction/swelling - ie bee sting) |
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How do you measure the level of oxygen in the blood?
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Pulse Oximetery
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Abdominal PALPATION
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Light palpation: 1-2cm
Deep Palpation: 5-8cm Rotate gently in clockwise direction |
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Light palpation is used for:
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determine skin surface, musculature
Look out for: -Guarding -Rigidity -Large masses -rebound tenderness |
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Deep palpation is used for:
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using one or both hands.
Looking for palpable organs - size, location, consistency, mobility, unidentified masses etc |
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Palpable organs
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Inferior liver edge
right kidney pulsatile Aorta rectus muscles ascending colon/cecum sigmoid colon uterus full bladder spleen (ONLY if pathology present) Left kidney (ONLY if pathology present) |
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What does Murphy's refer to?
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If there is pain when looking at the inferior margin of the liver, it indicates an inflamed Gall bladder.
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What is the duckbill used for?
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Finding the right kidney.
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If there is tenderness in Lower Right Quadrant.....
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appendicitis
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GCS
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Glasgow Coma Scale:
a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person. |
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GCS has how many tests? and what are they?
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3 Tests:
(E)YE response (V)ERBAL response (M)OTOR response |
