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Health Ass. Exam 2
| Question | Answer |
|---|---|
| signs of respiratory distress | nasal flaring, pursed lip breathing, use of accessory muscles, color (hands, face, chest, nails), shape of nails (clubbing), tripod |
| ruddy/purple | COPD, CHF |
| cyanosis | hypoxia, cold |
| tripod position usually means | COPD |
| chest wall normal | AP < lateral; 1:2 ratio |
| chest wall barrel chest | AP >/= lateral; 1:1 ratio |
| chest wall pectus excavatum | funnel chest, sunken sternum; inherited but can be repaired |
| chest wall pectus carinatum | pigeon chest, extra cartilage going forward common in males with vitamin D deficiency |
| costal angle | <90 degrees |
| slope of ribs | 45 degrees |
| assess for equal expansion, trachea midline, equal scapulae | place thumbs at T9-T10, pressing together -> pt takes deep breath -> thumbs move 5-10 cm apart |
| tactile fremitus | vibration of bronchial tubes |
| tactile fremitus intepretations | use ball/ulnar edge of hand on lung while patient says "99" should be symmetrical and easily lobes (easy to diminish in lungs) |
| decreased tactile fremitus | COPD |
| vesicular lung sounds | low pitched, normal over peripheral lung fields |
| bronchial | normal over trachea, loud and harsh |
| broncho-vesicular | normal by sternum and between scapulae |
| fine crackles (fine rales) | high pitched, rubbing hair by ear |
| coarse crackles (coarse rales) | loud, low pitched; may clear with coughing inhaled air collides with secretions in trachea and large bronchi |
| wheezes | high, musical whistling air passing through CONSTRICTED airway (ASTHMA) |
| stidor | wheeze with OBSTRUCTION of air |
| clubbing (respiratory sign) | hypoxia |
| cyanosis (respiratory sign) | hypoxia |
| pursed-lip breathing and tripod | respiratory distress and possible COPD |
| barrel chest (respiratory sign) | COPD, emphysema |
| auscultation of lungs | pt breathes deeply at each point, from lungs C7 - T10 bilaterally (ladder) for one cycle also listen under arms for lungs (RUL, RML, RLL, LUL, LLL) uses diaphragm |
| assess chest expansion posterior | place thumbs at T9-T10, pressing together as pt takes deep breath thumbs should move 5-10cm |
| assess chest expansion anterior | place thumbs along costal margins and pointing toward xiphoid process |
| bronchophony | testing for clarity, "99" should be slightly muffled clear "99" = fluid or mass |
| egophony | eee to aye to a normal = eee aye/a = fluid or mass |
| whispered pectoriloquy | whispers 1-2-3 normal = sounds muffled whisper is clear = fluid or mass |
| pleural effusion | fluid surrounding lungs |
| tests for pleural effusion | whispered pectoriloquy, bronchophony, egophony |
| pneumothorax | air between lungs and chest wall hyperresonance and tympany with percussion dyspnea, axiety, tachycardia, pain, diminished lung sounds |
| atelectasis | collapsed lung |
| hemothorax | blood in lung |
| pulmonary embolus | clot in lungs and travel to legs (usually) and pulmonary arties blocked |
| tuberculosis | bacteria spread via droplet progressive fatigue, anorexia, weight loss, chronic cough, night sweats |
| asthma | chronic inflammation and narrowed airways allergic reaction, inflammation, bronchospams |
| pneumonia | infection inflames aveloi (pus or fluid) and decreases gas exchange, cough, fever, chills, respiratory distress |
| bronchitis | increased mucus in airways (inflammation) |
| emphysema (COPD) | permanently enlarged air sacs, no elastin |
| leading cause of death | lung cancer |
| risk factors of lung cancer | smoking, genetic predisposition, exposure to toxins, poor diet |
| decrease risk of lung cancer | stop smoking, seek care for prolonged couth or pain in chest area |
| sternal angle | ridge joining manubrium to the body of sternum, 1 inch below sternal notch |
| costal angle | formed by R and L costal margins where they meet xiphoid process |
| Location of heart | in mediastinum, from 2-5th ICS base = top, apex = bottom |
| aortic | 2nd ICS, RSB |
| pulmonic | 2nd ICS, LSB |
| erbs | 3rd ICS, LSB |
| tricupsid | 4th ICS, LSB |
| mitral | 5th ICS, LMCL |
| lub | atrioventricular valves closing (bi and tricupsid) |
| S1 is best heard over? | apex (beginning of systole) |
| dub | semilunar valves closing (pulmonary and aortic) |
| S2 is best heard over? | base (beginning of diastole) |
| S3 | ventricular gallop, after S2 fluid overload - extra blood into ventricles (CHF) common in children and athletes |
| S4 | atrial gallop, before S1 non-compliant ventricle (CAD, hypertension, cardiomyopathy) |
| murmurs | turbulent blood flow with swooshing or blowing sound caused by increased/decreased blood velocity, narrow valves, abnormal chamber opening |
| murmur grade I | difficult to hear, experienced and quiet environment needed |
| murmur grade II | not readily heard with stethoscope |
| murmur grade III | requires no effort, heard immediately with stethescope |
| murmur grade IV | loud with thrill |
| murmur grade V | very loud, easily palpated thrill |
| murmur grade VI | audible with stethoscope near chest |
| capillary refill purpose | index of peripheral perfusion and cardiac output |
| capillary refill | depress and blanch nail bed then release and note the time of color return (<2 sec) |
| sequence of cardiovascular exam | inspect, palpate, percuss, auscultate |
| cardiovascular exam - inspection | inspect for symmetry and visible pulsations (apical pulse on thin people or children) |
| cardiovascular exam - palpate | palpate apical pulse at mitral for thrills (turbulence of blood flow) and heaves/lifts (sustained systolic outward movement of precordium) |
| bruit | blowing, swishing = blood flow turbulence (should be NONE) check carotid artery with bell by having pt exhale and hold breath |
| cardiovascular exam - auscultate | auscultate for S1 and S2, noting rhythm, extra heart sounds, etc use both bell and diaphragm listen at 45 degrees, lying on left side and sitting up while leaning forward |
| thrills | turbulence of blood flow (feeling) check apex and carotid artery |
| allens test | close of radial and ulnar arties and have pt open and close wrist then release and note time for color to return to hand |
| homan's sign | used to determine clot bend knee and flex the foot; pain = clot no longer used because it can dislodge clot |
| posterior tibial | medial ankle behind the bony protuberance |
| dorsalis pedis | top of foot between big toe and second |
| do you palpate carotids at same time | no, you could block arterial blood flow to brain (pt passes out) |
| apical pulse | 5th ICS, LMCL full minute palpate when pt is in supine position or HOB raised slightly |
| sequence of blood flow through heart | superior/inferior vena cava -> right atrium -> tricupsid -> right ventricle -> pulmonary valve -> pulmononic artery -> lungs -> pulmonary veins -> left atrium -> bicupsid -> left ventricle -> aortic valve -> aorta -> body -> veins -> superior/inferior |
| What defines jugular venous distension | increased jugular pressure from increased pressure in superior vena cava causing bulge |
| diastole | ventricles are relaxed and filling with blood |
| systole | ventricles are contracting and ejecting blood |
| arterial system | carries OXYGENATED blood under HIGH pressure system (maintain BP by contracting and dilating from stimuli) strong and elastic walls to withstand pressure demands |
| venous system | carries DEOXYGENATED blood under LOW pressure system ( valves within veins skeletal contractions) |
| pulse deficit | difference between apical and radial pulse |
| lymphedema | high swlling of limbs could be caused by mastectomy or removal of lymph nodes |
| ankle brachial index calculation | systolic in ankle/ brachial systolic |
| ankle brachial index | apply BP cuff above ankle to determine pressure of posterior tibial or dorsalis pedis then divide by brachial systolic pressure should be 1-1.2; less than or equal = peripheral artery disease |
| arterial ulcers (ischemic) | breaking down nerve endings without adequate circulation, bone exposed, NO BLEEDING, pallor, dry skin, loss of hair, fissuring of nail |
| venous ulcers (stasis) | more pale granulation tissue with BLEEDING or drainage, shallow flat (doesn't penetrate fascia or bone) and has sloping edge with thin and blue margin of growing epithelium |
| risks factors for cardiovascular disease | nutrition, smoking, alcohol, excercise, drugs, hypertension (high in african americans), cholesterol |
| sequence of abdominal assessment | inspection, auscultation, percussion, palpation |
| costovertebral angle tenderness indicates | kidney infection |
| bowel sounds (where to auscultate) | begin in RLQ then move clockwise, listening if you can't hear begin again at RLQ and listen for 5 min |
| active bowel sounds | 5-30 sounds a min |
| hyperactive | almost constant = hunger, diarrhea, early obstruction |
| hypoactive | <5 = peritonitis, late obstruction, common after surgery |
| absent | none, same as hypoactive (late obstruction, common after surgery, peritonitis) |
| aorta (abdomen) | palpate above upper abdomen and L of midline using oppsoing thumbs and fingers for pulsation (firm and deep) |
| normal aortic finding (abdomen) | 2.5-4 cm wide |
| abnormal aortic finding (abdomen) | vigorous, wide, exaggerated pulsations = abdominal aortic aneurysm |
| spleen | 9-11 ICS, about 7 cm long DO NOT PALPATE OR PERCUSS, could rupture |
| liver | 6-12 cm |
| stool color: black | blood high in GI tract (old) |
| stool color: red | blood low in GI tract (new) |
| stool color: gray/clay-colored | gallbladder issue - gray = pancreatitis & clay = gallbladder and liver problems |
| stool color: green | diarrhea/gastroenteritis (bowel inflammation) or diet |
| stool can change because of | medications and food |
| appendicitis | rovsing's blumberg test, obturator test (internally and externally rotate knee), ilipsoas test (lighting R leg and applying pressure = pain at mcburney's point) |
| cholecystitis | murphy's sign (palpate liver and have pt breathe deeply pain = cessation of inspiration |
| murphy's | test for gallbladder inflammation palpate liver while pt takes deep breath = pain will stop pt from inspiration = positive |
| iliposoas | test for appendicitis lift pts R leg and pish down on right thigh while pt pushes again = pain = positive |
| mcburney's point | pain in RLQ with appendicitis |
| basic techniques for abdominal exam | pt lay flat on back with knees slightly bent (helps change contour of stomach to make it easy to listen to), make sure they emptied bladder and in a warm, bright room |
| breast examination | examine up to collarbone, out to armpit, middle of chest, and bottom of ribcage palpate tail of spence, and all breast tissue |
| looking for during breast examination | looking for: texture and elasticity (thickening = bad), tenderness and temperature (tender = period), masses (location, size in cm, shape, mobility, consistency, tenderness), nipples (wear gloves and compress gently), or mastectomy or lumpectomy sites |
| abnormalities on breast inspection | Peau d’orange, paget disease, retracted nipple, dimpling, retracted breast tissue, mastitis, mastectomy, fibroadenomas, benign breast disease |
| Breast mass characteristics | fibroadenoma, benign, cancerous chart location, size, shape, consistency, tenderness, mobility, borders, retraction (cancerous) |
| tail of spence | tail of breast extending into armpit |
| site of most breast tumors | tail of spence and upper outer |
| paget's | redness, scaling and flaking of nipples, underling invasive ductual carcinoma |
| peau D'orange | enlarged pores due to edema of breasts, skin look like orange peel |
| cheyne's strokes | apnea because of drug overdose, heart problems, etc. |
| 4 F's for abdominal distension | fluid, fetus, feces, flatulence |
| 4 F's for cholistestitus | female, fourty, fat, fertile |
| retraction of nipple is because of | age, cancer, duct ectasia (pepperoni nipples) |
Created by:
AV25
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