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health assessment


thoracic cage bony structure with a conical shape, which is narrower at the top
diaphragm floor of the thoracic cage, and separates the thoracic cavity from the abdomen
ribs 1-7 attach directly to the sternum
ribs 8-10 attach to the costal cartilage above
ribs 11, 12 floating ribs
costochondral junctions the points at which the ribs join their cartilages, not palpable
The thoracic cage consists of the sternum, 12 pairs of ribs, 12 thoracic vertebrae, and the diaphragm, which forms the floor.
The sternum (or breastbone), which has three parts a manubrium, body, and xiphoid process;
The sternal angle (or angle of Louis), which is continuous with the second rib;
the costal angle is where the right and left costal margins meet at the xiphoid process.
On the anterior chest use landmarks such as the midsternal and midclavicular lines.
On the posterior chest use landmarks such as the vertebral and scapular lines.
on the lateral chest use landmarks such as the anterior axillary, posterior axillary, and midaxillary lines.
the angle of louis also marks the site of tracheal bifurcation into the right and left main bronchi
the midclavicular line bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular joint
The right lung is shorter than the left lung
The right lung has three lobes
the left lung has 2 lobes
The lobes are stacked in diagonal sloping segments and are separated by fissures that run obliquely.
the mediastinum is the middle section of the thoracic cavity containing the esophagus, trachea, heart and the great vessels
Anteriorly, the lung borders, the apex (or highest point) of the lungs lies 3 or 4 centimeters above the inner third of the clavicles.
The base (or lower border) rests on the diaphragm at about the fifth intercostal space in the right midclavicular line and at the sixth rib in the left midclavicular line.
Laterally, the lungs extend from the apex of the axilla to the seventh or eighth rib.
Posteriorly, C7 marks the apex, and T10 usually corresponds to the base. On deep inspiration, the base descends to T12.
The pleurae form an envelope between the lungs and the chest.
The pleural cavity is a potential space that contains a few milliliters of lubricating fluid.
The lubricating fluid prevents friction as the lungs move during respiration.
The bronchial tree protects the alveoli from small particulate matter by using mucus and cilia, which sweep particles upward for swallowing or expulsion.
The functional unit of the respiratory tract is the acinus.
The respiratory system has four major functions 1st, it supplies oxygen to the body for energy production; 2nd, it removes carbon dioxide as a waste product of energy reactions; 3rd, maintains homeostasis (or acid-base balance) in arterial blood. 4th maintains heat exchange.
During pregnancy, the growing uterus elevates the diaphragm 4 centimeters
Objective data, inspect the posterior and anterior chest, and Note the shape, configuration, and symmetry of the thoracic cage, including the anteroposterior ratio, placement of the scapulae, angle of the ribs, and development of the neck and trapezius muscles.
percuss over the lung fields to determine the predominant note.
the visceral pleura lines the outside of the lungs
the parietal pleura lines the outside of the chest wall
costodiaphragmatic recess potential space, when it abnormally fills with air or fluid, it compromises lung expansion
the acinus consists of bronchioles, alveolar ducts, alveolar sacs and the alveoli
hypoventilation slow, shallow breathing that causes carbon dioxide to build up in the blood
hyperventilation rapid, deep breathing causes carbon dioxide to be blown off
physical act of breathing respiration
inspiration air rushes into the lungs as the chest size increases
expiration air expelled from the lungs as the chest recoils
at 32 weeks of a babies life surfactant is present in adequate amounts
surfactant is a complex lipid substance needed for sustained inflation of the air sacs
orthopnea difficulty breathing when supine; state the number of pillows needed to achieve comfort
paroxysmal nocturnal dyspnea is the awakening from sleep with SOB and needing to be upright to achieve comfort
chest pain of chest origin occurs with muscle soreness from coughing or from inflammation of pleura overlying pneumonia
smoking history states whether the person smokes cigarettes or cigars, what age they started and how long, and how many packs per day they smoke
being the respiratory examination just after palpating the thyroid gland when you are standing behind the person
the spinous process should appear in a straight line
the thorax is symmetric in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine
the anteroposterior diameter should be less than the transverse diameter; ratio of 1:2 to 5:7
orthopnea difficulty breathing when supine; state the number of pillows needed to achieve comfort
paroxysmal nocturnal dyspnea is the awakening from sleep with SOB and needing to be upright to achieve comfort
chest pain of chest origin occurs with muscle soreness from coughing or from inflammation of pleura overlying pneumonia
smoking history states whether the person smokes cigarettes or cigars, what age they started and how long, and how many packs per day they smoke
being the respiratory examination just after palpating the thyroid gland when you are standing behind the person
the spinous process should appear in a straight line
the thorax is symmetric in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine
the anteroposterior diameter should be less than the transverse diameter; ratio of 1:2 to 5:7
people with COPD often sit in a tripod position
confirming symmetrical chest expansion hands on posterolateral chest wall, with thumbs at T9 or T10, pinch a small amount of skin and ask patient to take a breath in. watch for thumbs to separate
tactile fremitus palpable vibrations
sounds generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall tactile fremitus
decreased fremmitus occurs when anything obstructs transmission of vibrations (obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema)
crepitus coarse, crackling sensation palpable over the skin surface
resonance is a low pitched, clear, hollow sound that predominates in healthy lung tissue in the adult
a dull note signals abnormal density in the lungs (pneumonia, pleural effusion, atelectasis)
diaphragmatic excursion should be equal bilaterally and measure about 3-5 cm in adults
bronchial (tracheal) breath sounds have a high pitch with a low amplitude. inspiration is < than expiration and it is located in the trachea and larynx
bronchovesicular breath sounds has a moderated pitch and moderate amplitude. inspiration = expiration and it is located over major bronchi where fewer alveoli are located.
vesicular breath sounds have a low pitch with a soft amplitude. inspiration > expiration and is located over peripheral lung fields where air flows through smaller bronchioles and alveoli. Rustling, like the sound of the wind in the trees
adventitious sounds any added sounds that are not normally heard in the lungs (i.e., wheezing or crackles
normal voice sounds should be soft, muffled and indistinct, you can hear sound through the stethoscope but cannot distinguish exactly what is being said
barrel chest has a horizontal ribs and costal angle > 90 degrees
kyphosis outward curvature of the thoracic spine
pectus excavatum sunken sternum and adjacent cartilages
pectus carinatum forward protrusion of the sternum, with ribs sloping back at either side of vertical depressions along costochondral junctions
scoliosis S-shaped curvature of the thoracic and lumbar spine
bronchophony listening to a persons chest as they say 99. normal voice transmission will be muffled, soft and indistinct.
egophony auscultate the chest while the person says "ee-ee-ee-ee" , normal sound should be heard as eeee
whispered pectoriloquy ask the person to whisper a phrase while you auscultate. normal response should be faint, muffled, and almost inaudible
the precordium is the area on the anterior chest directly overlying the heart and great vessels
the heart extends from the 2nd to 5th intercostal space and from the right border of the sternum to the left midclavicular line
base of the heart broader, top part of the heart
apex of the heart the bottom part of the heart
the apex is normally palpable at the 5th intercostal space, 7-9 cm from the midsternal line
the superior and inferior vena cava return unoxygenated venous blood to the right side of the heart
the pulmonary veins return freshly oxygenated blood to the left of the heart
aorta carries blood out the the body
pericardium tough, fibrous, double walled sac that surrounds and protects the heart
pericardial fluid ensures smooth, friction free movement of the heart muscle
myocardium muscular wall of the heart. does the pumping
endocardium is the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves
atrioventricular valves separate the atria and the ventricles
right AV valve is the tricuspid valve
the left AV valve is the mitral valve
valves are anchored by collagenous fibers called chordae tendineae
the hearts filling phase diastole
the hearts pumping phase systole
semilunar valves are set between the ventricles and the arteries
SL valve on the right side of the heart pulmonic valve
SL valve on the left side of the heart aortic valve
SL valves open during systole
the rhythmic movement of blood through the heart is the cardiac cycle
the relaxation of the ventricles and fill with blood diastole
the closure of the AV valve contributes to the first heart sounds called S1
the closure of the semilunar valves contributes to the second heart sound called S2
S1 is usually loudest at the apex of the heart
S2 is usually loudest at the base of the heart
A third heart sound due to the vibration of ventricles that resist early, rapid filling S3
S4 is at presystole
S1 is at the beginning of systole
S2 is at the beginning of diastole
S3 is at the rapid filling stage (protodiastolic)
atria contract and push blood into non compliant ventricles, creating vibrations called S4
what are gentle, blowing or swooshing sounds due to turbulent blood flow murmurs
the SA (sinoatrial) node is known as the pacemaker of the heart
depolarization of the atria P wave
time necessary for atrial depolarization plus time for the impulse to travel through the AV node to the ventricles PR interval
depolarization fo the ventricles QRS complex
repolarization of the ventricles T wave
the stroke volume (volume of blood in each systole) times the number of beats per minute (rate) equals the cardiac output
the venous return that builds during diastole is called preload
the opposing pressure the ventricles must generate to open the aortic valve against the higher aortic pressure is called afterload
located in the groove between the trachea and the sternomastoid muscle carotid artery
empty unoxygenated blood directly into the superior vena cava jugular veins
internal jugular vein is not visible, lies deep and medical to the sternomastoid muscle, may be seen at the sternal notch
external jugular vein is more superficial, lies lateral to the sternomastoid muscle, above the clavicle
the fetal heart begins to beat at the end of the 3 week gestation
Before birth, the foramen ovale allows oxygenated blood from the placenta to be shunted to the left side of the heart and out to the general circulation.
before birth, The ductus arteriosus lets any remaining blood being directed to the lungs to be shunted into the aorta
arteriosclerosis calcification of vessel walls
The major risk factors for heart disease and stroke are high blood pressure, smoking, high cholesterol levels, obesity, and type 2 diabetes mellitus.
syncope sudden loss of strength and temporary LOC, due to lack of cerebral blood flow,
dyspnea Shortness of Breath
chest pain angina
orthopnea the need to assume a more upright position to breathe
cyanosis or pallor occurs with MI or low cardiac output states as a result of decreased tissue perfusion
palpate each carotid artery medial to the sternomastoid muscle in the neck
auscultate each carotid artery for the presence of a bruit
bruit is a blowing, swishing sound indication blow flow turbulence
internal jugular pulse is not palpable where as a carotid pulse is
a heave or a lift is a sustained forceful thrusting of the ventricle during systole
during hepatojugular reflux, if heart failure is present, the jugular veins will elevate and stay elevated for as long as you push
apical impulse is the pulsation created as the left ventricle rotates against the chest wall during systole
the apical impulse occupies what space the 4th or 5th intercostal space, or inside the midclavicular line
to help find the apical pulse, ask the pt to exhale and then hold their breath, while you find the pulse
a thrill is a palpable vibration
the valve in the second right intercostal space is the aortic valve
the valve in the second left intercostal space is the pulmonic valve
the valve in the left lower sternal border is the tricuspid valve
the valve in the 5th interspace at round the left midclavicular line is the mitral valve
erbs point can be heard at the 3rd intercostal space
a pulse deficit signals a weak contraction fo the ventricles
S1 is caused by the closure of the AV valves
S2 is causes by the closure of the SL valves
A split S2 is a normal phenomenon that occurs toward the end of inspiration in some people
A split S2 sounds is heard only in the pulmonic valve, 2nd left intercostal space
innocent murmur indicates having no valvular or other pathological cause
functional murmur is due to increased blood flow in the heart
decreased cardiac output occurs when the heart fails as a pump, and the circulation becomes backed up and congested
acute onset of heart failure may be associated with as following a MI when direct damage to the heart's contracting ability has occurred
chronic onset of heart failure may be associated with hypertension, when the ventricles must pump against chronically increased pressure
vessels are tubes for transporting fluid, such as blood or lymph
the heart pumps freshly oxygenated blood through the arteries to all the body tissues
arteries contain elastic fibers, which stretch during systole and recoil with diastole
the pressure wave sent through arteries a pulse
the temporal artery is palpated in front of the ear
the carotid artery is palpated in the groove between the sternomastoid muscle and the trachea
the major artery suppling the arm is the brachial artery
the brachial artery bifurcates into the ulnar and radial arteries
the major artery in the leg is the femoral artery
intraluminal valves ensure unidirectional blood flow in veins
the right lymphatic duct empties into the right subclavian vein,
the right lymphatic duct drains the right side of the head and neck, right arm, right side of the thorax, right lung and pleura, right side of the heard and the right upper section of the liver
the left lymphatic duct empties into the left subclavian vein
the left lymphatic duct drains the rest of the body
the functions of the lymphatic system are 1, conserve fluid and plasma proteins that leak out of the capillaries. 2, form a major part of the immune system that defends the body against disease. 3, absorb lipids from the intestinal tract
small, oval clumps of lymphatic tissue located at intervals along vessels lymph nodes
cervical nodes drain the head and neck
axillary nodes drain the breast and upper arm
epitrochlear node drain the antecubital fossa and drains the hand and lower arm ( at the elbow)
inguinal nodes in the groin, drain most of the lymph of the lower extremities
the spleen is located in the left upper quadrant of abdomen
the spleen has four function destroy old red blood cells, produce antibodies, store red blood cells, and filter microorganisms from the blood
ateriosclerosis is peripheral blood vessels grow more rigid with age
atherosclerosis or deposition of fatty plaques on the intima of the arteries
prolonged bedrest, prolonged immobility and heart failure increase the risk for deep venous thrombosis and subsequent pulmonary embolism
claudication distance is the number of blocks walked or stairs climbed to produce pain
edema is bilateral when the cause is generalized (heart failure)
edema is unilateral when it is the result of a local obstruction or inflammation
edema in the upper extremities occurs when lymphatic drainage is obstructed
when palpating the brachial pulse, the force should be equal bilaterally
modified allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery
anchor your thumbs on the knee and curl your fingers around into the popliteal fossa popliteal pulse
posterior tibial pulse is on the side of the foot by the ankle
dorsalis pedis pulse is on top of the foot, just lateral to and parallel with the big toe
1+ pitting mild pitting
2+ pitting moderate pitting
3+ pitting deep pitting, leg looks swollen
4+ pitting very deep pitting, leg is grossly swollen and distorted
varicosities occur in the saphenous veins
lymph nodes are small, firm (shotty) mobile and nontender
enlarged, warm, tender nodes indicate current infection
raynauds's phenomenon is episodes of abrupt, progressive tricolor change of the fingers in response to cold, vibration or stress
lymphedema is hight protein swelling of the limb, most commonly due to breast cancer treatment
occlusions in the arteries are caused by atherosclerosis, which is chronic gradual buildup of fatty streaks, fibroid plaque, calcification of the vessel wall
an anerurysm is a sac formed by dilation in the artery wall
most common site for atherosclerosis is the aorta
large, oval cavity extending from the diaphragm down to the brim of the pelvis abdomen
solid viscera are those that maintain a characteristic shape (liver, pancreas, sleep, adrenal glands, kidneys..)
hollow viscera depends on the contents (stomach, bladder, small intestine, colon)
soft mass of lymphatic tissue on the posterolateral wall of the abdomen spleen
soft, lobulated gland located behind the stomach pancreas
posterior to the abdominal contents, retroperitoneal, and bean-shaped kidneys
12th rib forms an angle with the vertebral column costovertebralangle
because of the placement of the liver, the right kidney rests 1-2cm lower than the left kidney
epigastric area area between the costal margins
umbilical area area around the umbilicus
hypogastric, or suprapubic area area above the pubic bone
bad cholesterol LDL
normal range for cholesterol 120-200mg/dl
hematocrit HCT for infants 1-3 days 44%-72%
HCT for children 6-12 years is 35%-45%
HCT for adult male 37%-49%
HCT for adult female 36%-46%
Good cholesterol HDL-C
normal values for HDL-C for adult male 35-65 mg/dl
normal values for HDL-C for adult female 35-80 mg/dl
serum triglycerides (TGs) or blood fats used to screen for hyperlipidemia and the risk for coronary artery disease
TG levels for ages 20-65 are <150 mg/dl
serum TG levels are associated with Coronary artery disease
hemoglobin Hb determination is used to detect iron deficiency anemia
Created by: 691650210