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Health Assessment #2
respiratory, cardiovascular, abdominal, head, neck and face
| Question | Answer |
|---|---|
| when auscultating the lungs, what would "crackles" indicate? | fluid in the alveoli or abrupt opening of the alveoli |
| when assessing the lungs, what would "wheezing" indicate? | narrowing of wider airways |
| what does ap: lateral ratio tell you and what problem in patients is it usually used for? | chest configuration (barrel chested indicative of congestive obstructive pulmonary disease) |
| percussion over normal adult lungs would produce? | resonance |
| what is circumoral cyanosis? | central cyanosis or blue mucous membranes (blueish discoloration around the mouth) |
| what are normal breath sounds? | bronchial, bronchovesicular, vesicular |
| describe bronchial lung sounds | harsh, high pitch, loud amplitude, inspiration < expiration, normally heard in trachea and larynx |
| describe bronchovesicular sounds | moderate pitch, moderate amplitude, inspiration = expiration, normally heard over major bronchi (fewer alveoli) |
| describe vesicular sounds | rustling, low pitch, soft amplitude inspiration > expiration, normally heard in peripheral lung fields |
| what are the major lobes in the lungs? | right upper lobe, right middle lobe, right lower lobe, left upper lobe, and left lower lobe (left side only has 2 lobes due to heart taking up space) there are 5 lobes total |
| what is pleural effusion? what would you see on an x-ray? | collection of excess fluid in the intrapleural space, would present as whitening on an x-ray |
| what is pneumothorax? what would you see on an x-ray? | free air in pleural space causes partial or complete lung collapse, would present as black on x-ray |
| what are musculoskeletal changes that occur with aging? | loss of cartilage elasticity, decreased muscle strength, increased AP diameter, and senile kyphosis |
| what are lung tissue changes that occur with aging? | decreased elasticity and surface area of lung tissue, atrophy of cilia, decline in pulmonary reserve, and decrease in vital capacity |
| what does tactile fremitus involve? | palpable vibration tested over the posterior chest 5 locations down the right and left sides of the spine while the patient repeats "99" or "blue moon" |
| what does increased tactile fremitus indicate? | occurs with compression or consolidation of lung tissue (lobar pneumonia) |
| what does decreased tactile fremitus indicate? | when anything obstructs transmission of vibrations (pneumothorax, pleural effusion, emphysema) |
| What does egophony involve? | auscultating the posterior chest while patient repeats "ee-ee-ee" sound, you should hear "ee-ee-ee" if "aa-aa-aa" is heard, this may indicate consolidation or compression |
| what type of patient would present with "crackles"? | patients with heart failure and emphysema |
| what type of patient would present with "wheezing"? | patients with asthma and chronic bronchitis |
| describe sibilant wheezing | high pitched and polyphonic |
| describe sonorous rhonchi wheezing | low pitched and monophonic |
| What exam finding would you expect to see in asthma? | inspection-short of breath, increased respiratory rate, audible wheeze; palpation-tactile fremitus decreased; percussion-resonance; auscultation-diminished air movement |
| what exam finding would you expect to see in tuberculosis? | inspection-cough with yellow/green sputum, dyspnea, orthopnea; palpatation-skin moist at night from night sweats, percussion: dull over effusion; auscultation-decreased vesicular breath sounds |
| what exam finding would you expect to see in emphysema? | inspection-barrel chested, shortness of breath, tachypnea; palpation-decreased tactile fremitus and chest expansion; percussion-hyperresonance; auscultatation-decreased breath sounds |
| what exam finding would you expect to see in pneumothorax? | inspection-unequal chest expansion, tachypnea, cyanosis; palpation-tactile fremitus decreased, tracheal shift to opposite side, tachycardia; percussion-hyperresonance; auscultation-breath sounds decreased |
| what exam finding would you expect to see in pneumonia? | inspection-increased respiratory rate, guarding and lag expansion on affected side; palpation-chest expansion decreased on affected side, tactile fremitus increase, percussion-dull; auscultation-breath sounds louder |
| list different breathing patterns | normal, sigh, tachypnea, bradypnea, cheyne stokes, hyperventilation hypoventilation, biot's, chronic obstructive breathing |
| describe cheyne stokes | increase in rate and depth in a regular pattern followed by apnea |
| describe biot's | similar to cheyne stokes but in irregular patterns |
| what are the symptoms of a myocardial infarction? | chest discomfort, pain radiating to jaw and usually left arm, shortness of breath |
| when looking at cholesterol what is LDL? | low density lipid (<100=optimal, 160-190=high) we want low |
| when looking at cholesterol what is HDL? | high density lipid (low-40>HDL<60-high) we want high |
| what is considered normal and elevated total cholesterol? | <200=desirable, >240=high |
| describe the cardiac cycle | superior/inferior vena cavae->right atrium->tricuspid valve->right ventricle->pulmonic valve->pulmonic artery->pulmonic arteries->lungs->pulmonic vein->left atrium->mitral valve->left ventricle->aortic valve->aortic arch->systemic circulation |
| what is happening in S1? | S1 is the beginning of systole (ventricular ejection) the aortic and pulmonic valves are open while the tricuspid and mitral vales are closed |
| what is happening in S2? | S2 is the beginning of diastole (ventricular filling) the tricuspid and mitral valves are open while the aortic and pulmonic valves are closed |
| when and why would you hear an S3? | you would hear an S3 sound during rapid ventricular filling due to early diastolic filling sound (common: kids & 3rd tri) indicates fluid volume overload (CHF & non compliant ventricle) |
| when and why would you hear an S4? | you would hear an S4 sound during slow ventricular filling due to late atrial contraction in diastole (common: athletes) indicates decreased ventricular compliance (stiff ventricle, HTN, cardiomyopathy) |
| what is a murmur? | a turbulent blood flow (gentle/blowing/swooshing sound) that results from increase in velocity, decrease in viscosity or structure defect in valves |
| when would you hear a murmur? | can be heard in the heart during systole (more common) or diastole |
| describe a thrill | can be felt ("you feel a thrill") |
| describe a bruit | can be heard ("you hear a bruit") |
| what is jugular venous distention and why does it occur? | elevated pressure in the jugular vein which can be indicative of left heart failure due to backup of deoxygenated blood |
| describe the hepatojugular reflex | place patient in supine position and place right hand on right upper quadrant of the abdomen and press down for 30 seconds if no heart failure jugular veins will rise and recede if heart failure jugular veins will rise and and stay elevated for whole push |
| what are the precordial anatomical landmarks? | aortic (2nd ICS right SB) pulmonic (2nd ICS left SB) erb's point (3rd ICS left SB) tricuspid (5th ICS left SB) mitral (5th ICS left MCL) |
| what is the order of an abdominal exam? | inspection, auscultation, percussion, and palpation |
| describe ascities | fluid build up in the peritoneal cavity |
| describe rebound tenderness | often conducted with appendicitis, pushing down on the lower right quadrant of the abdomen and producing more pain as you relieve pressure than as you apply pressure |
| what is McBurny's point? | 2/3 of the way down and diagonally from the umbilicus to the right anterior superior iliac spine (often related to the appendix) |
| what is Cullen's sign? | bruising around the umbillicus |
| what is Grey Turner's sign? | bruising in the flanks (posterior lower back) |
| what causes a diastolic murmur? | regurgitation of blood through the aortic or pulmonic valves or blood flow through stenotic tricuspid or mitral valve |
| what causes a systolic murmur? | regurgitation of blood through the tricuspid or mitral valves or blood flow through stenotic aortic or pulmonic valve |
| how are murmurs graded? | 1: only cardiologists hear this, 4: loud associated with thrill and 6: you can hear from outside of a room |
| describe pericardial friction rub | sand paper rubbing together sound due to inflammation of the pericardium |
| what determines cardiac output? | heart rate x stoke volume |
| describe varicose veins | dilated and "knotted" |
| describe caput medusae | dilated and smooth veins |
| what is rectus diastasis? | splitting of the rectus and producing a "bulge" when in the motion to sit up |
| describe paracentesis | drainage of fluid in the peritoneal cavity (ascities) |
| define xerosis | face dehydration |
| define xerostomia | mucous membranes are dry |
| define torticollis | neck stiffness due to stress or heavy lifting |
| define bruxism | involuntary clenching/grinding of jaw |
| define epistaxis | bleeding from the nose |
| describe palpable fissure | the measurement of space between the eyelids on each individual eye |
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