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Patient Evaluation

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Created by: sukar

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Question	Answer
Assessment By Auscultation Normal Breath Sounds: Vesicular	normal breath sounds = vesicular
Assessment By Auscultation Normal Breath Sounds: Bilateral Vesicular	normal sounds in both lungs
Assessment By Auscultation Normal Breath Sounds: Bronchial	normal sounds heard over the trachea or bronchi. the sounds heard over lung periphery = lung consolidation
Assessment By Auscultation Changes	changes in the breath sounds will identify where the problem is.
Assessment By Auscultation Egophony	patient is told to say "E" sounds like "A" = Pneumonia = lung consolidation
Assessment By Auscultation Bronchophony/Whispered Pectoriloquy	increased intensity of spoke voice = pneumonia and consolidation
Assessment By Auscultation Increased/Decreased	any increase in the spoken voice indicates pneumonia any decrease obstructed bronchi pneumothorax, emphysema
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/Rales	rales/ crackles = secretion/ fluid coarse rales (rhonchi) = large airway secretions Tx: patient needs suctioning
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/ Medium Rales	medium rales = middle airway secretions Tx: patient need chest physical therapy
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/ Fine Rales	fine rales = (moist crepitant rales) = alveoli, fluid patient has CHF/ pulmonary edema Tx: IPPB, heart drugs, diuretics, and oxygen
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/ Wheeze	due to bronchospasm Tx: bronchodilator unilateral wheeze = foreign body obstruction Tx: bronchoscope
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/ Stridor	due to upper airway obstruction supraglottic = (epiglottis) subglottic = (croup, post extubation) foreign body aspiration (solids or fluids)
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/ Stridor Treatment	topical decongestant (racemic epinephrine) for swelling/edema suction/bronchoscope for secretions/foreign body intubate for SEVERE swelling and epiglottis
Assessment By Auscultation Abnormal Breath Sounds/Adventitious/ Pleural Friction Rub	coarse or crunching sound caused by inflamed surface of visceral & parietal rubbing Association: TB, pneumonia, pulmonary infarction, cancer Tx: steroids and antibiotics
Assessment By Auscultation Heart Sounds/Normal/S1	sounds made by the closure of the heart valves first sound S1= mitral and tricuspid valve at beginning of ventricular contraction
Assessment By Auscultation Heart Sounds/Normal/S2	second sound S2 occurs when systole ends. the ventricles relax the pulmonic and aortic valves close.
Assessment By Auscultation Heart Sounds/Abnormal/S3	if you hear S3 in adults = abnormal = suggest CHF = myocardial infarction or cardiomegaly
Assessment By Auscultation Heart Sounds/Abnormal/S3 &S4	are low pitched may be difficult to discriminate
Assessment By Auscultation Heart Sounds/Abnormal/Heart Murmurs	caused by turbulent blood flow. heart valve defect
Assessment By Auscultation Heart Sounds/Abnormal/Heart Murmurs Occurs	murmurs occur when blood is pushed through an abnormal opening such as an atrial septal defect. or patent ductus arteriosus.
Assessment By Auscultation Heart Sounds/Abnormal/Heart Bruits	are the sounds made in an artery or vein that moves at an abnormal speed. heard over stethoscope over the identified vessel carotid
Assessment By Auscultation Blood Pressure measured	measure the systolic and diastolic pressures.
Assessment By Auscultation Blood Pressure	use a sphygmomanometer to measure cuff pressure.
Assessment By Auscultation Blood Pressure/Normal	Adult: 120/80 acceptable: 90/60 to 140/90
Assessment By Auscultation Blood Pressure/Increased	hypertension = indicates stress = hypoxemia
Assessment By Auscultation Blood Pressure/Decreased	hypotension = indicates poor perfusion = hypovolemia, CHF