Exam 3

Which lung sound is continuous, high-pitched with musical instrument sound that is polyphonic and occurs mainly during expiration but can be present with inspiration as well?

High-pitched wheeze

What is the best way to assess for extra heart sounds, such as S3 and S4?

Place the patient on their left side and listen with the bell of the stethoscope over the apex of the heart.

Pancreas Physiology

Plays a vital role in maintaining appropriate blood sugar levels of 100mg/dl It secretes insulin when you're satiated and blood sugar levels are high

Objective Data in Respiratory Assessment that would confirm subjective data:

Pulse oximetry Resp. rate Skin color Use of accessory muscles Posture Full sentences

Lung Inspection

Rate Rhythm Quality of Respiration Position Thorax Shape

Venous Ulcers

proximal to the medial malleolus, irregular shape, shallow, mild to moderate pain, normal pedal pulses, increased edema, normal skin temp, flaky, dry skin, leg elevation lessens pain

Which are the semilunar valves?

pulmonic and aortic

Which lung is shorter?

right because of the liver

What is JVD a sign of?

right sided heart failure

Where do you assess the aortic valve?

right sternal border at 2nd ICS

Gallbladder Physiology

secretes bile and stores it until needed for digestion

Spleen Anatomy

small spherical shaped spleen located at about the midpoint of the body.

Appendix Physiology

stores normal flora

Expiration (PASSIVE):

the diaphragm and the external intercostals relax, decreasing the volume of the thoracic cavity and the lungs and increasing the air pressure in the lungs, causing the air to be pushed out -triggered by hypercapnia

Alveoli:

tiny sacs of lung tissue specialized for the movement of gases between air and blood

Small Intestine Physiology

to absorb nutrients (sugars, amino acids, fatty acids, etc.) into the bloodstream (about 90%)

Appendix Anatomy

tubelike pouch attached to cecum below ileocecal valve

Bronchi:

two short branches located at the lower end of the trachea that carry air into the lungs.

During _______, the ventricles are relaxed and the AV valves are ________ to allow blood to flow through the atria and ventricles.

Diastole, opened

Adrenal Physiology

- Located above each kidney - Adrenal Medulla -> Secretes Catecholamines (epinephrine & norepinephrine) - Adrenal Cortex -> Secretes cortisol, aldosterone, androgens

Gallbladder Anatomy

- Located in the right upper quadrant of abdomen, underside of liver, attached by loose connective tissue - Size: pear shaped, approximately 4 inches long - Lined with rugae and has three different layers

Assessing Abdominal Pain

-NEVER palpate if suspected appendicitis, dissecting ABD, aortic aneurysm, polycystic kidneys, or transplanted organs. -NEVER administer pain medications before a medical exam

Adrenal Anatomy

-Near kidney -Cortex/medulla -Different zones produce different hormones -Good blood supply

Venous Insufficiency Symptoms

-Progressive, pitting edema of leg -Itching -Discomfort with standing -Ankle skin is swollen, shiny, and brownish -Ulcerations (possible)

How do you auscultate for a carotid bruit?

1. Auscultate with the bell of the stethoscope 2. Press lightly so you don't create a false bruit or compromise circulation 3. Have the patient take a breath and hold it for a second while you listen. This prevents you from hearing breath sounds. 4. Then compare sides.

Large Intestine Physiology

1. chyme moves from ileum to cecum and peristaltic waves occur to rectum 2. H2O is absorbed as chyme moves through causing the chyme to become solid and become feces 3. feces are stored in rectum causing the rectum to stretch 4. stretch signals muscle reflect which forces feces out

Small Intestine Anatomy

Duodenum - most chemical digestion Jejunum - prominent site for nutrient absorption Ileum - more absorption (B12 and bile salts) Cecum - a pouch connected to junction of small/large intestine, receives chyme

Normal ejection fraction (SV):

60-65%

Bronchioles:

Airways in the lungs that lead from the bronchi to the alveoli.

Which breath sounds are found at the site of the bronchi and are located anteriorly at the 1st and 2nd intercostal space & posteriorly in between the scapulae?

Bronchovesicular

The right middle lobe is auscultated with the stethoscope where?

Anteriorly on the right at the 4th intercostal space

Great Vessels:

Aorta Superior & Inferior Vena Cavas Pulmonary veins Pulmonary Artery

S2 represent the closure of which valves?

Aortic and Pulmonic

The order of heart valve auscultation is the following (starting at the angle of Louis..downward):

Aortic, pulmonic, tricuspid, mitral

S1 is best heard where?

Apex of the heart

What causes S4?

Atria contracting against a stiff walled ventricle, hypertension, MI, ischemic cardiomyopathy, hypertrophy

The ____________ separate the atria and ventricles.

Atrioventricular valves

S2 is best heard where?

Base of the heart

When auscultating the posterior part of the chest the upper lobes are found?

Between C7 to T3

How do you assess cardiac output?

CO(4900mL-5000mL) = HR x SV

Stomach Anatomy

Consists of the Fundus (top), Body (middle), Pylorus (bottom), and Antrum (exit). Lesser curvature is the inside curve, Greater Curvature is the outside curve. Rugae is the internal, folded lining of the stomach.

Subjective Data in Respiratory Assessment

Cough Shortness of breath Chest pain with breathing History of respiratory infections Smoking history Environmental exposure Self-care behaviors

Turgor:

Elasticity of the skin

Internal Respiration:

Exchange of gases between cells of the body and the blood in systemic capillaries

True or False: Low-pitched wheezes are polyphonic sounds that can be cleared when coughing.

False

You are auscultating a patient's lung sounds. During your assessment, you note there is a low-pitched harsh, grating sound that sounds like a pleural friction rub. However, you're not sure if this is a pleural friction rub or pericardial friction rub. What do you do next to determine the difference?

Have the patient hold their breath and note if the sound is still present

In order to auscultate for an aortic regurgitation heart murmur, what is the best position to place the patient in?

Have the patient sitting-up, leaning forward

Liver Anatomy

It is divided into four lobes, the right and left are separated by falciform ligament, the caudate and quadrate are visible on ventral surface. Situated in right hypochondrium and epigastrium.

Which are the atrioventricular valves?

Mitral (bicuspid) and tricuspid

How to assess for JVD?

Place the patient at a 45 degree angle in the supine positon Have the patient turn their head to the left...so you can assess the right side Find the sternomastoid muscle where the external jugular vessel rests Note if the vessel is bulging or large (greater than 2cm)

Which lung has 3 lobes?

Right lung (left has 2 lobes)

When auscultating the anterior part of the chest, specifically the apex of the lungs, it is best to auscultate where with the stethoscope?

Slightly above the clavicle

A high-pitched, harsh sound that is monophonic and is present only during inspiration:

Stridor

During _______, the ventricles are contracted and the AV valves are ________ to allow blood to flow out of the heart.

Systole, closed

Stomach Physiology

Temporary storage tank for food Site of food breakdown Chemical breakdown of protein begins Delivers chyme (processed food) to the small intestine

Which part of the stethoscope is used to auscultate S3 and S4?

The bell

Mediastinum:

The space between the two lungs where the heart, blood vessels, esophagus, and lymph node are found.

What is non-pitting edema?

Tissues are so engorged with fluid that it can not be displaced with manual pressure. Indicates lymphatic issues.

Kidney Physiology

To filter the blood of waste (ex. urea) and excess water to form urine

Where are bronchial breath sounds auscultated?

Tracheal area

True or False: During auscultation, the anterior part of the chest mainly provides an assessment of the upper lobes of the right and left lungs, while the posterior part of the chest provides mainly an assessment of the lower lobes of the right and left lungs.

True

DVT signs and symptoms

Unilateral leg swelling, pain or tenderness, skin discoloration (redness), Palpation of cord-like obstruction over vein

What is a cause of the extra heart sounds known as S3?

Ventricle filling due to fluid volume overload or heart failure

Which breath sounds are found anteriorly and posteriorly throughout the peripheral lung fields?

Vesicular

What is pitting edema?

When finger pressure applied on the swollen extremity leaves an indentation mark on the skin. Indicates cardiac problems.

Clubbing:

abnormal widening and thickening of the ends of the fingers and toes associated with chronic oxygen deficiency

When is S3 heard?

after S2

Venous Insufficiency

an abnormal circulatory condition characterized by decreased return of venous blood from the legs to the trunk of the body

What is S1 split and what causes it?

asynchronous closing of the aortic and pulmonic valves caused by right bundle branch block

When is S4 heard?

before S1

Bruit:

blowing, swooshing sound - indicates partial obstruction

Large Intestine Anatomy

cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, anus

Surfactant:

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

Atelectasis:

collapsed lung; incomplete expansion of alveoli

Kidney Anatomy

cortex, medulla, renal artery, renal vein, pelvis, renal pyramid, ureter, adrenal glands

Discontinuous breath sounds:

crackles, pleural friction rub

Stridor:

crowing heard on inspiration (coup, foreign body obstruction, large airway tumor)

Flow of Blood Through of the Heart:

deoxygenated blood enters the vena cavas, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, oxygenated blood enters the pulmonic veins, left atrium, mitral (bicuspid) valve, left ventricle, aortic valve, aorta, rest of body

Arterial Insufficiency Symptoms

diminished pulses; cool, shiny skin; absence of hair on toes; pain of lower extremities on elevation; ulcers may be present - pale in color with well-defined edges and no bleeding

Pancreas Anatomy

divided into four portions; head, neck, body and tail.

Pleura:

double-layered membrane surrounding each lung

Pleural Friction Rub:

dry sound, creaking, grating, heard on inspiration & expiration (pleurisy, tuberculosis, abscess, pneumonia)

Fine Crackles:

dry, high-pitched popping heard on inspiration (COPD, CHF, pneumonia)

External Respiration:

exchange of gases between inhaled air and blood in the pulmonary capillaries

Sibilant wheezes:

high-pitched, musical heard on expiration (asthma, bronchitis, emphysema, tumor)

DVT causes

immobility, trauma, sepsis, clotting problems, surgical procedures, dehydration, obesity, cancer, estrogen therapy or any condition that cause sowing of venous flow can cause a clot

Arterial Insufficiency

inadequate blood flow through the arteries

Inspiration (ACTIVE):

increased thoracic volume, creates negative pressure to draw in. -expansion of thorax via lowering of diaphragm and rib elevation/expansion (external intercostal muscles) --> negative pressure -triggered by hypoxemia

Abdominal Assessment Order:

inspection, auscultation, percussion, palpation

What is JVD?

jugular vein distention -- bulging of the neck veins

Which lung is narrower?

left because of the heart

Where do you assess the mitral valve?

left mid-clavicular line at 5th ICS

Where do you assess the pulmonic valve?

left sternal border at 2nd ICS

Where do you assess the tricuspid valve?

left sternal border at 5th ICS

Sonorous wheezes (rhonchi):

low-pitched snoring heard on inspiration and expiration (asthma, bronchitis, tumor)

Arterial Ulcers

lower one third of leg, toes, web spaces. smooth edges, well defined, lack of granulation tissue, tend to be deep. severe pain, diminished or absent pedal pulses, normal edema, decreased skin temperature, thin and shiny tissue, hair loss, yellow nails. leg elevation increases pain.

Liver Physiology

major center for metabolism (physical & chemical process whereby food is synthesized into complex elements; complex substances are transported into simple ones, & energy is made available for use by the organism)

S1 represents the closure of which valves?

mitral and tricuspid

Coarse Crackles:

moist, low-pitched popping heard on inspiration & expiration (gurgling, pneumonia, edema, bronchitis)

Ventilation:

movement of air in and out of the lungs