NUR 2010 Exam 2

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Author:
MLBuonarosa
ID:
107456
Filename:
NUR 2010 Exam 2
Updated:
2011-10-10 12:23:06
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Thorax lung heart neck
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Description:
Thorax, lung, heart, neck material for Exam 2
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  1. Characteristics of normal breath sounds:
    Bronchial
    • Intensity and Pitch: Loud and high
    • Quality: Course or tubular
    • Duration: Insp < Exp
    • Locations: Larynx and trachea
  2. Characteristics of normal breath sounds:
    Bronchovesicular
    • Intensity and Pitch: Intermediate & Int
    • Quality: Intermediate
    • Duration: Insp = expiration
    • Locations: Anterior-between 1st and 2nd interspaces; between scapula
  3. Characteristics of normal breath sounds:
    Vesicular
    • Intensity and Pitch: Soft and low
    • Quality: Whispering undertones
    • Duration: Insp>exp
    • Locations: Over most of lung fields
  4. Bronchophony
    • During auscultation, ask patient to say "99"
    • Normal: sounds are muffled or difficult to distinguish
    • Abnormal (e.g., consolidation): easily understood or louder
  5. Egophony
    • During auscultation, have patient say ee
    • Normal: muffled, difficult to hear
    • Abnormal: ee sounds like A
  6. Whispered pectoriloquy
    • During auscultation, ask patient to whipser "one, two, three"
    • Normal: faint, muffled, difficult to hear
    • Abnormal: Louder and clearer than whispered sounds
  7. Techniques for breath sounds
    • bronchophony, egophony, whispered pectoriloquy
    • Abnormal results found with consolidation, or compression (e.g., lobar pneumonia, atelectasis (collapsed lung), or a tumor)
  8. Wheeze
    • Sounds musical, high pitched
    • Futtering of narrowed airway walls (think of a vibrating reed)
    • Take note of if it occurs during inspiration or expiration or both
  9. stridor
    • Stridor is an abnormal, high-pitched, musical breathing sound caused by a blockage in the throat or voice box (larynx). It is usually heard when taking in a breath.
    • Emergency situation!
  10. Eupnea
    • Normal respiration rate
    • 12-20 breaths/minute
  11. dyspnea
    difficulty breathing
  12. apnea
    periods without respirations
  13. hyperpnea
    • rapid + deep breathing
    • hyperventilation
  14. Cheyne-Stokes
    periods of deep breathing followed by periods w/o respirations
  15. crepitus
    • air under skin
    • discovered during palpation
  16. Chest expansion test
    • Place thumbs at T10 with fingers around rib cage
    • push loose skin into a fold
    • assess for symmetric side to side expansion while patient breathes
  17. Tactile fremitus
    • Do when concerned about consolidation or obstruction
    • Palmar base or ulnar surface of hand above scapula
    • patient says, "99"
    • Vibration results are reduced with obstruction, fluid, or tumors
  18. Crackle
    • Result from fluid in ariway or alveoli
    • Sounds like velcro
  19. Rhonchi
    • AKA course wheezing or gurgling
    • Caused by secretions moving during respiration
    • commonly accompanies pneumonia
    • Lower pitch, but louder volume
  20. Assessment of patient with atelectasis
    • Shortness of breath
    • Decreased breath sounds
    • Decreased O2 saturation
    • Increased tactile fremitus
  21. Preload
    • Streching of muscle fibers in ventricles
    • Stretching results from blood volume in ventricles at end of distole
    • Poor venous return=poor preload
    • Right heart problems cause left heart problems
  22. Contractility
    • Inherent ability of myocardium to contract normally
    • Influenced by preload
    • Greater the stretch (i.e., preload), the more forceful the contraction
  23. Afterload
    • amount of pressure the ventricle muscles must generate to overcome higher pressure in the aorta to get blood out
    • Reflects changes in radius of arterioles
    • Afterlooad increased in hypertension and vasoconstriction
  24. Stroke volume
    Amount of blood ejected from heart with each heart beat
  25. Cardiac output
    Stroke volume x beats/min

    CO = SV x R
  26. Ejection fraction (EF)
    • Fraction of blood pumped out of heart with each beat
    • Normal EF = 55% or higher
    • Echocardiogram is test used to determine EF
    • Congested heart failure: low EF, causes shortness of breath
  27. First heart sound (S1)
    • LUB
    • Closure of tricuspid and mitral valves
    • Beginning of systole
    • Loudest at apex
    • Coincides with carotid artery pulse
  28. Second heart sound (S2)
    • DUB
    • closure of pulmonic and aortic valves
    • end of systole
    • loudest at base
  29. Third heart sound (S3)
    (SLOSH-ing-in ) (S1, S2, S3)
    • Normally can't hear diastole
    • Heart failure: when the ventricles fill, a vibration is created (ventricles resistance to fill)
    • Ventricular gallop
    • Low pitched, use bell of stethoscope
  30. Fourth heart sound (S4)
    (a-STIFF-wall) (S4, S1, S2)
    • Ventricle filling sound
    • Heard at end of diastole
    • Related to ventricular filling resistance
    • Atria contract and push blood into noncompliant ventricle
    • heard right before S1
    • Best heard at apex
    • Conditions: hypertension
    • Use bell
  31. Conditions leading to cardiac murmurs
    • Increase in velocity of blood flow
    • Decrease in viscosity of blood (e.g., anemia)
    • Structural defects in the valves or unusual openings in the chambers
  32. Mumurs
    • Timing: systolic or diastolic
    • Quality: crescendo, decrescendo, crescendo-decrescendo (blowing, harsh, or rumbling or musical)
    • Location: 5 places to auscultate on the anterior chest
    • Radiation: where the murmur sound radiates; radiates in direction of blood flow
    • Intensity: loudness graded 0-6
    • Pitch: low, medium, high

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