Unit 4

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polly0101
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132940
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Unit 4
Updated:
2012-02-17 22:25:46
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Cardiovascular respiratory
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Nursing 111
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  1. What is PMI and where is it found?
    Point of maximum impulse, apex of the ventricle, 5th intercostal space, midclavicular, left side. Also know as the apical pulse
  2. What is a thrill?
    Continuous palpable sensation like the purring of a cat or vibrations
  3. Where can you hear the aortic valve?
    2nd right intercostal space alongside the sternum
  4. Where can you hear the tricuspid valve?
    4th left intercostal space alongside the sternum
  5. Where can you hear the pulmonic valve?
    2nd left intercostal space alongside the sternum
  6. Where can you hear the mitral area?
    5th left midclavicular space midclavicular
  7. What is the epigastric area?
    Landmark used to palpate for aortic abnormalties, located at the tip of the sternum
  8. What is Erb's point?
    Where S1 & S2 are heard equally, 3rd left intercostal space alongside the sternum
  9. What is the apical area?
    Same as mitral area, 5th left intercostal space midclavicular. The apical pulse will be a light tap in the area at the apex
  10. What are palpatations?
    Sensation of rapid or irregular beating of the heart
  11. What is a murmur?
    Sustained swishing or blowing sounds heart at the beginning, middle or end of the systolic or diastolic phase. Due to increased blood flow through a normal valve or back flow through a valve that fails to close
  12. What is S4?
    Atrial gallop occurs just before S1 or ventricular systole. Similar to the sound of Tennessee. Due to atrial contraction pushing against a ventricle that is not accepting blood because of heart failure.
  13. What is S3?
    Extra heart sound. A ventricular gallop, occurs just after S2 at the end of ventricular diastole. Due to premature rush of blood into the ventricle thatis is stiff or dilated as a result of heart failure and hypertension. S1, S2, S3 sounds like Kentucky
  14. What is S2?
    Follows the short systolic pause and precedes the long diastolic pause, year hear it best at the aortic area
  15. What is S1?
    Occurs after long diastolic pause and preceding the short systolic pause. S1 is high pitched, dull in quality, and heard best at the apex
  16. What is a doppler?
    Ultrasound stethoscope used to hear the sound of pulse wave that is difficult to palpate
  17. Explain jugular veins?
    Most accessible veins for examination. Drain bilaterally from the head and neck into the superior vena cava. EJ lies superficially and is above the clavicle. IJ is lies deeper along the carotid
  18. What is claudication?
    side effect of periperal artery disease. Venous stasis in the legs and feet
  19. What is a Dysrhythmia?
    Failure of the heart to beat at regular successive intervals
  20. Describe Rales?
    Crackles, most common in dependent lobes. Caused by sudden reinflation of groups of alveoli. Can be fine high-pitched, medium low-pitched, or coarse and loud
  21. Describe wheezes?
    High-pitched, continuous musical sounds like a squeak heard continuously during inspiration or expiration. Heard all over lung fields
  22. Describe Rhonchi
    Loud, low-pitched rumbling course sounds heard during inspiration or expiration. heard over trachea and bronchi.
  23. Describe pleural friction rub
    Dry, rubbing, or grating heard during inspiration or expiration. Heard all over lateral lung field
  24. What are adventitious sounds?
    Sounds often superimposed over normal sounds. Include rales, wheezes, rhonchi, and pleural rub. Abnormal lung sounds
  25. What is respiratory expansion?
    a test that indicates the use of accessory muscles on inspiraton. How far the chest expands during inhalation and exhalation
  26. What is orthopnea?
    Shortness of breath while laying flat
  27. What is dyspnea?
    Clinical signs of hypoxia, subjective sensation of difficult or uncomfortable breathing. Shortness of breath usually associated with exercise or excitement
  28. What is tactile fremitus?
    Sound waves created by the vocal cords that are heard and felt through the chest. Vibrations
  29. What is edema (pitting and non-pitting)?
    • Accumulation of excess fluid in the interstitial space.
    • Pitting-Depression in the edematous tissue that disappears slowly
    • Non-pitting-abnormal excess accumulation of serous fluid in connective tissue or in a serous cavity
  30. What is somnolence?
    Quality or state of being drowsy
  31. What is cyanosis?
    A bluish or purplish discoloration of skin due to deficient oxygenation of the blood
  32. What is barrel chest?
    Anteroposterior diameter equals transverse diameter, characterized aging and chronic lung disease. Rounded bulging chest related to a lung disease, usually occurs because lungs are overinflated with air
  33. What are acessory muscles?
    Muscles of respiration. Only used during forces breathing (exercise, asthma attack), Can be used in normal breathing rhythm when a breathing pattern disorder exists
  34. What is vesicular breath sounds?
    Soft, breezy and low-pitched. Inspiratory phase is 3x longer than expiratory phase, best heard over lung's periphery (except scapula). Created by air moving through smaller airways. Heard at the periphery
  35. What are bronchovesicular breath sounds?
    Blowing sounds that are medium pitched and medium intesity. Inspiratory phase is equal to expiratory phase. Best heard posteriorly between scapulae and anteriorly over bronchioles lateral to sternum at 1st and 2nd intercostal spaces. Created by air moving through lungs. Between scapula, lateral to sternum
  36. What are bronchial breath sounds?
    Loud and high-pitched with hollow quality. Expiration lasts longer than inspiration. Heard only over trachea. Caused by air moving through trachea close to chest wall. Treacheal, louder expiration lasts longer
  37. What is the apical-radial pulse?
    The pulse over the groove along the radial or thumb side of the client's wrist. Used because it is easy to palpate
  38. What is the carotid pulse?
    reflect heart function better than periperal ateries because their pressure correlates with the aorta. Supplies oxygenated blood to the head and neck. Sternocleidomastoid muscle protects it
  39. What is the brachial pulse?
    Peripheral pulse found in the groove between biceps and triceps muscles at the antecubital fossa. Used to assess status of circulation to lower arm
  40. What is the radial pulse?
    Radial or thumb side of forearm at wrist, common site used to assess character of pulse peripherally and assess status of circulation to hand
  41. What is the ulnar pulse?
    Ulnar side of forearm at wrist, site used to assess status of circulation to hand, also used to perform allen's test
  42. What is the temporal pulse
    Over temporal bone of head, above and lateral to eye, easily accessible site to assess pulse in children
  43. What is the femoral pulse?
    Below inguinal ligament, midway between symphysis pubis and anterior superior iliac spine. Used to assess character of pulse during physiological shock or cardiac arrest when peripheral pulses are not palpable, used to assess status of circulation in legs
  44. What is the popliteal pulse?
    Behind knee in popliteal fossa, site used to assess status of circulation in lower leg
  45. What is dorsalis pedis pulse?
    Along top of foot between extension tendons of great and first toe, site used to assess status of circulation to foot
  46. What is posterior tibial pulse?
    Inner side of ankle, below medial malleolus, used to assess status of circulaton to foot
  47. What are pulsations?
    The rhythmic beat of the heart and blood vessels, a throbbing
  48. What is pulse deficit?
    Radial pulse is slower than the apical pulse because ineffective contractions fail to send pulse waves to the periphery
  49. What is the peripheral pulse?
    Includes radial pulse, brachial pulse, ulnar pulse, femoral pulse, popliteal pulse, dorsalis pedis pulse, and posterior tibial pulse. Measure these pulses for equality and symmetry
  50. What is the pedal pulse?
    Pulse in the foot
  51. What is variscosity?
    Distended, swollen knotted veins
  52. What is phlebitis?
    Inflammation of a vein that occurs commonly after trauma to the vessel wall, immobilization and prolonged insertion of IV catheters. Usually associated with formation of clots
  53. What are lymphatics?
    Vessels that carry lymph (extracellular tissue fluid)
  54. What is systole?
    Ventricles contract and eject blood from the left ventricle into the pulmonary artery. Period where the heart is contracting specifically the contracting of the left ventricle
  55. What is diastole?
    The ventricles relax and the atria contract to move blood into the ventricles and fill the coronary arteries. Minimal arterial pressure on the atria during relaxation and dilation of the ventricles. The time when the ventricles fill with blood
  56. What is bronchophony?
    If fluid is compressing the lung, the vibrations from the client's voice are transmitted to the chest wall and the sound becomes clear.
  57. What is whispered pectoriloquy?
    When the whispered voice becomes clear and distinct due to lung abnormalties
  58. What are the different lung lobes called?
    Right upper, right middle, right lower, left upper and left lower.
  59. Where do you assess the lungs?
    Anterior, posterior, lateral
  60. What are the posterior chest landmarks?
    Left scapular, vertebral, right scapular
  61. What are the lateral chest landmarks?
    Posterior axillary, midaxillary, anterior axillary
  62. What are the anterior chest landmarks?
    Midsternal, midclavicular, anterior axillary
  63. What does percussion of the lungs do?
    Assess density, assess borders of the lungs, dullness may indicate fluid or mass, hyperresonance may be heard when air trapping occurs
  64. What is eupnea?
    Normal breathing
  65. What is apnea?
    absence of breathing
  66. Whatis bradypnea?
    slow but regular breathing
  67. What is cheyne-stokes?
    gradually become faster and deeper than normal than slower
  68. What is hyperventilation?
    deeper, normal rate
  69. What is kussmauls breathing?
    deeper without pauses
  70. What is tachypnea?
    increased rate
  71. What is the scale when assessing veins & arteries?
    • 0-absent
    • 1+weak
    • 2+normal
    • 3+full
    • 4+bounding
  72. What is bruits?
    The blowing, swishing sound caused by blood passing turbulently through a narrowed section of vein or artery
  73. What is the murmur grading scale?
    • 1-very faint
    • 2-quiet but heard with stethoscope
    • 3-Moderately loud
    • 4-Loud
    • 5-Very loud, can be heard with stethoscope partly off chest
    • 6-Very loud, can be heard without stethoscope

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