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Bronchial vesicular sounds
- Anterior both sides of sternum 1&4 intercostal space
- Posterior between scapula close to spine
- Moderate souns, egual inspiration and expiration
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Vesicular sounds
- Peripherial lung field
- Low pitch, soft, long inspiration short exspiration
- 1, 5-9 intercostal space
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Pulmonary Consolidation
Mass, pneumonia-make sounds that shouldnt be heard in that area
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Brochial
- High pitched, loud, harsh
- Heard over thrachea
- Short inspiration long exspiration
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Right lung
3 lobes, shorter than left
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Left lung
2 lobes, contoured to heart
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Lung anatomy
- Trachea
- Bronochioles
- Alveoli
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Apex of lung location
- 3/4-1 inch above clavicale
- 1/3 in the clavicale bone
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Anterior Base of lung
- 6th rib midclavicular
- 8th rib midaxillary
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Posterior Apex of lung
- T-1 is apex
- C7 (vertebra prominance) is the land mark at base of neck
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Posterior Base of lung
T-10 base of lung
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Breathing motion
Intercostal muscles and diaphragm make breathing happen
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Crepitus
- Air in subcantanous tissue, makes a crackle sound when you palpate
- subcantanous emphazema
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Tectile Fremitus
- virbtations felt by palms of hand
- symetrical sound that decreases at base
- no vibrations means blockage, fluid in area
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Chest expantion
- Should be equal
- Poss. atelectasis, pneumonia if unequal
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Percuss of thorax
listen between intercostal spaces should be resonance over muscle, dull over bone
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Resonance
Sound heard when palpating over tissue
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Diaphragmatic Excursion
the measurment of diaphragm between exspiration and inspiration
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Auscultation
- Compare side to side
- listen for full cycle
- deep breaths
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Stridor
- Crowing sound abnormal breathing HIGH pitched
- upper airway inflammation
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Rhonchi
low pitched, course, thick secretions
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Wheeze-high
high pitched musical squeaking
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Crackles
- Rales-secondary to fluid in airway, wet air way sound
- Signs of C.H.F.
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Pleural friction rub
rough, grating, inflammed surface
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Thorax evaluation
- Check facial expression, pallor, level of conciousness, ect
- lose of conciousness=low O2
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Increase AP diamiter
- Barrel chest-expanded chest perminitly
- increase in CO2 levels-not being removed from lungs
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Chest excursion
hands at base of lung to check for even expansion
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Dead space
Area in lung where there is NO gas exchange
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Colapsed lung
- air get out of lung into plural cavity and pushes on lung causes lung to colapes
- trachea will shift from midline in this case
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Manubrium
Sternum between supra sternal notch and angle of louise
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Costal angle
90 degree or less
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Supra Sternal Notch
Top of sternum just below trachea
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Sternal angle/angle of louis
- Where 2nd rib is felt
- Major land mark
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Xiphoid process
At bottom of sternum
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Apex of heart
5th intercostal space
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Treachea
Largest air way, in front of esophogus
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Tensio Nuemo Thorax
Pressure building up in plural cavity may rupture and collapes trechea
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Brochi
Bifocates at angle of louis
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Brochiolies
- lead to aveliolies
- gas exchange path from aveliolies
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Aveliolies
- Gas exchange!
- Inter-avelio space where gas exchang happens
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Atelectasis
- Total or partial collapse of the lung
- Dull over airless area, trachea shifted to affected side
- Chest tube used to drain blood or air
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Bronchophony test
say 99 if heard load and distinct it is ABNORMAL
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Whispered pectoriloquy test
- whisper 123, should be muffled
- if loud and distinct means there is a consolidation
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Egophony test
say E, if the E sound changes to an A sound that area is consolidated
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Asthma
- Obscured wheeze maybe crackles
- Hyper-resonant
- Decreased tactile fremitus
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Emphysema
- Hyper-resonant-obscured wheeze
- Breath sounds decreased to absent
- Decreased tactile fremitus
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Pneumothorax
- Trachea moves to opposite side
- Hyper-resonant, percussion drumlike over pleural air
- Decreased to absent breath sounds and tactile frem
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Pleural effusion
- build up of fluid between layers of tissue in lung and chest cavity
- dull to flat percussion
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Skin has three layers
Epidermis, dermis, subcutaneous
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Epidermis layers
- Basal cell layer-makes new skin
- Horny layer-sheds every 4 weeks
- Helps regulated body temp
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Dermis
- Conective tissue and collegen
- Elastic tissue
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Terminal hair
thick hair on head eyebrow
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Sebaceous gland
in dermis opens to hair follicle, produces sebum
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Eccrine gland
open to surface of skin produces sweat
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Apocrine gland
opens to hair follicle produces milky substance-sweat, body odor
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Nail assessment
- Shap and Contour
- Consistency
- Capillary refill
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Clubbing
- Bending of fingernail downward
- curve larger than 180
- low oxygen in blood-heart problem
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Jaundice
- liver problem
- look in eye for detection-white
- look at hard/soft pallet for detection-black
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Danger signs of pigmented lesions
- A:asymmetrical shap
- B:border irregularity
- C:color
- D:diameter greater than 6mm
- E:elevation
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Flat macular hemorrhage
- Purpura
- Ecchymosis
- Petechiae
- Hemangioma
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Purpura
- extensive patch of ecchymosis and petechiae
- flat red purplish
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Ecchymosis
Purplish patch resulting from the passage of blood into the subcutaneous tissue
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Petechiae
small dot like spot on body surface, caused by bleeding from superficial capillaries
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Hemangioma
benign skin lession consisting of dense, elevated masses of blood vessels
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