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Assessment Test 4
Thorax and Lungs, Heart and Neck Vessels, Documentation, and Physical Exam
195
Nursing
04/19/2011

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Cards

Term
sternum, ribs, costochondral junctions, thoracic vertebrae, and diaphragm
Definition
the 5 things that make up the thoracic cage
Term
midsternal line, midclavicular line, and anterior axillary line
Definition
what are the three anterior reference lines?
Term
vertebral line and scapular line
Definition
what are the two posterior reference lines?
Term
anterior axillary line, midaxillary line, and posterior axillary line
Definition
three lateral reference lines
Term
pleural cavities
Definition
contains the lungs
Term
mediastinum
Definition
the middle section of the thoracic cavity that contains the esophagus, trachea, heart, and great vessels
Term

apex- highest point, 3-4 cm above the inner 3rd of the clavicle

base- lowest point, rests on the diaphragm at 6th rib in the midclavicular line

laterally- from apex of axilla to 7th or 8th rib

posteriorly- down to T10, T12

Definition
lung borders 
Term
right lung
Definition
which lung is shorter and has three lobes
Term
the right lung
Definition
which lung has a horizontal fissure and a right oblique fissure
Term
the left lung
Definition
which lung is more narrow and has two lobes?
Term
the left lung
Definition
which lung has a left oblique fissure?
Term
the LLL and LUL
Definition
what does the left oblique fissure divide?
Term
left lower lobe and left upper lobe
Definition
in the left lung, what are the lobes called?
Term
right upper lobe, right middle lobe, and right lower lobe
Definition
in the right lung, what are the lobes called?
Term
divides RUL and RML
Definition
what does the horizontal fissure in the right lobe divide?
Term
the RML and RLL
Definition
in the right lobe, what does the right oblique fissure divide?
Term
visceral pleurae
Definition
lines the outside of the lungs
Term
parietal pleura
Definition
lines the inside of the chest wall and diaphragm
Term
costodiaphragmatic recess
Definition
located below the lungs, comprises lung expansion when abnormally filled with air or fluid
Term
visceral, parietal, costodiaphragmatic
Definition
the three thoracic pleurae
Term
trachea
Definition
anterior to esophagus, begins at cricoid cartilage, bifurcates below sternal angle at T4 and T5 into the right and left bronchi, and the right bronchi is shorter, wider, and vertical
Term
supply oxygen to the body for energy, remove carbon dioxide, maintain homeostasis of arterial blood, and maintain heat exchange
Definition
what are the major functions of respiratory system?
Term
pons and medulla
Definition
involuntary control of respirations
Term
hypercapnia
Definition
increase carbon dioxide in the blood; normal stimulus to breathe
Term
hypoxemia
Definition
decrease of oxygen in the blood
Term
inspiration
Definition
increase chest size, diaphragm contracts, descends, and flattens
Term
expiration
Definition
chest recoils, diaphragm relaxes
Term
tuberculosis
Definition
what disease is more prevalent in cross-cultural care?
Term
size in the thoracic cavity
Definition
what influences pulmonary function?
Term
palpable vibration
Definition
fremitus
Term
touch
Definition
tactile
Term
the costal angle
Definition
what should be less than 90 degrees?
Term
the angle of Louis
Definition
this is where the trachea bifurcates into left and right bronchi
Term
C7
Definition
vertebral prominence
Term
at about the 8th rib
Definition
when does the scapula end
Term
wheezing
Definition
this sound is heard whenever there is airway obstruction
Term
rhonchi
Definition
this sound occurs with secretions in the chest
Term

high-pitched wheezing sound

Definition
stridor
Term
stridor (ex. child with croup)
Definition
this sound is heard when there is significant inflammation in the UPPER airway
Term
non-pathogenic
Definition
atelectic crackles are what?
Term
louder (ex. emphesema, COPD)
Definition
if there is more air in the lungs, when you percuss the sound will be...
Term
in the intercostal spaces... not on top of the ribs
Definition
where do you percuss on the chest?
Term
hypertrophic
Definition
in COPD patients, neck muscles are... 
Term
tripod position
Definition
COPD patients often sit in what position?
Term
scoliosis and kyphosis
Definition
what are two examples of skeletal deformities of the spinous processes?
Term
with barrel chest (ex. emphysema)
Definition
when is the AP diameter equal?
Term
cough? shortness of breath? chest pain with breathing? history of respiratory infections? smoking history? environmental exposure? self-care behavior?
Definition
what are the health history questions to ask when assessing the thorax?
Term

1. shape and configuration (spinous processes, thoracic symmetry, and AP diameter)

2. neck and trapezius muscles

3. position

4. skin color and condition

Definition
when inspecting the posterior chest what do you look at?
Term
at T9 or T10
Definition
where do you test for symmetrical chest expansion?
Term
they decrease
Definition
what happens to the vibrations when something obstructs transmission of vibrations, ex. emphysema, obstructed bronchus?
Term
they increase
Definition
what happens when the vibrations are over areas of consolidation ex. pneumonia
Term
tactile fremitus
Definition
palpate in five places, ask the patient to say "99", vibrations should be equal on both sides
Term
relative location of bronchi to chest wall, thickness of chest wall, and pitch and intensity
Definition
factors that affect intensity of tactile fremitus include...
Term
resonance, hyperresonance, dull
Definition
3 types of percussion notes
Term
nine
Definition
how many places do you percuss on the back?
Term
resonance
Definition
normal lung, air-filled, low-pitched, clear, hollow sound
Term
hyperresonance
Definition
lower-pitched, booming sound, has too much air is present, ex. emphysema and pneumothorax
Term
dull percussion sound
Definition
soft, muffled thud, signal abnormal density in lungs, ex. pneumonia, pleural effusion, or tumor
Term
vesicular, bronchial, bronchovesicular
Definition
characteristics of normal breath sounds
Term
vesicular
Definition
low, soft pitch heart over the peripheral lung fields
Term
bronchial
Definition
loud, high pitch heard in the trachea and larynx (heard on the anterior chest best)
Term
bronchovesicular
Definition
moderate pitch heard over major bronchi where fewer alveoli are located
Term
adventitious sounds
Definition
added sounds not normally heard in the lungs
Term
crackles, wheezes, rhonchi, stridor
Definition
examples of adventitious sounds
Term
hyperinflated lungs
Definition
these type of lungs do not make as much noise
Term

1. obstruction

2. emphysema patients (loss elasticity, decreased force of inspired air, hyperinflated lungs do not make as much noise)

3. silent chest

Definition
3 things that can cause decreased breath sounds
Term
consolidation (ex. pneumonia) and compression (ex. pleural effusion)
Definition
increased breath sounds
Term
hyperventilation
Definition
increase in both rate and depth, blows off CO2
Term
hypoventilation
Definition
irregular slow shallow pattern, retains CO2
Term
Cheyne-Stokes Respiration
Definition
breathing patterns fluctuates from regular, to rapid and shallow, to periods of apnea (ex. drug OD, increased ICP, meningitis)
Term
enhances voice sounds when auscultating the posterior chest
Definition
what does compression and consolidation of lung tissue do?
Term

dull- heart and liver

tympanic- gastric space

hyperresonance- hyperinflated lungs

flat- bone

Definition
what organ has a dull note, what has a tympanic note, hyperresonance, flat note?
Term
forced expiratory time
Definition
number of seconds it takes to exhale from total capacity to residual volume
Term
forced expiratory time
Definition
measures air flow obstruction, ask person to inhale deepest breath possible and then blow it all out hard, as quick as possible with mouth open, listen over the sternum
Term
97-98%
Definition
normal pulse oximetery
Term
pulse oximetery
Definition
varies depending on hemoglobin level, acid-base balance, and ventilatory status
Term
atelectasis 
Definition
a collapse in alveoli
Term
pneumonia
Definition
infection of parenchyma, leaving alveoli filled bacteria and fluid instead of air, results to decrease surface area, which causes hypoxia
Term
crackles
Definition
adventitious sound associated with pneumonia
Term
crackles, wheezes
Definition
adventitious sounds associated with bronchitis
Term
atelectasis and emphysema
Definition
2 respiratory conditions that don't have adventitious sounds associated with them
Term
emphysema
Definition
destruction of pulmonary CT (connective tissue) that leads to permanent enlargement of air sacs to bronchioles and rupture of interalveolar walls, which results in hyperinflated lungs.
Term
hyperresonant
Definition
emphysema percussion will sound..
Term
atelectasis and pneumonia
Definition
which two respiratory conditions would have dull percussion?
Term
the whole area across chest wall
Definition
precordium
Term
bronchitis and asthma
Definition
these 2 respiratory conditions would have resonant percussion
Term
2nd to 5th
Definition
the heart goes from which intercostal space to which intercostal space?
Term
Definition
Term
pulmonary artery, pulmonary veins, aorta, and superior and inferior vena cava
Definition
the great vessels
Term
left to body, right to lungs
Definition
where do the left and right sides of the heart pump blood?
Term
the AV valves open, allowing the ventricles to fill with blood
Definition
what happens to which valves during diastole
Term
semilunar valves
Definition
the valves between the ventricles and the arteris
Term
pulmonic on the right and aortic on the left. they open during systole to allow blood to be ejected from the heart
Definition
what are the two SL valves
Term

1. pericardium- tough double-walled sac that surrounds and protects the heart

2. myocardium- the muscular wall of the heart; it does the pumping

3. endocardium- the thin layer of endothelial tissue that lines the inner surface of the heart chambers and valves

Definition
the layers of the heart wall
Term
mediastinum
Definition
the middle third of the thoracic cage
Term

open- during beginning of systole (S1)

close- during end of systole (S2)

Definition
the valves open during what and close during what
Term
tricuspid (right side) and mitral/bicuspid (left side)
Definition
the two atrioventricular valves 
Term
the base of the heart
Definition
where is S2 best heard at?
Term
the apex of the heart
Definition
where is S1 best heart at?
Term
when the mitral and tricuspid valves swing shut
Definition
S1 (first heart sound)
Term
when the semilunar valves close
Definition
S2 (second heart sound) occurs...
Term
the right side
Definition
which side of the heart has less pressure
Term
SA node (it has an intrinsic rhythm)
Definition
the "pacemaker"
Term
during diastole
Definition
when do extra heart sounds occur if they are present?
Term
third heart sound. it occurs immediately after S2
Definition
this sound occurs with heart failure, volume overload
Term
the fourth heart sound
Definition
the ventricles become resistant and noncompliant. heard just before S1
Term

1. frequency- heart sounds are described as high pitched or low pitched

2. intensity- loud or soft

3. duration- very short for heart sounds; silent periods are longer

4. timing- systole or diastole 

Definition
4 characteristics of sound (how they are described)
Term
cardiac output
Definition
equals the volume of blood in each systole (stroke volume) times the number of beats per minute (rate)
Term
preload and afterload
Definition
what two things affect the heart's ability to increase cardiac output
Term
preload
Definition
the venous return that builds during diastole. it is the length to which the ventricular muscle is stretched at the end of diastole just before contraction
Term
afterload
Definition
the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. it is the resistance against which the ventricle must pump its blood
Term
4-6 L/min
Definition
what is normal cardiac output?
Term
60-100
Definition
how many times does the SA node beat per minute?
Term
preload
Definition
indicator of volume status of blood in heart
Term
the efficiency of cardiac function
Definition
the carotid artery and jugular veins reflect what?
Term
SA node--> AV node--> bundle of his--> R and L bundle branches
Definition
pathway of conduction
Term
afterload
Definition
pressure that LV has to pump against to get blood to the body
Term
carotid artery
Definition
the artery located in the groove between the trachea and the sternomastoid muscle, medial to and alongside that muscle
Term
jugular veins
Definition
these empty unoxygenated blood directly into the superior vena cava. they give info about activity on the right side of the heart
Term
internal and external
Definition
name the two jugular veins
Term
internal jugular vein
Definition
this vein is larger and lies deep and medial to the sternomastoid muscle
Term
external jugular
Definition
this vein is more superficial; it lies lateral to the sternomastoid muscle, above the clavicle
Term

S4- tennessee

S3- kentucky

Definition
what word does S4 sound like? and S3?
Term
heart disease and stroke
Definition
what two things are more prevalent for African Americans?
Term
shortness of breath that occurs when sleeping
Definition
PND
Term
difficulty breathing when laying down
Definition
orthopnea
Term
lie back and turn head slightly away from you
Definition
to assess the jugular veins what do you need to tell the patient to do?
Term
palpate and look for a symmetric pulse. grade the pulse on a scale of 1-3. and auscultate for a bruit- listen in 3 spots on each side 
Definition
how do you assess the carotid arteries?
Term
a palpable vibration
Definition
what is a thrill?
Term
S1
Definition
which heart sound is louder at the apex?
Term
S1
Definition
which heart sound coincides with carotid artery pulse?
Term
R wave
Definition
S1 coincides with what wave on an electrocardiogram?
Term
aortic, pulmonic, erb's point, tricuspid, mitral
Definition
what are the five auscultatory areas?
Term
second right interspace
Definition

where is the aortic valve area

Term
second left interspace
Definition
where is the pulmonic valve area
Term
left lower sternal border
Definition
where is the tricuspid valve area
Term
the fifth interspace at around left midclavicular line (nipple line)
Definition
where is the mitral valve area
Term
for a full minute
Definition
how long do you listen to the apical impulse?
Term
sinus arrhythmia
Definition
the rhythm varies with the person's breathing, increasing at the peak of the inspiration and slowing with expiration. it occurs normally in young adults and children
Term
pulse deficit
Definition
signals a weak contraction of the ventricles; it occurs with atrial fibrillation, premature beats, and heart failure
Term
pulse deficit
Definition
when you notice any irregularity, check for _____ _______ by auscultating the special beat while simultaneously palpating the radial pulse
Term
a blood clot
Definition
if homan's sign is positive (pain), then what is that possibly indicative of?
Term
in front of the ear
Definition
where do you palpate the temporal artery?
Term
brachial (major artery supplying blood to the arm), radial (thumb side), and ulnar (pinky side)
Definition
what are the three arteries of the arm?
Term
venous system
Definition
low pressure system
Term
femoral (major one- inguinal pulse site), popliteal (pulse site behind the knee), dorsalis pedis (top of foot), and posterior tibial (inside of ankle)
Definition
what are the 4 arteries in the leg?
Term
femoral and popliteal
Definition
the two types of deep veins
Term
great saphenous and small saphenous (sometimes used for open heart surgery)
Definition
the two types of superficial veins
Term
deep (femoral and popliteal), superficial (great and small saphenous), and perforators (connecting veins)
Definition
what are the 3 types of veins in the leg?
Term

1. contracting skeletal muscles

2. breathing

3. valves

Definition
what are the three mechanisms of venous flow?
Term
lymphatics
Definition
retrieve excess fluid from the tissue spaces and return it to the bloodstream
Term
right lymphatic duct and thoracic duct
Definition
the 2 lymphatic ducts
Term
the right subclavian vein
Definition
what does the right lymphatic duct empty into?
Term
right lymphatic duct
Definition
drains right side of head and neck, right arm, right side of thorax, right lung and pleura, right side of the heart, right upper section of the liver
Term
thoracic duct
Definition
drains the rest of the body and empties into the left subclavian vein
Term
spleen, tonsils, and thymus
Definition
what are the organs that aid the lymphatic system?
Term

1. to conserve fluid and plasma proteins that leak out of the capillaries

2. to form a major part of the immune system that defends the body against disease

3. to absorb lipids from the intestinal tract

Definition
what are the functions of the lymphatic system?
Term
cervical, axillary, epitrochlear (middle of arm), and inguinal
Definition
what are the four superficial groups of lymph nodes?
Term
the spleen
Definition
the storage site for RBCs
Term
thymus gland
Definition
this functions more in a child
Term
oral contraceptives
Definition
what medication increases the risk of a DVT?
Term
1-2 seconds
Definition
how long should capillary refill take?
Term
modified Allen test
Definition
this test is used to evaluate the adequacy of collateral circulation prior to cannulating the radial artery. (this is the test we did in class where you depress the radial and ulnar arteries and the person opens and closes their fist.. when you take off the pressure, the blood should return. if it doesn't, then the ulnar artery is occluded)
Term
lymphedema
Definition
removal of lymph nodes with breast surgery, or damage to lymph nodes and channels with radiation therapy for breast cancer; can impede drainage of lymph
Term
viewing the finger from the side (used to detect early clubbing)
Definition
what is the profile sign?
Term
if they are hard and fixed
Definition
what are characteristics of lymph nodes that are worrysome?
Term
breasts
Definition
anterior chest wall between the second and sixth ribs
Term
nipple
Definition
center of the breast; rough, round, protuberant
Term
areola
Definition
surrounds the nipple; small elevated sebaceous glands
Term
Cooper's ligaments
Definition
these become contracted when there is a malignancy there- creates dimples
Term
sitting
Definition
when examining the woman's axillae, how should she be positioned?
Term
enlargement of breast tissue in men. usually happens in puberty. it's temporary and it's usually one-sided
Definition
what is gynecomastia?
Term
inframammary ridge
Definition
a firm transverse ridge of compressed tissue in the lower quadrants
Term
swelling in the lymph system
Definition
lymphadenopathy
Term

1. solid- liver, kidneys, etc.

2. hollow- the shape depends on the contents (bladder, stomach, colon, etc.)

Definition
what are the two types of viscera?
Term
no bowel movement for three days
Definition

what constitutes constipation?

 

Term
difficulty swallowing
Definition
dysphagia
Term

normal- flat, rounded

abnormal- scaphoid, protuberant

Definition
describe normal and abnormal contour of abdomen
Term

abdomen is large and firm, rounded 

(ex. bowel obstruction)

Definition
protuberant
Term
abdomen shape of patient who is anorexic, wasted
Definition
scaphoid
Term

hyperactive- loud, high-pitched, rushing, tinkling sounds that signal increased motility

hypoactive or absent- follow abdominal surgery or with inflammation of the peritoneum

Definition
two distinct patterns of abnormal bowel sounds
Term
5 minutes
Definition
to declare an abdomen has having absent bowel sounds, how long do you have to listen for?
Term
legal document, communication and care planning, quality assurance, financial reimbursement, education, and research
Definition
what are some patient medical record purposes?
Term
confidential (never leave a computer unattended), accurate and complete, organized, timely (time of entry must reflect the time that you did it), and concise
Definition
what are the principles of documentation?
Term
narrative, SOAP (IE), PIE, focus, and charting by exception
Definition
5 kinds of documentation formats
Term
SOAP (IE)
Definition
doctor documentation
Term
PIE
Definition
nurse documentation
Term
if nothing is wrong, just click on to the next section without writing anything. 
Definition
charting by exception
Term
problem, intervention, evaluation
Definition
what does PIE stand for
Term
subjective, objective, assessment, plan, intervention, evaluation
Definition
what does SOAP (IE) stand for?
Term
PIE
Definition
incorporates plan of care, includes outcomes which increase quality assurance, less redundancy, easily adapted to computer charting
Term
handoff
Definition
hot topic with joint commission. ensures quality
Term
handoff
Definition
occurs when care for a patient is transferred from one health provider to another. receiving staff must have up-to-date assessment data
Term
use a standardized format- SBAR, communicate face to face with current and historical data, ensure limited interruptions, use "read-back" policies, and use written documentation to supplement handoff
Definition
what are some strategies for effective handoff?
Term

S- situation, state concisely why you are communicating

B- background, describe circumstances that lead up to the situation

A- assessment, give objective/subjective data pertinent to the situation

R- recommendation, make suggestions for what needs to be done to manage the patient

Definition
what does SBAR stand for and mean?