Term
|
Definition
| Area of exterior chest that overlays heart and great vessels. |
|
|
Term
| Which part of the heart occupies most of the anterior cardiac surface? |
|
Definition
| Right ventricle and pulmonary artery |
|
|
Term
| How many impulses per minute can the AV node generate? |
|
Definition
|
|
Term
| How many impulses per minute can the Bundle of His and Purkinje Fibers generate? |
|
Definition
|
|
Term
| Which 3 mechanisms move blood through veins? |
|
Definition
1. Contracting skeletal muscle
2. Pressure gradient caused by breathing
3. Intraluminal valves |
|
|
Term
| What are 3 functions of the lymphatic system? |
|
Definition
1. Conserve fluid and plasma proteins that leak from capillaries
2. Immunity
3. Absorb lipids from intestinal tract |
|
|
Term
| What are 3 functions of the spleen? |
|
Definition
1. Store and destroy old RBCs
2. Produce antibodies
3. Filter microorganisms |
|
|
Term
| What is the thymus' main immunological role? |
|
Definition
| Develop T lymphocytes for specific immune response. |
|
|
Term
| If edema is cardiac-related, would both feet or only one foot swell? |
|
Definition
|
|
Term
| What hair is a part of cardiac assessment? |
|
Definition
| Leg hair--if they have none, there is a cardiac abnormality/issue. |
|
|
Term
| Which 3 cardiac-specific medical history questions should you ask in a cardiac assessment? |
|
Definition
1. Congenital heart defect?
2. Elevated cholesterol?
3. Coronary artery disease? |
|
|
Term
| What are 2 non-cardiac-specific past medical history questions that should be asked in cardiac assessment? |
|
Definition
1. Diabetes?
2. Renal disease? |
|
|
Term
| Which childhood illness can be important in a cardiac assessment? |
|
Definition
|
|
Term
| Describe the unique presentation of women with heart disease as opposed to males. |
|
Definition
N&V
Indigestion
SOB
Extreme fatigue without chest pain
Hot/burning sensation or tenderness in back, shoulders, arms, jaw |
|
|
Term
| What cardiac changes occur as an adult ages? |
|
Definition
1. Heart rate slows
2. Decreased elasticity and contractility
3. Fibrous changes in connective tissue
4. Calcification of aorta and arteries |
|
|
Term
| What equipment is needed for a physical exam of the heart? |
|
Definition
1. Stethoscope with bell and diaphragm
2. Sphygmomanometer
3. Two 15-cm rulers
4. Watch with a seconds hand
5. Tangential lighting |
|
|
Term
| From head to toe, what do you INSPECT during cardiac assessment? |
|
Definition
1. With head elevated 30-45 degrees: JVD >2 cm above sternal angle?
2. Jugular vein pulsation height
3. Precordium with tangential lighting: Skin (scars, striae), heaves, pulsations, shape of thorax |
|
|
Term
|
Definition
Right ventricular failure
Pulmonary edema
Ineffectiveness of heart as a pump |
|
|
Term
| What do you PALPATE during cardiac assessment? |
|
Definition
1. APETM: pulsations, lifts, thrills
2. Peripheral pulses |
|
|
Term
| If you palpate a thrill, what will you likely auscultate in that same spot? |
|
Definition
|
|
Term
| Where are S1 and S2 loudest? |
|
Definition
S2 at the base (top)
S1 at the apex (bottom) |
|
|
Term
| What should you assess if you hear a murmur? |
|
Definition
1. Timing/duration
2. Loudness: Ranges from I-VI; very faint/not even sure if you heard it, to very loud, heard without stethoscope with a palpable thrill |
|
|
Term
| What are the 3 classifications of murmurs? |
|
Definition
1. Innocent: systolic
2. Functional: high-output states
3. Pathological: structural abnormalities |
|
|
Term
| What does clubbing of the fingernails indicate? |
|
Definition
| Chronic hypoxia (cystic fibrosis, congenital heart disease, etc.) |
|
|
Term
| Besides symmetry, skin, and pulses, what else should you inspect and palpate during a peripheral vascular system assessment? |
|
Definition
Temperature
Capillary refill
Nail beds
Epitrochlear node
Hair distribution
Varicosities
Ulcers
Edema |
|
|
Term
| Describe the pitting edema scale |
|
Definition
1+: barely perceptible pit
2+: deeper pit that rebounds in a few seconds
3+: deep pit, rebounds in 10-20 seconds
4+: Deeper pit, rebounds in >30 seconds |
|
|
Term
| List the lines of reference of the thorax. |
|
Definition
1. Midsternal
2. Midclavicular
3. Anterior axillary
4. Midaxillary
5. Posterior axillary
6. Scapular
7. Vertebral |
|
|
Term
|
Definition
| Prominent sternal protrusion |
|
|
Term
|
Definition
| Indentation of lower sternum |
|
|
Term
|
Definition
| AP:T 1:1; common in COPD and babies |
|
|
Term
|
Definition
| Tingling around lips, hands, and feet that can accompany dyspnea |
|
|
Term
|
Definition
| Shortness of breath/difficulty breathing while laying on one side |
|
|
Term
|
Definition
| Difficulty breathing while sitting up |
|
|
Term
| What can sudden onset dyspnea indicate? |
|
Definition
Anaphylaxis
Pulmonary embolism
Pneumothorax
Anxiety (feels like you can't get a deep enough breath) |
|
|
Term
| Why might sputum be foul-smelling? |
|
Definition
|
|
Term
| What does purulent sputum look like? |
|
Definition
|
|
Term
| What does mucoid sputum look like? |
|
Definition
| See-through white or gray |
|
|
Term
| Who might have morning and nocturnal coughing? |
|
Definition
|
|
Term
| What medication commonly causes coughing? |
|
Definition
|
|
Term
| How do you determine if a cough is acute or chronic? |
|
Definition
Acute: Less than 3 weeks
Subacute: 3-8 weeks
Chronic: Over 8 weeks |
|
|
Term
| If a patient complains of chest pain, how should you further assess it? |
|
Definition
With movement?
With cough?
After eating? |
|
|
Term
| What are important history questions to ask in assessing infants' and childrens' respiratory systems? |
|
Definition
Low birth weight? (Can affect lung development)
Assisted ventillation?
Difficult feeding/recurrent spitting up? (Aspiration?)
Apneic periods?
Sibling SIDS death? |
|
|
Term
| List items for INSPECTION during respiratory assessment? |
|
Definition
1. Mode of breathing
2. Lips, skin, mucus membranes color
3. Audible?
4. Breathing posture
5. Retractions?
6. Symmetrical movement?
7. Accessory muscles/nasal flaring?
8. Cough?
9. R: pattern, depth, rate
10. Throax shape/AP:T
11. Nails: clubbing, capillary refill? |
|
|
Term
| List items for PALPATION during respiratory assessment? |
|
Definition
1. Trachea: midline
2. Costal angle: <90
3. Pulsations?
4. Masses?
5. Tenderness?
6. Thoracic expansions, symmetry
7. Tactile fremitus
8. Spine (straight?) |
|
|
Term
| What can tenderness indicate upon thorax palpation? |
|
Definition
| Inflammation of the underlying pleura |
|
|
Term
| What are possible causes of changes in tactile fremitus? |
|
Definition
Increased: pneumonia
Decreased: unilateral pneumothorax, pleural effusion, bronchial obstruction, atelectasis. Bilateral COPD, chest wall thickening, fat |
|
|
Term
| Is tactile fremitus usually present over precordium? |
|
Definition
| No; normal findings are for tactile fremitus to be absent or decreased over precordium. |
|
|
Term
| List items for PERCUSSION during respiratory assessment? |
|
Definition
Ladder from apices to bases (7 points)
Diaphragmatic excursion |
|
|
Term
| Describe the diaphragmatic excursion test? |
|
Definition
| Ask patient to inhale and hold their breath. Percuss from thorax down to determine where dullness replaces resonance. This is the approximate location of the diaphragm. Ask the patient to exhale and hold their breath and perform the percussion again. Measure the difference between the two marks; it should be 3-5 cm although it may be larger in athletes. |
|
|
Term
| List some reasons diaphragmatic excursion might be higher than normal? |
|
Definition
Atelectasis
Pleural effusion
Diaphragmatic paralysis |
|
|
Term
| What sound does the heart produce with percussion? |
|
Definition
| Dullness. If you hear resonance, it may indicate COPD. |
|
|
Term
| What should you AUSCULTATE for in respiratory assessment? |
|
Definition
1. Sounds generated by breathing
2. Adventitious sounds?
3. IF abnormal, listen for spoken and whispered voice through chest wall |
|
|
Term
| What are the 3 sounds generated by breathing? (not adventitious) |
|
Definition
1. Bronchial
2. Bronchovesicular
3. Vesicular |
|
|
Term
|
Definition
Normal.
Soft, low pitch.
Inspiration + first 1/3 of exhalation is audible.
Heard over most of both lungs. |
|
|
Term
| Bronchovesicular breath sound |
|
Definition
Length of inspiration = exhalation.
Audible at 1st and 2nd intercostal spaces, and between scapulae. |
|
|
Term
|
Definition
Louder, high pitched.
Exhalation length greater than inhalation.
Heard over manubrium and trachea if at all. |
|
|
Term
| Which part of your stethoscope do you listen to breath sounds with? |
|
Definition
|
|
Term
| Crackles: Mechanism and causes? |
|
Definition
AKA Rales.
Mechanism: Excess airway secretions.
Causes: Bronchitis, respiratory infetions, pulmonary edema, atelectasis, fibrosis, congestive heart failure. |
|
|
Term
| Wheeze: Mechanism and causes? |
|
Definition
Mechanism: Rapid airflow through obstructed airway.
Causes: Asthma, pulmonary edema, bronchitis, congestive heart failure. |
|
|
Term
| Rhonchi: Mechanism and causes? |
|
Definition
Low-pitched. Snoring quality.
Mechanism: Transient airway plugging.
Causes: Bronchitis. |
|
|
Term
| Pleural rub: Mechanism and causes? |
|
Definition
Mechanism: Inflammation of pleura.
Causes: Pneumonia, pulmonary infarction. |
|
|
Term
| Stridor: Mechanism and causes? |
|
Definition
Mechanism: Partial blockage of airway from object or inflammation; laryngeal spasms in upper airway.
CAuses: Croup, aspiration, spasm |
|
|
Term
| If you hear adventitious lung sounds, what are your next assessment steps? |
|
Definition
Does it clear with coughing?
Is it on inspiration and/or exhalation?
Do R and L sound the same? |
|
|
Term
| What are the three tests you perform if you hear adventitious lung sounds, if tactile fremitus was abnormal, or if you hear dullness upon percussion? |
|
Definition
Bronchophony
Whispered pectoriloquy
Egophony |
|
|
Term
| What PHYSIOLOGIC changes occur in the geriatric patient's respiratory system as they age? |
|
Definition
Loss of elasticity in pulmonary septa
Atrophy of alveoli
Decreased muscle tone
Degeneration of bronchial epithelium and mucus glands
Skeletal changes |
|
|
Term
| What are the results of the physiologic changes that occur in aging respiratory systems? |
|
Definition
Reduction in vital capacity
Reduction in oxygen diffusion
Decreased expiratory flow rate
Increased susceptibility to infection |
|
|
Term
| What are normal findings of a respiratory assessment of an infant? |
|
Definition
Barrel chest 1:1
R 30/minute at rest or 60/min with crying
Nasal patency
Symmetry |
|
|
Term
| What is the forced expiratory test and what can it tell you? |
|
Definition
| Listen over trachea with diaphragm of stethoscope while patient exhales. If it takes 6-8 seconds, it's twice as likely the patient has COPD. You need 3 consistently high readings, but allow time for rest. |
|
|
Term
| Late inspiratory crackles that appear suddenly are most consistent with what etiology? |
|
Definition
|
|
Term
| Arterial insufficiency ulcer |
|
Definition
Painful
Circular
Deep
Often involves joint space
Minimal leg edema |
|
|
Term
| Venous insufficiency ulcer |
|
Definition
Superficial
Irregular borders
Miminally painful
Moderate to severe leg edema |
|
|
Term
|
Definition
| S3 and S4 heard on auscultation |
|
|
Term
|
Definition
| caused by rapid deceleration of blood against ventricular wall |
|
|
Term
|
Definition
|
|
Term
|
Definition
| S3 and S4 heard on auscultation |
|
|
Term
| Up to how many liters, and how high a FiO2% can you give through a nasal cannula? |
|
Definition
Up to 6 liters per minute
Up to 44% |
|
|
Term
| How high a FiO2% can you give to someone through a simple mask? |
|
Definition
|
|
Term
| What is the minimum liters per minute with ANY oxygen mask? |
|
Definition
|
|
Term
| How should you determine how many liters per minute of oxygen to give through a partial rebreather mask? What Fi02% can be achieved through a partial rebreather? |
|
Definition
| Choose a flow rate between 6-15 lpm, based on which rate keeps the bag inflated 2/3 full during inspiration. The patient can get 70-90% oxygen. |
|
|
Term
| How much FiO2% can a patient get with a nonrebreather mask? |
|
Definition
|
|
Term
| Whenever oxygen is administered at over 5 lpm, what should also be included? |
|
Definition
|
|
Term
| Describe the pattern of lymph drainage in the breast. |
|
Definition
| Pectoral, subscapular, and lateral (brachial) nodes drain into the central axillary nodes, which drain into the infraclavicular and supraclavicular nodes. |
|
|
Term
| Age at which you're at more risk for breast carcinoma than cyst or fibroadenoma? |
|
Definition
|
|
Term
| Besides the obvious questions such as cancer history/previous biopsy, family history, and mammogram history, what are some important questions to ask during a breast assessment? |
|
Definition
Medications (hormone replacement therapy, oral contraceptives?)
Pregnancies: Breasts are not fully developed until pregnant
Menstrual history
BSE/CBE?
Alcohol?
Physical activity? |
|
|
Term
| Paget's disease of the breast |
|
Definition
| Cancerous skin of the nipple and/or areola, usually with another mass(es) inside the same breast. |
|
|
Term
| During INSPECTION of the breast, you assess 4 things in 4 views. What are the 4? |
|
Definition
Assess: 1) Skin changes? 2) symmetry, 3) contour, 4) retractions/dimpling?
4 views: Hands at side, hands over head, hands on hips, leaning forward. |
|
|
Term
|
Definition
| Size of breasts similar, with nipples pointing in same direction. Skin smooth without redness or lesions. No discharge in nonpregnant/nonlactating women. Palpation does not elicit pain; lymph nodes nonpalpable, no masses. |
|
|
Term
| What is the rationale behind having a clinical breast exam every 3 years starting at age 20? |
|
Definition
| So that everyone has a baseline established by age 35. |
|
|
Term
| Age when you should start annual mammograms? |
|
Definition
|
|
Term
| What are the MODIFIABLE risks for breast cancer? |
|
Definition
Obesity after menopause.
Sedentary lifestyle.
Use of HRT or OC.
First pregnancy after age 30.
Never breast fed a child.
>1 alcoholic drink/day
Radiation/chemicals in environment |
|
|
Term
| What are some NONMODIFIABLE risks for breast cancer? |
|
Definition
Female gender
Increasing age
History of benign lump or epithelial hyperplasia
Early menarche/late menopause
Previous history of reproductive or thyroid cancer
Caucasian |
|
|
Term
| What are the 3 salivary glands of the mouth? |
|
Definition
Parotid/Wharton's ducts
Sublingual/ Stenson's ducts
Submandibular |
|
|
Term
| Besides PQRSTU, what questions should be asked when a patient complains of dysphagia/odynophagia? |
|
Definition
Can you point to where you feel it?
What types of foods cause it? |
|
|
Term
| Acute vs. chronic diarrhea |
|
Definition
Acute: 2 weeks or less; possible infection
Chronic: 4 weeks or more; possible Chron's or ulcerative colitis |
|
|
Term
| What are the 2 subtypes of jaundice? |
|
Definition
| Intrahepatic and extrahepatic |
|
|
Term
| What are 5 major functions of the liver? |
|
Definition
1. Glucose storage
2. Metabolism of proteins, lipids, carbohydrates
3. Production, secretion of bile
4. Production of clotting factors
5. Detoxification |
|
|
Term
| What are the secretions of the pancreas? |
|
Definition
Exocrine: bicarbonate, pancreatic enzymes
Endocrine: insulin, glucagon |
|
|
Term
| What is the rationale for asking questions about medications in the abdominal health history? |
|
Definition
Some affect the stomach lining.
Liver vs. kidney metabolism
Polypharmacy |
|
|
Term
| How can you tell angina and indigestion apart? |
|
Definition
| Angina may present as indigestion, but angina is precipitated by exertion and relieved by rest. |
|
|
Term
|
Definition
| Chronic or recurrent pain centered in upper abdomen |
|
|
Term
|
Definition
| Heartburn, acid reflux, regurgitation. Mucosal damage on endoscopy. |
|
|
Term
|
Definition
Dysphagia
Odynophagia
Recurrent vomiting
GI bleed
Weight loss
Anemia |
|
|
Term
| Why would you ask about a blood transfusion in the abdominal health history? |
|
Definition
| Liver and spleen are affected |
|
|
Term
|
Definition
N/V
Anorexia
Jaundice
Clay colored stools
Fatigue |
|
|
Term
| 4 types of urinary incontinence |
|
Definition
Urge
Functional
Overflow
Stress |
|
|
Term
| What might you consider in a patient who has no bowel sounds, with a firm and guarding abdomen? |
|
Definition
|
|
Term
| What might you consider in a patient who has diffuse LLQ pain with a palpable mass? |
|
Definition
|
|
Term
| What might you consider in a patient who has RLQ pain radiating from umbilicus, with abdominal wall rigidity, and positive Rovsing, psoas, and obturator signs? |
|
Definition
|
|
Term
| What GI symptoms can an increase in intracranial pressure cause? |
|
Definition
|
|
Term
| At what age does screening for colorectal cancer start? |
|
Definition
50
45 for African Americans |
|
|
Term
| What is the preferred method of screening for colorectal cancer? |
|
Definition
| Colonoscopy every 10 years |
|
|
Term
| What are alternate methods of screening for colorectal cancer? |
|
Definition
Fecal Immunohistochemical Testing (FIT) yearly
CT colonography every 5 years
Flexible sigmoidoscopy every 5 years |
|
|
Term
| What does hematemesis look like? |
|
Definition
|
|
Term
| If a patient has no appetite (anorexia), what questions should you ask? |
|
Definition
Intolerance?
Reluctance from anticipated discomfort?
Unpleasant fullness?
Early satiety? |
|
|
Term
| What gender is more at risk for gastrointestinal cancers (esophogeal, stomach, colon, liver, pancreatic, bladder)? |
|
Definition
|
|
Term
| Diabetes mellitus increases the risk for which types of GI cancers? |
|
Definition
| Colon and pancreatic cancers |
|
|
Term
|
Definition
Forceful contraction, distension, or stretch of organs or organ capsules.
May be difficult to localize.
Often palpable near midline at organ level.
May be described as gnawing, burning, cramping, aching.
Associated symptoms: pallor, sweating, N&V, restlessness. |
|
|
Term
|
Definition
Inflammation of the parietal peritoneum.
Described as steady, aching, more severe, more localized.
Usually aggravated by moving and coughing. |
|
|
Term
|
Definition
Initial pain becomes more intense and radiates.
Superficial or deep, but usually well-localized. |
|
|
Term
| 6 F's of abdominal distention |
|
Definition
Feces
Flatus
Fetus
Fibroids
Fat
Fluid |
|
|
Term
| 4 possible contours of abdomen |
|
Definition
Scaphoid
Flat
Rounded
Protruberant (distended) |
|
|
Term
| Inspection of Abdomen (list items) |
|
Definition
Skin: color, scars, striae
Hair pattern
Venous pattern
Visible peristalsis or pulsations?
Respiratory movements
Posture
Rectus abdominus muscle
Umbilicus: position, shape, color
Masses |
|
|
Term
|
Definition
Listen for bowel sounds in all 4 quadrants.
Listen for 5 minutes before documenting "absent"
Vascular sounds: Abdominal aorta, renal arteries, iliac arteries, femoral arteries, venous hum above umbilicus |
|
|
Term
| Liver/spleen friction rub |
|
Definition
| Pronounced with inspiration; indicates peritoneal irritation/inflammation |
|
|
Term
|
Definition
| "stomach growls" common when hungry |
|
|
Term
|
Definition
Light palpation
Tenderness?
Muscle integrity
Masses?
Full bladder? |
|
|
Term
| What tests, in what order, should you perform if you suspect ascites? |
|
Definition
1. Dullness shift
2. Fluid wave
3. Ultrasound |
|
|
Term
| Physiologic changes in abdomen of geriatric patient |
|
Definition
Diminished muscle tone
Increased fat deposition
Altered GI motility
Decreased gastric acid
Increased malignant disease
Gastric bypass more common now |
|
|
Term
|
Definition
| Benign condition of fluid collected around the testicle |
|
|
Term
|
Definition
| Veins in testicle dilate and cause enlargement and lumpiness |
|
|
Term
| Risk factors for testicular cancer |
|
Definition
Age 20-54
Undescended testicle
Previous germ cell tumor
Family history
Caucasian |
|
|
Term
| Symptoms of testicular cancer (1 in 4 have none) |
|
Definition
Painless lump
Aching lower abdomen/scrotum
Hormonal changes (breast tenderness, gynecomastia, early masculinizing traits) |
|
|
Term
| Normal findings from prostate palpation |
|
Definition
4 cm
Smooth surface
Consistency of rubber ball
Heart-shaped |
|
|
Term
| What are diet-related risk factors for prostate cancer? |
|
Definition
High levels of calcium
Diet high in meats, fats, and dairy |
|
|
Term
| How does PSA relate to prostate cancer? |
|
Definition
If levels are <2.5, not much risk, retest every 2 years.
As levels go up, chance is greater, more testing.
If levels are >10, there is a 50% chance of prostate cancer. |
|
|
Term
| What are some things that can cause false positives on PSA screening? |
|
Definition
Benign prostatic hyperplasia
Age
Recent ejaculate |
|
|
Term
| What can cause false negatives on PSA screenings? |
|
Definition
Certain medications/herbs
Obesity |
|
|
Term
| What causes benign prostatic hyperplasia? |
|
Definition
Imbalance of testosterone and estrogen
Increase in dihydrotestosterone
Incidence increases with age |
|
|
