Healh assessment exam #3 (chapters 19, 20, 21, 22, 25 and 27)

Bony structure with a conical structure shape which is narrower at the top
- Sternum
- 12 pairs of ribs
- 12 thoracic vertebrae
- Diaphragm

thoracic cage

Contains: Esophagus, Trachea, Heart, & Great Vessels
Right & Left pleural cavities are on either side (contain lungs)

mediastinum

which lung is larger and why

The right lung -- it has three lobes instead of two

two types of pleurae

parietal and visceral

trachea is __________________ to the esophagus

anterior

The passages that direct air into the lungs

bronchi

Space filled with air not available for gas exchange
the volume of air inhaled that doesn't participate in gas exchange in the lungs

dead space

Is a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli
the area of the lung in which gas exchange takes place

acinus

4 major functions of the Respiratory System

1.Oxygen supply
2.Removal of Carbon Dioxide
3.Maintaining hemostasis
4.Maintaining heat exchange

when you have too much carbon dioxide in your blood

hypercapnia

is when you have too little oxygen in your blood

hypoxemia

is the physical act of breathing

ventilation

Air rushes into the lungs as the chest size increases

inspiration

Air is expelled from the lungs as the chest recoils

exhalation

Mechanical expansion and contraction in the respiratory system primarily refers to the process of breathing, where the diaphragm muscle contracts to ___________________ the chest cavity, causing air to flow into the lungs (inhalation), and then relaxes to __________________ the chest cavity volume, pushing air out of the lungs (exhalation)

expand
decrease

Vertical diameter lengthens & shortens (occurs due to upward or downward movement of the _____________________)

diaphragm

Anteroposterior (AP) diameter increases or decreases due to elevation or depression of the _________

ribs

•Suprasternal Notch
•Sternum
•Sternal Angel
•Costal Angle

anterior thoracic landmarks

•Vertebrae Prominens
•Spinous Processes
•Inferior Border of the Scapula
•Twelfth rib

posterior thoracic landmarks

•Do you have a cough?
•Any shortness of breath?
•Any past chest pain with breathing?
•Any past history of lung disease?
•Ever smoke cigarettes? What age did you start?
•How many per day? For how long? Ever tried to quit?
•Any living or work conditions that affects your breathing?
•Last TB skin test, chest radiography, flu vaccine?

subjective respiratory system data collection

Palpable vibration from sounds generated from the larynx are transmitted through patent bronchi & the lung parenchyma to the chest wall
Use the palmer base of the fingers- touch patient's chest while they repeat the words "ninety-nine" or "blue moon"
Start over lung apices & palpate from one side to the other

tactile fremitus

Hands placed on the posterolateral chest wall with thumbs pointing together
Side hands medially to pinch up a small fold of skin between thumbs
Ask patient to take a deep breath
As the patient inhales deeply, providers thumbs should move apart symmetrically

symmetric chest expansion

Description: High-pitched, short crackling, popping sound heard during inspiration. Not cleared by coughing
Mechanism:
inspiratory- Inhaled air collides with previously deflated airways, suddenly pop open
Expiratory- Sudden airway closing
Examples:
Late inspiratory- Occur with restrictive disease- pneumonia, heart failure
Early inspiratory- Occur with obstructive disease- chronic bronchitis, asthma, emphysema
Posturally induced crackles- crackles appear with a change in position

crackles (FINE)

Description: Loud, low pitched bubbling & gurling sounds. Start in early inspiration & may be present with expiration. May decrease with coughing or suctioning (reappear shortly)
Mechanism: Inhaled air collides with secretions in trachea & large bronchi
Examples: Pulmonary edema, pneumonia, pulmonary fibrosis, terminally ill that have a depressed cough reflex

crackles (COARSE)

Description: Similar to fine crackles- do not last, are not pathologic, Disappear after first few breaths (heard axillae, bases)
Mechanism: Heard when alveoli reexpand
Examples: Aging adults, bedridden, just aroused from sleep

Atelectatic

Description: Very superficial sound- coarse & low pitched. Sound in heard inspiratory & expiratory
Mechanism: Pleurae become inflamed & lose normal lubricating fluid. Pleural surfaces rub together during respirations. Heard best in anterolateral wall
Example: Pleuritis

pleural friction rub

Description: High-pitched- musical squeaking sounds polyphonic- predominate in expiration (but can occur in both)
Mechanism: Air squeezed/compressed through passageways that are narrowed
Examples: Diffuse air obstruction- acute asthma, chronic emphysema

wheeze

Description: Low-pitched-monophonic, musical note, single note, snoring, moaning sounds. They are heard throughput the respiratory cycle. May clear with coughing
Mechanism: Airflow obstruction
Examples: Bronchitis, single bronchus obstruction from airway tumor

rhonchi

Description: High-pitched- monophonic, inspiratory, crowing sounds- louder in neck than chest wall
Mechanism: Originating in larynx/trachea, Upper airway obstruction from swollen, inflamed tissue or lodged foreign body
Example: Croup, acute epiglottis, foreign inhalation- may be life threatening

stridor

Lung sounds:
air passing in and out

normal

lung sounds:
shoveling large rocks

coarse crackles

lung sounds:
pop rocks or slurping drink

fine crackles

lung sounds:
blowing a musical horn

wheezing

lung sounds:
walking on a creaky, wooden floor

pleural friction rub

lung sounds:
snorkeling or snoring

rhonchi

lung sounds:
seal barking

stridor

•Respiratory system alone does not function until birth
•Newborn's first respiratory assessment is part of Apgar scoring system
•Infants breathe through nose rather than mouth (obligate nose breathers)
•Count RR for one full minute
•Hold infant against body
•Assess while sleeping

infant. resp system considerations

•Enlarge uterus elevates the diaphragm
•Increase in total circumference of the chest cage
•Increased oxygen demands (increased tidal volume)
•Physiologic dyspnea affects 75% women

pregnancy resp system considerations

•Increase in AP diameter- gives a round barrel shape & kyphosis
•Chest expansion somewhat decreased
•Costal cartilage more calcified results is less mobile thorax
•Stiffer structures in lungs- harder to inflate
•Decreased number of intra-alveolar septa & decreased number of alveoli
•Less surface area for gas exchange

aging resp system considerations

•May need more support to complete assessment
•May have to complete assessment by rolling patient

acutely ill resp system considerations

Respiratory rate, pulse rates; BP; O2 saturation
Lung auscultation
Place on O2, inhaler administration

immediate assessments

•Smoking Cessation
•Asthma Prevention
•Immunizations- Flu, COVID, pneumonia

resp system health promotion

•Past History
•Health Goals
•Lifestyle & personal habits- smoking cessation
•Occupational health
•Environmental exposure- prevention of asthma
•Medications- Immunizations

resp system risk reduction

surface landmarks of the abdomen

abdomen
linea alba
rectus abdominis

internal landmarks of the abdomen

Peritoneum
Mesenteries
Viscera
Greater Omentum
Solid Viscera

are those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus)
may be palpable

solid viscera

Shape depends on content
Stomach, Gallbladder, Small intestines, Colon, Bladder
Are not typically palpable

hollow viscera

•Liver
•Gallbladder
•Duodenum
•Head of pancreas
•Right kidney and adrenal
•Hepatic flexure of colon
•Part of ascending and transverse colon

right upper quadrant

•Cecum
•Appendix
•Right ovary and tube
•Right ureter
Right spermatic cord

right lower quadrant

•Part of descending colon
•Sigmoid colon
•Left ovary and tube
•Left ureter
•Left spermatic cord

left lower quadrant

•Stomach
•Spleen
•Left lobe of liver
•Body of pancreas
•Left kidney and adrenal
•Splenic flexure of colon
•Part of transverse and descending colon

left upper quadrant

•Aorta
•Uterus (if enlarged)
•Bladder (if distended)

midline

•Any change in appetite? Loss?
•Any difficulty swallowing?
•Any foods you cannot tolerate?
•Any abdominal pain?
•Any nausea or vomiting?
•How often are bowel movements?
•Any past history of GI disease?
•What medications are you taking?
•Tell me all the food you ate in the last 24 hours, starting with (breakfast, snack, lunch, snack, dinner, snack)

subjective data about the abdomen

Use diaphragm of stethoscope to assess
Start in the RLQ and move clockwise
Note character & frequency of bowel sounds
Normal bowel sounds 5-30 times per minutes (not counted)
Hyperactive (borboygmus)
Hypoactive
Must listen for 5 minutes before deciding if bowel sounds are absent

bowel sounds

Loud, high pitched, rushing tinkling sounds
Increased mobility

hyperactive bowel sounds

Diminished or absent sound
Decreased mobility

hypoactive bowel sounds

Done when patient reports abdominal pain or when you elicit tenderness during palpation
Hold hand at 90˚ or perpendicular to the abdomen
Push down slowly and deeply- them lift up quickly

rebound tenderness

Palpation of the liver causes pain
Ask the patient to take a deep breath- normal response is no pain

inspiratory arrest (murphy sign)

Pain at the McBurney point- draw a straight line from the anterior superior spinous process of the ileum to the umbilicus. McBurney point is located at 1.5-2inches from the ileum

McBurney Point Tenderness

Patient is supine, lift the right leg straight up, flexing the hip, then push down over the lower part of the right thigh as the person tries to hold the leg up
Negative test if patient feels no change

Iliopsoas Muscle Test

normal stool color

brown

bowel color:
bleeding in upper GI tract

black/dark

bowel color:
bleeding in lower GI tract

bright red

bowel color:
excess bile, change in diet, diarrhea

green

bowel color:
fat in stool, malabsorption issues

yellow

bowel color:
lack of bile, pancreatic and liver dieases

light-colored

bristol stool chart:
separate hard lumps, like nuts (hard to pass)

type 1

bristol stool chart:
sausage-shaped but lumpy

type 2

bristol stool chart:
like sausage but with cracks on its surface

type 3

bristol stool chart:
like a sausage or snake, smooth and soft

type 4

bristol stool chart:
soft blobs with clear-cut edges (passed easily)

type 5

bristol stool chart:
fluffy pieces with ragged edges, a mushy stool

type 6

bristol stool chart:
watery, no solid pieces
entirely liquid

type 7

documentation for stool (6)

Time
Characteristics about stool
- Amount ( small, medium, large)
- Color
- Consistency
- Shape
- Source

•Abdomen is protuberant
•Umbilical cord- 2 arteries 1 Vein
•Monitor umbilical cord for infection
•Umbilical hernia- prominent when infant cries (usually disappears by 1 year)
•Diastatis recti-usually disappears by early childhood
•No vascular sounds should be heard
•Tympany over stomach, dullness over liver
•Watch for 1st passage of meconium

infant considerations abdomen

•Under 4 years abdomen is protuberant
•Use objective signs to aid in abdominal pain assessment

child considerations abdomen

•Symptoms: Nausea/vomiting
•Reflex
•constipation

pregnancy considerations abdomen

•Salivation decreases
•Delayed esophageal emptying
•Decrease in acid secretion
•Incidence of gallstones increases
•Decrease in the size of the liver
•Constipation is not a physiologic consequence of aging
•Increased deposits of subcutaneous fat on the abdomen

aging adult considerations abdomen

Penis
Glans
Foreskin or Prepuce
Circumcision
Corona
Urethra

male genitalia

Rugae
Cremaster muscle
Testis

scrotum

which testis is lower

left is lower than the right

The junction of the lower abdominal wall & the thigh

inguinal area

•Any urinary frequency, urgency, or awakening during night to urinate?
•Any pain or burning with urinating?
•Any trouble starting urine stream?
•Urine color cloudy or foul-smelling? Red-tinged or bloody?
•Any pain or sores in penis?
•Any lump in testicles or scrotum? Do you perform testicular self-examination (TSE)?
•In a relationship now involving intercourse? Use a contraceptive? Which one?
•Any contact with partner who has sexually transmitted infection? Was it treated with antibiotics?

subjective data for male genitalia

Normally appears wrinkled, hairless, & without lesions
Dorsal vein may be present
Glans
Skin without lesions

skin condition of male genitalia

a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis
foreskin cannot be pulled forward to cover the glands

paraphimosis

an anatomical congenital malformation of the male external genitalia
urethral opening on ventral (underneath) surface

hypospadias

a rare birth defect located at the opening of the urethra
urethral opening on dorsal (top) surface

epispadias

Smooth, semi firm, & nontender

shaft

Scrotal size varies with ambient room temperature
Asymmetry is normal, left half is usually lower than the right
Spread rugae out between fingers, lift sac to inspect the posterior surface

scrotum skin condition

Normally feel oval, firm & rubbery, smooth, & equal bilaterally & are freely moveable & slightly tender to moderate pressure
Testicular Torsion
Epididymitis

testes objective data

Palpate each cord between your thumb & forefinger along the length from the epididymis to the external inguinal ring
Should feel like a smooth, nontender cord

spermatic cord objective data

Normal urine is clear and slightly acidic with a pH range of 4.5 to 8.0
Little or no protein
No glucose
Fewer than 5 RBCs (red blood cells) or WBCs (white blood cells)
Urine specific gravity- 1.003-1.030

urinalsysis

Creatinine normal 0.7-1.5mg/dL- are fairly constant day to day
Blood urea nitrogen (BUN) 10-20mg/DL- rises with dehydration or an increase in protein intake

serum analysis of kidney function

urine color:
medication side effect: amitriptyline, indomethacin
foods: asparagus
dye after prostate surgery

blue

urine color:
urine contains melanin, melanuria

dark gray

urine color:
liver disease, especially with pale stools, jaundice
myoglobinuria
some medications or food dyes
blood in urine

tea

urine color:
with menses
some foods: beets, berries, food dyes
some laxatives
kidney stones
UTI

pink

urine color:
blood in urine
nephritis, cystitis
cancer (prostate, bladder)
following prostate surgery

red

urine color:
medication side effect: rifampin for meningitis, Pyridium, warfarin
some foods, food dyes, laxatives
dehydration

orange

urine color:
gold or concentrated with dehydration
some laxatives
food or supplements with B-complex vitamins

amber