27.2c | Chest, Lungs, Heart, Blood Vessel, and Abdomen Examination

difficulty moving air in or out of the lungs

prolonged inhalation or exhalation indicates …

inspiratory stridor

sounds of an upper airway obstruction

expiratory wheezing or rhonchi

sounds of a lower airway obstruction

funnel chest (pectus excavatum)

condition in which the lower portion of the sternum is depressed

pigeon chest (pectus carinatum)

condition in which the sternum curves outward

ventilation problem

if the patient's skin retracts in the supraclavicular, suprasternal, or intercostal area suspect a …

paradoxical movement

if multiple ribs are fractured, creating a traumatic flail chest, you can find … of that part of the chest wall during breathing

thoracic kyphoscoliosis

abnormal spinal curvature that deforms the chest

retractions in the intercostal space

… can appear when airflow is impeded during inspiration

bulging in the intercostal spaces

… can appear when air flow is impeded during exhalation

tactile fremitus

palpated vibrations on the chest wall when the patient speaks

pneumothorax

a hyperresonant sound in the right chest can indicate a …

hemothorax

a dull sound in the right chest can indicate a …

crackles (or rales)

light crackling, popping nonmusical sounds heard during inspiration

air passing through moisture in the bronchoalveolar system or from the abrupt opening of closed alveoli

crackles are caused by …

chronic bronchitis and heart failure

early inspiratory crackles are associated with …

shortly after inspiration starts

early inspiratory crackles begin … and stop soon after

loud, low pitched, long, similar to the sound of water boiling

often audible at the mouth

early inspiratory crackle sound

CHF, interstitial lung diseases

late inspiratory crackles are associated with …

first half of the inspiratory phase and continue into late inspiration

late inspiratory crackles begin in the …

soft, high pitched, very brief

late inspiratory crackles sound

base of the lungs

late inspiratory crackles appear first at the …

move upwards

late inspiratory crackles … as the pt's condition worsens

wheezing

continuous, high pitched musical sounds similar to a whistle

air moves through partially obstructed smaller airways

wheezes occur when …

asthma, bronchospasm, foreign bodies

causes of wheezing include …

small bronchioles

wheezing often originates in the …

end of exhalation

wheezing first appears at the …

worse

the closer to inspiration wheezing appears, the … the patient's condition is

rhonchi

continuous sounds with a lower pitch and a snoring quality

secretions in the larger airways

cause of Rhonchi

bronchitis, pneumonia

Rhonchi are a common finding in …

early exhalation

Rhonchi usually appear in …

stridor

a predominantly high-pitched inspiratory sound

partial obstruction of the larynx or trachea

stridor indicates a …

pleural friction rubs

the squeaking or grating sounds of the pleural lining rubbing together

the pleural layars are inflamed and have lost lubrication

pleural friction rubs occur when …

pneumona, pluerisy

common causes of pleural friction rubs

these sounds occur whenever the pt's chest wall moves

pleural friction rubs appear during the entire respiratory cycle because …

effusion

fluid in the pleural space causing a decrease in functional lung tissue

consolidation

infectious pus causing collapsed alveoli

effusion, consolidation

no breath sounds in some areas can be caused by …

bronchophony

… occurs when fluid or consolidated tissue replaces the normally air-filled lung

whispered pectoriloquy

whispered words sounding loud and clear through a stethoscope placed on the chest

egophony

an /i/ sound sounding nasal and bleating when heard through a stethoscope

consolidation of lung tissue

a positive egophony test indiciates …

lung tissue is filled with fluid or solid material

a positive whispered pectoriloquy test indicates the …

tension pneumothorax

the trachea deviates away from the affect side in cases of …

pulmonary fibrosis and atelectasis

the trachea tugs toward the affect side during inhalation in cases of …

disorder of the underlying lung, pleura, or diaphragm

if you detect decreased thoracic expansion or feel unilateral delay, suspect a …

diastole

period in which the ventricles relax

greater

during diastole, the pressure in the atria is … than the pressure in the ventricles

tricuspid valve, mitral valve

higher pressure in the atria opens the … on the right side and the … on the left side

blood from the atria to fill the ventricles

opening of the tricuspid and mitral valves allows ….

systole

period in which the ventricles collapse and the tricuspid and mitral valves closing, preventing backflow into the atria

S1 sound (“lub”)

the sound generated by the vibrations of the tricuspid and mitral valves closing

pulmonic semilunar valve

increased pressure in the right ventricle opens the …

lungs

the opening of the pulmonic semilunar valve sends deoxygenated blood to the …

aortic semilunar valve

increased pressure in the left ventricle opens the …

body

the opening of the aortic semilunar valve sends freshly oxygenated blood to the …

ventricles

at the end of systole, pressure in the … falls

close tightly to prevent backflow

at the end of systole, the pulmonic and aortic semilunar valves …

S2 sound (“dub”)

the vibration of the pulmonic and aortic semilunar valves closing generates the …

60-100 times per minute

this cardiac cycle repeats approximately … in the healthy adult at rest

heart murmurs

extra sounds that occur when valves do not fully open or close, causing turbulent flow

downstream

when auscultating heart sounds, always listen …

apex of the heart

listen for S1 at the …

near the lower left sternal border

the apex of the heart is found …

the base of the heart

listen for S2 sounds at …

second intercostal space, near the sternum

the base of the heart is found at the …

pulsus paradoxus

amplitude of the pulse diminishing with inspiration and increasing with exhalation

thrills

humming heard when palpating the carotid artery

bruits

the sounds of turbulent blood flow around a partial obstruction

80% occlusion

the presence of a bruit suggests at least an … of the artery

fluid volume overload or something such as CHF or cardiac tamponade is blocking venous return to the heart

abnormal bilateral distention indicates …

a localized problem

unilateral distention suggests …

splitting

hearing two sets of sounds instead of one because the mitral and aortic valves close slightly before the tricuspid and pulmonic valves

normal

splitting of S2 during inspiration is … in healthy children and young adults

abnormality

expiratory or persistent splitting suggests an …

ventricular gallop

a third sound, S3, is sometimes called the …

vibrations that result when blood fills a dilated ventricle

S3 develops from …

pathological

S3 is usually considered … in patients over 30

ventricular failure and ventricular volume overload

S3 generally develops w/ … and disappears when the problem is resolved

low-pitched

S3 is a … sound heard in early to mid-diastole

atrial gallop

S4 is also called an …

atrial contraction forces blood into a ventricle that has decreased compliance or resists filling

an S4 develops from vibrations produced in late diastole when … and causes volume overload

apex of the heart while the patient is lying on their left side

you can listen for S3 or S4 at the …

ejection click

results from a stiff or stuck valve

opening snap

results when a stenotic mitral or tricuspid valve's leaflets recoil abruptly after ventricular diastole

pericardial friction rub

occurs when inflammation causes the heart's visceral and parietal surfaces to rub together at each heartbeat

murmur

a rumbling or vibrating noise that results from turbulent blood flow through the heart valves, a large artery, or a septal defect

chronic arterial insufficiency

yellow or brittle nails or poor color in the fingertips indicates …

arterial occlusion proximal to the pulse point

if you detect a weak or absent pulse in one extremity, suspect an …

move proximally to another artery

if you cannot palpate a distal artery, …

inflamed

the epitrochlear lymph nodes will only be palpable if they are …

arterial occlusion

unilateral coldness indicates an …

environmental problem, bilateral occlusion, or a general circulatory problem

bilateral coldness is due to an …

absent pulse

when assessing a peripheral pulse, a score of 0 indicates a(n) …

weak or thready pulse

when assessing a peripheral pulse, a score of 1+ indicates a(n) …