Health Assessment Exam 1

bronchial sounds

trachea (ant)

upper back (post)

short inspiration, LONG expiration

high pitched, loud, harsh

bronchiovesicular

equal inspiration and expiration

medium sounds

vesicular

peripheral lung fluids

LONG inspiration, short expiration

soft, breezy, low volume

wheezes

mostly expiration

high pitched, musical

caused by bronchoconstriction (asthma)

stridor

mostly inspiration

harsh, crowing

upper airway obstruction

fine crackles

end of inspiration

crackling/popping

fluid in lungs (pneumonia)c

coarse crackles

inspiration directly into expiration

bubbling, gurgling

more fluid, larger airways

rhonchi

mostly expiration

harsh, snoring

secretions (bronchitis, pneumonia)

cheyne-stokes

cycles of gradually increasing then decreasing depth/rate

followed by periods of apnea

could be heart failure, drug overdose, stroke

kussmaul

deep, rapid, labored breathing

no apnea

response to severe metabolic acidosis

needs emergent intervention

cardiac auscultation sites pneumonic

ape to man

aortic valve

2nd ICS, right sternal border

S2 dubp

pulmonic valve

2nd ICS, left sternal border

S2 dub

erb’s point

3rd ICS, left sternal border

S1 and S2 equally

tricuspid valve

4th ICS, left sternal border

S1 lubm

mitral valve

5th ICS, midclavicular line

S1 lub

S1 lub sound

lub

closure of mitral and tricuspid valves

loudest at apex

marks beginning of systole

S2 sound

dub

closure of aortic and pulmonic valves

loudest at base

marks the beginning of diastole

S3 - “Ken-tuck-Y”

early diastole

low pitched, heard with bell

may be normal in children, young adults, and pregnancy

older adults: heart failure/volume overload

S4 - “Ten-nes-see”

late diastole, just before S1

low pitched, heard with bell at apex

always abnormal

indicates stiff ventricles (LV hypertrophy, hypertension)

PAD ulcer location and appearance

toes, top of feet, lateral ankle

minimal drainage, pale of necrotic deep punched out edges, round

PVD ulcers location and appearance

medial lower leg/ankle

swollen, draining, deep pink/red granulation, irregular edges, shallow

causes of orthostatic hypotension

volume depletion (dehydration/blood loss)

meds (antihypertensives, diuretics)

neurologic disorders

cardiovascular conditions

prolonged bed rest/aging/etc

OH signs and symptoms

lightheaded

dizzy

weakness

syncope

OH vital signs

lying - 5 mins

sitting - 1 min

standing - 1 min

standing - 3 mins