Health assessment exam 3

what are the three anterior sternal landmarks

suprasternal notch

sternum

sternal angle (around the 2nd rib)

vertebra prominins

flex your head and feel the most prominent bony spur protruding at the base of the neck. This is C7

spinous process

count down the spinal knobs on the vertebrae.

the scapula

the lower tip is usually at the 7th and 8th rib 

twlfth rib

palpate midway between the spine and the person’s side to identify its free tip

the right lung has

3 lobes

the left lobe has 

2 lobes

the most remarkable point about the posterior chest is that

it is almost all lower lobe

pleurae

serous (clear) membrane that form an envelope between the lungs and the chest wall

visceral pleura

lines the outside of the lungs 

parietal pleura

lines the inside of the chest wall and diaphragm

the respiartory unit goes from

bronchioles, alverolar ducts, alveolar sacs, alveoli

Alveoli 

transfer oxygen to the bloodstream to remove carbon dioxide 

alevoil have capillaires which are

tiny blood vessels that surround the alevoil

what is the first major function of the respiratory system

supplying oxygen to the body for energy production

what is the second major function of the respiratory system

removing carbon dioxide as a waste product of energy reactions

what is the third major function of the respiratory system

maintaining homeostatis (acid base balance)

what is the fourth major function of the respiratory system

maintaining heat exchange

not as important in humans

carbon dioxide is a 

acid

what is the respiratory center of the brain

the brain stem (pons and medulla)

hypercapnia

too much carbion dioxide in the blood

hypoxemia

decreased level of oxygen in the blood stream

the medulla responds most to

carbon dioxide (hydrogen and oxygen not as much)

what is the primary function of the diaphram

facilitates breathing

what is the dome shaped muscle responsible for breathing

diaphragm

the diaphram separates 

the thoracic cavity from the abdominal cavity

when the diaphramg contracts it moves

downward creating a vacuum

as we age the thorax cartilage becomes calcified maKING IT

less mobile

respiratory muscle strength declines after age 

50

as we age, elasticity, # of alveoli, vital capacity, risdual volume

decrease

some diseases that are caused by genetics and environment would be

lung cancer, tuberculosis, and asthma

lung cancer is the 

second most commonly diagnosed in men and women 

tuberculosis is

an airborn lung disease that has infected 1/3 of the population

tuberulosis is considered a

magritory disease

high risk of Tb are

immunocompromised (HIV), in shelters, prisons

asthma has a

5.8 % prevelance in children under the age of 18 

asthma is mainly caused by

living situations like secondary smoke

adult asthma

inflammation of brochials

asthma is very easily

reversable 

if the person coughs up sputum that means it is

productive

when someone coughs up blood that is called

hemoptysis

important to ask when someone has asthma is

if they have SOB (shortness of breath)

SOB with exertion

short at breath at rest or if they get up to do something

SOB when laying down is called

orthopnia 

if the patient is orthopinic they will sit it the

tripod position

when examining and inspecting the thorax and lungs

note the shape/configuration of chest walls

position the person takes to breath

skin color and condition

bloodish tint in the skin is called

cyonosis 

the second thing to do when examining the lungs and throax is

palpate

when palpating the thorax and lungs you must confirm

symmetric chest expansion by placing your hands on the chest wall

aasking the patient to take a deep breath to feel for crepitus, what is crepitus

course crackling sensatin heard on the skin surface

air excapes lungs and enters subcu

feels like bubble wrap

tactile fremitus is 

vibrations heard

if you have a weakened fremitus

may be obstructred bronchus

increased firmetus means

compression of consolidation from one tissue

the third step when examining the thorax and lungs is to 

percuss 

resonance is

the low pitched, clear hollow sound that is mainly in healthy lung tissue

percussing the lungs is done

side to side

when examining the lungs the fourth step is to

auscultate 

listen to at least one full

respiration (one breath in and out) on 9 locations on each side

meaning 18 breaths

the spaces to asculate are between each

rib

on the posterior side when ausculating there are 9 sites on each side, how many are there on the anterior

5 on each side, 10 breathes

forced espiratory time

number of seconds it takes for a person to exhale from TLC to RV

measures airflow obstructions

4 seconds or less

Pulse oximetry measures

arterial saturation

oxygen pairing capacity 

spo2 97% and above 

SPO2

peripheral oxygen saturation

SPO2 is the

percentage of oxygenated hemoglobin in relation to the total amount of hemoglobin in the blood

kyphosis

hump back

Kyphosis impacts

respirations

barrel chest

obstructive pulmonary disease and elasticity in lungs is not good anymore

normal respiratory rate for an adult is

12-20

tachypnea

fast breathing

bradypnea

slow breathes

hyperventilation

breathing rapidly and deaply removing more carbon dixodie than it produces

dizziness, lightheadness, tingling in hands and feet

hypoventiliation 

abnormally slow and shallow brathing resulting in high carbon dioxide and low oxygen 

poor sleep, tired during day, patient becomes acidotic 

adventishish

not normal

crackles(rales) wheezes and rhonchi are more in the

lower airway

bronchophony

repeat 99 for hearing 99 super clear

egophony

have the patient reapt e e e

might hear a a a

whispered pectoriloquy 

whisper one two three listening for very clear speech 

heart and great vessels are located in the

mediastinum

the valves of the heart

prevent back flow of blood back into the heart

carotids are located in the

depression next to the trachea

internal jugular veins are located

deeper and near carotid. Not palpable, usually not visible

jugular vein is often

visibile above middle of clavical

never palpate or massage both carotids because 

they may pass out 

right sided heart failure will cause

jugular vein extension

epicardium

thin muscle layer on the outside of the heart

myocardium 

thick layer of muscle that does the actual pumping 

endocardium

lines the chambers and valves

the heart has its own

circulation and electrical system. operate independently of eachother, but are complementary

Systole

ventricular concration and ejection of clood 

during systole the AV valves close to

prevent blood from being forced backwards

diastole

ventricular relaxation that allows time for the ventricles to fill

during diastole, smeilunar valves close to 

prevent backflow int the heart 

S1

occurs with closure of the AV valves (tricuspid and mitral)

S2

occurs with closure of the semilunar valves and signals he end of systole

lub is the 

S1

dupp is

S2

S3(ventricular gallups)

ventricle filling creates vibrations that can be heard over the chest

mainly heard in children and young adults

Kentucky

S4 (aterial gallup)

occurs at the end of diastole. the atria contract and push blood into a noncompliant ventricle 

Tennessee 

a murmur is a

gentle, blowing swooshing sound that can be heard on the chest wall

some reasons a murmur can occur are

blood velocitty increases (exercise)

viscosity of blood decreases (anemia)

structural defects like blood backs up and moves back throuigh the valves (leaky valves)