Health Assessment

hemoptysis

blood streaked speutum

Orthopnea

trouble breathing when laying down

Dyspnea

trouble breathing

What are things that cause dyspnea?

• anxiety

• anaphyalyxis

• pulmonary embolism

Wheezes

partial airway obstruction

What processes may cause wheezing?

• asthma

• tissue inflammation

• foreign body entered trachea

What is a cough

protective reflex

What do you assess a cough for?

• duration

• dry vs productive

• color

• frequency

Chest pain types

• myocardial infarction

• pericarditis (inflammation of the pericardium)

Respiratory issues

• bronchitis (inflammation of the bronchioles)

• pneumonia (fluid in the lungs)

Gastrointestional issues

• reflux esophagitis

Musculoskeletal Issues

• cervival arthrities

• herpes zoster

What comes first in assessing the patient?

Inspection. Must observe the patient first before touching them

In what position should the patient be for the posterior thorax and lung exam?

Sitting with arms crossed over the chest and hands on the shoulders.

Why does the patient cross their arms over their chest during the posterior lung exam?

To move the scapulae laterally, exposing more of the lung fields for examination.

In what position should the patient be for the anterior thorax and lung exam?

Supine (lying on their back).

What should you do if the patient cannot sit up for the lung exam?

Roll the patient onto one side, then the other, and examine the dependent lung on each side.

What do you look for during an initial survey for respiration and the thorax

• rate, rhythm, depth, and effort of breathing

• color of skin

• shape of chest

• facial expressions

• level of consciousness

• listen to breathing

• inspect the neck

What accessory muscles are for the pulmonary system?

• sternocleomastoids

• scalens

• abdominal muscles

What is the tripod position for?

Helping a patient that is struggling to breathe to expand there lungs

Normal skin findings for pulmonary.

• same color as body

• no lesions

• no abnormal moles

• no cyanosis

What three structures should you observe during the neck assessment in a pulmonary exam?

Jugular veins

Accessory muscles

Trachea

Why are the jugular veins observed during a pulmonary assessment?

To check for no jugular vein distention (JVD). This can mean patient has fluid overload, right side heart failure, increased central venous pressure

What are the normal jugular vein findings?

There is no distention present when patient is sitting upright

Which accessory muscles are commonly used during labored breathing?

• Sternocleidomastoid

• Scalene muscles

• Trapezius (may assist in severe respiratory)

What are normal findings in breathing?

No accessory muscles are used during quiet breathing

What is a normal chest shape?

• Transverse diameter is 1:2

• Chest appears oval (apple like)

• Costal angle is less than 90 degrees

What is a barrel chest?

• Diameter is 1:1

• Air is trapped in the chest

• Chest appears rounder

Conditons with barrel chest?

• COPD

• Emphysema

What is pectus excavatum (funnel chest)

Sternum is pushed inward and can decrease lung expansion

What is pectus carinatum (pigeon chest)?

Sternum protrudes outward. Can affect breathing

Palpation of the trachea process

• fingers and thumbs should be on either to note position

What position should the trachea be?

midline

Process of palpating the chest

• Palpate the anterior, posterior, and lateral chest by placing hands on the chest wall

What is the purpose of palpating for chest excursion?

To assess symmetry of chest expnasion during breathing

Where are hands placed for anterior chest excursion?

• costal margins with fingers spreads and thumbs about 2 inches apart

Where are your hands placed for posterior chest excursion?

At the 8th–10th ribs with:

Fingers spread

Thumbs about 5 cm (2 inches) apart

What should the patient do for chest excursion?

• take a deep breath, while examiner feels for chest expansion

What is tactile fremitus?

is the vibrations of the chest wall prouduced by the trachea

Palpation of chest for tactile fremities

• use palmar side of hands

• Have patient say “99” to feel for vibrations

Normal findings for palpation of tactile fremitiues

vibrations are most prominent over major bronchi and decrease as you progress downward

What does increased tactile fremitus indicate?

That the air in the alveoli is replaced with fluid, so the vibrations travel more easily

What does decreased tactile freminites mean?

There is an obstruction in the alveolis

What is a pneumothorax?

collapsed lung

What is crepitus?

Air trapped leaking from lungs and being trapped under the skin

How to assess for tenderness?

• Use pads of finders and apply gentle and firm pressure upon chest and ask patient if they feel any pain

How to assess for crepitus?

• use pads of fingers to gently palpate the chest and neck

• feel for crackling or popping sensation under the skin

• Compare both sides

Where should you percuss when assessing lungs?

intercostal spaces

What is the correct pattern for lung percussion?

• start at top of the lungs

• percuss side to side

• move downward to the bases

How many landmarks on each side of the posterior back for lung percussion?

9 on each side

What is the normal percussion sound over healthy lungs?

• resonsance

• low pitched, clear, and hallow

What does hyperresonance sound like and mean?

• There is too much air in the lungs

• low-pitched, booming sound

What does dullness sound like and mean?

• There is fluid/bloackage in the lungs

• soft, muddled sound

How should the patient be positioned for lung ausculatation?

sit upright and lean forward slightly

What breathing instructions should you give during lung auscultation?

To breathe deeper than normal through the mouth

Which part of the stethoscope is used to auscultate breath sounds?

The diaphragm.

How should you auscultate the lungs?

• Listen to one full inspiration and one full expiration at each location.

• Compare side to side in symmetrical locations.

Where are bronchial breath sounds heard?

Over the trachea and larynx.

Where are bronchovesicular breath sounds heard?

• Over the major bronchi

• Between the scapulae

• 1st–2nd intercostal spaces near the sternum

Where are vesicular breath sounds heard?

Over the peripheral lung fields.

Which breath sound is heard over most of the lungs?

vesticular

What does the broncial region of the lungs sound like?

high pitched and loud

What does the vesticular region of the lungs sound like?

soft and low pitch

What are crackles (rales)?

• Are short popping sounds that are caused by fluid in the alveoli or there is a collapsed airway

Do crackles clear with coughing?

no

What do fine crackles sound like?

Rolling hair between your fingers near your ear.

What do coarse crackles sound like?

Velcro being ripped apart.

What are wheezes (sibilant wheezes)?

• high pitched and usually heard during expiration

• Caused by narrowed airways and inflammation

What conditions commonly cause wheezes?

asthma and chronic bronchitosis

What are rhonchi (sonorous wheezes)?

• low-pitched, snoring sounds

• prmoninent during expirations

• Dur to thick mucous or foreign bodies

Do rhonci’s clear with a cough?

yes

What conditions commonly cause rhonchi?

bronchitois

airway obstruction

tumor

What is stridor?

• high pitched crowing that is the loudest over the neck

• due to obstruction in airway from foreign body or swollen tissue

What usually cause stridor?

epiglottis

How many landmarks are in the anterior chest for ausculatation?

10

How many landmarks are in the posterior chest for ausculatation?

18

What is a pleural friction rub?

• grating sound of leather that is due to the inflammed pleura rubbing together

Atelectasis

complete or partial collapse of the lunge

pneumothorax

puncture in lung so air goes in and out incorrectly

What is the main function of the cardiovascular system?

• Provide oxygen and nutrient to body cells

• remove waste

• maintain perfusion to organ and tissues

Base of the heart

Top of the heart around the 2nd intercostal space

Apex of the heart

• Bottom of the heart

• located at the 5th intercostal space, left midclavicular line

What is PMI (Point of Maximal Impulse)

Where the bottom of the heart is and where it is most strongly felt

What is cardiac output (CO)?

The volume of blood ejected by each ventricle in one minute.

What is stroke volume (SV)?

The amount of blood ejected from one ventricle with each heartbeat.

What is preload?

The amount of stretch on the ventricular muscle before it contracts.

What is myocardial contractility?

The ability of the heart muscle to contract (squeeze) forcefully after it has been filled.

What is afterload?

The resistance the ventricles must overcome to pump blood out of the heart.

Arrthmyeas

skipped heart beat, palpations

What side of the patient’s body do we do a heart assessment?

right side

Bruit for a carotid artery

An abnormal whoosing sound heard over the neck with a stethescope

What causes a bruit?

turbulent blood flow

When checking the carotid artery with stethescope should the patient hold their breath?

yes

What is the purpose of assessing the jugular venous pressure (JVP)?

To estimate right atrial pressure and assess the patient's fluid volume status and right heart function.

How should the patient be positioned to assess JVP?

• Make the patient comfortable.

• Raise the head of the bed to about 30°.

• Place a small pillow under the head to relax the sternocleidomastoid muscle.

Which way should the patient's head be turned during JVP assessment?

Turn the head slightly away from the side being examined.

What is a normal finding when assessing JVP?

The internal jugular venous pulsation is visible but not distended at about 30–45°.

What are the three patient positions used during a precordial (heart) assessment?

• Supine (lying on the back)

• Left lateral (left side-lying)

• Sitting up and leaning forward

When does the lub sound occur?

When the AV valves close

What are the antrioventricular valves

• tricupid valves

• mitral valve