health assessment module 2

what role do thorax and lungs play in perfusion

oxygenates the blood, allowing perfusion to happen

what is gas exchange

process of moving oxygen into blood and removing co2 from the body to support cellular functions

what is ventilation

moves air in and out of the lungs

what is diffusion

exchanges o2 and co2 in the lungs

what is perfusion

transporting o2 to the tissues

what should be assessed to examine ventilation

respiratory rate and pattern, labor of breathing, breath sounds

what does impaired ventilation cause

dyspnea

abnormal respiratory rate

wheezes or crackles

what should be assessed when examining diffusion

o2 sats

skin color

mental status

what does impaired diffusion cause

low sp02

cyanosis

restlessness or confusion

what should be assessed when examining perfusion

hr and bp

capillary refill

skin temp

what does impaired perfusion cause

weak pulses

hypotension

cool, pale skin

what does thoracic cage protect

heart and lungs (+liver and spleen)

what makes up the thorax (ribcage)

sternum, clavicle, scapulae, 12 sets of ribs, and 12 vertebrae

what seperates the thorax from the abdomen

diaphragm

what is the suprasternal notch

u shaped depression above sternum and between clavicles

what is the manubrium

4-5 cm below suprasternal notch, attaches to ther sternum

what is the sternal angle (angle of louis)

continuous with the 2nd rib, palpable bony ridge where the manubrium meets the body of the sternum

what is the carina

found at the sternal angle (t4-t5), marks birufication of trachea, site of cough reflex

what is the midsternal line

runs vertically down center of sternum

what is the midclavicular line (MCL)

parallel to the midsternal line between the sternoclavicular and acromioclavicular joints

what is the anterior axillary line

extends down from the top of anterior axillary fold when arms are at the sides

what is supraclavicular

above the clavicle

what is the vertebral line

runs vertically down center of vertebral spinous process

what is the midscapular lines

parallel to vertebral line, runs certically through the middle of each scapula

what are posterior axillary lines

runs vertically along the posterior edge from the top of each axilla down to the lower thoracic area

what are midaxillary lines

drop from middle of axilla running parallel between anterior and posterior axillary lines

how many lobes does each lung have

right = 3

left = 2

explain the differences in the 2 lungs shape and why that is

right lung is shorter than the left to account for the liver
left lung is narrower and has a cardiac notch to account for the heart

how are lung sounds auscultated

apex to base
auscultated easily above the clavicle

where does the lung base rest

on the diaphragm 6th rib MCL and 8th rib midaxillary line

what is the purpose of the upper respiratory tract

filter, warm, and humidifies air
protect airway
voice production

what is the lower respiratory tract made up of

trachea, bronchi, bronchioles, and alveoli

what is the difference between right and left bronchi

right bronchi is shorter, wider, and more vertical than left

what are pleurae

thin slippery serous membranes that form an envelope around the lungs and are filled with lubricating fluid to help the lungs during breathing
can potentially fill with air or fluid that compromise lung expansion

what are the trachea and bronchi functions

transport gases between environment and lungs

what are goblet cells and where are they found

line the bronchi
secrete mucous to trap particles and cilia that sweep particles upwards where they can be swallowed or expelled

where does gas exchange occur

alveoli and alveolar duct

what part of the brain initiates the automatic process of respiration

brainstem

what is the main trigger for breathing in healthy adults

increased co2 levels in the blood

what occurs during inhalation

diaphragm contracts (moves downward and flattens)

external intercostal muscles contract causing ribs to move up and out

thoracic cavity expands
intrapulmonary pressure becomes lower than atmospheric pressure

air flows into the lungs (500-800ml of air taken in per breath)

what occurs during exhalation

diaphragm relaxes (rises and domes up)

ribs move down and in

thoracic cavity decreases in size

intrapulmonary pressure higher than atmospheric pressure

air flows out of lungs

what are the mechanisms of breathing

supply o2 to body for energy production

remove co2 (waste product of energy reactions)

maintain homeostasis (acid-base balance) of arterial blood
maintain heat exchange

what is the typical ph of the blood

7.35-7.45

how does gas exchange affect ph

increased co2 leads to decreased ph

what parts of the brain influence respiration

pons and medulla send signals via phrenic nerve to diaphragm

what does compliance mean in terms of the lung

ease of lung expansion

what are some things that should be assessed during a respiratory system assessment

cough or sputum presence

SOB

allergies

chest pain or tightness

past hx or smoking hx

environmental considerations

what can be observed about the respiratory system from inspection

appearance, position of body, posture, skin color, labor of breathing, accessory muscle use, respiratory rate, nail color and shape, shape and configuration of chest wall, straight spine, symmetric scapula, thorax should be symmetrical and elliptical shape, ribs should slope downwards at 45 degrees, AP to transverse diameter ratio (2:1)

what is cheyne stokes respiratory pattern

a repeating cycle of gradually increasing breath depth and speed, followed by a gradual decrease, culminating in a temporary pause in breathing

what is tripod and position and what could it be indicative of

leaning forward on a stationary object such as a table or with their elbows on their knees
could indicate respiratory distress

what is a barrel chest

AP diameter is equal to transverse diameter of chest

• normal in aged patients

what is diaphragmatic excursion

ribs moving when breathing

what are some normal breath sounds

vesicular, bronchovesicular, and bronchial

what are vesicular breath sounds and where is it heard

soft, low pitched

heard over most lung fields

what are bronchovesicular breath sounds

moderate intensity

heard near sternum and between scapulae

what are bronchial breath sounds and where is it heard

loud, high-pitched

heard over trachea

what are adventitious (abnormal) breath sounds

fine crackles, coarse crackles (rales), wheezes, rhonchi, pleural friction rub

what are fine crackles

high pitched, short cracking, popping sounds

what are coarse crackles and what do they indicate

discontinuous, popping sounds

fluid in alveoli (heart failure or pneumonia)

what are wheezes and what do they indicate

musical, high pitched

narrowed airways (asthma)

what are rhonchi and what do they indicate

low pitched, snoring

mucus in large airway

what are pleural friction rub sounds and what do they indicate

grating, creaky

inflamed pleura rubbing

should u use diaphragm or bell in lung auscultation

diaphragm

what movement pattern should you auscultate lungs in

start at apexes and move down to bases in a side to side pattern, and avoid bones
do midaxillary areas as well

how long do you listen for during lung auscultation

one full inspiration and expiration

where are abnormal sounds in lungs more likely to be heard and why

posterior lower lobes because fluids and foreign material will be pulled here by gravity

what should you do if you hear crackles in lung

have the patient cough and try again

what is perfusion in terms of the heart

heart’s ability to deliver oxygen and nutrients to tissues

what does inadequate perfusion lead to

tissue hypoxia (lack of 02 leading to tissue injury or death)

where is the heart located

mediastinum (central portion of thoracic cavity between lungs)

where are the base/apex of heart located (in terms of ribs)

base: top (2nd/3rd rib)
apex: bottom point (5th intercostal space)

where do the great vessels lie

above the heart

what are the 3 layers of the heart wall

pericardium: fluid/blood filled sac that protects the heart
myocardium: muscle portion that contributes to electric impulses
endocardium: lines chambers and valves

difference between atria and ventricles

atria are upper chambers that recieve blood
ventricles are lower chambers that pump blood out

what are the 2 av valves

tricuspid/ mitral (bicuspid valve)
connect the atria to the ventricles

what are the 2 semilunar valves

aortic and pulmonary valve
regulate blood flow out of ventricles

explain the path of blood flow through the heart (start at vena cava, end at body)

vena cava > right atrium > tricuspid valve > right ventricle > pulmonary valve > pulmonary artery > lungs> pulmonary veins > left atrium > mitral valve > left ventricle > aortic valve > aorta > rest of the body

what is the cardiac cycle

the complete movement of the heart and includes the period from the beginning of one heartbeat to the beginning of the next

what is measured during diastole BP measurement

the resting pressure of vasculature

what is measured during systole BP measurement

amount of pressure it takes to push blood from inside to outside of ventricles

what makes the s1 sound, what does it signal, and where is it heard loudest

lub
av valves closing after blood moves from atria to ventricles w
signals beginning of systole
loudest at apex

what makes the s2 sound, what does it signal, and where is it heard loudest

dub
semilunar valves shutting after blood ejected out of ventricles
signals end of systole
loudest at base

what is a heart murmur

sound of turbulent blood flow and collision currents caused by valve or heart lining damage

what order should heart sounds be auscultated in

aortic valve, pulmonary valve, erb’s point, tricuspid valve, mitral valve

where is the aortic valve

right second intercostal space

where is pulmonic valve

left second and third intercostal spaces close to sternum

what is erb’s point

place where valves are heard equally, and murmurs may be heard better

where is tricuspid valve

at or near the lower left sternal border

where is the mitral valve

at and around the cardiac apex (5th intercostal space, midclavicular line)

when listening to heart sounds, what are u paying attention to

turbulence, rate, and rhythm

how do u check for a pulse deficit

apical pulse - radial pulse = pulse deficit

list the order of electrical conduction system

originates in sinoatrial (aka sinus) (sa) node > spreads across atria and causes atrial contractions > pause at atrioventricular (av) node to allow ventricles to fill > then AV bundle (aka bundle of his) > bundle branches > purkinje fibers (trigger contraction of ventricles) wh

what is the primary and secondary pacemaker and their average bpm

primary : sa node (60-100bpm)

secondary pacemaker (40-60bpm)

what happens if there is an sa node failure

bradycardia due to secondary pacemaker having to create contractions at a lower rate (40-60bpm)

what happens if there is an av node block

delays or absent ventricular conduction (missed beats )

what causes dysrhythmias

irregular heart rhythm due to problems with electrical pathway

what is used to record electrical activity of the heart

ekg, ecg

what does a p wave signify

depolarization of the trium

what does the QRS complex signify

depolarization of the ventricle

what does the t wave signify

repolarixation of the ventricles (rebuilding of electrical activity in ventricles)