NRSE 210 Exam #2 part 2

external ear (function, structures)

• funnel sound waves

• auricle (pinna), external auditory canal, tympanic membrane

Auricle (pinna)- (structure)

cartilage structure, includes orkle at top

External auditory canal (structure)

3 cm, lined with glands that secrete cerumen

cerumen

ear wax

• keeps foreign objects out, lubricates ear 

Tympanic membrane (description, location)

eardrum

• pearly grey, oval slightly concave

• separates external and middle ear

Middle ear (description, function)

small air- filled cavity

• contains ossicles (malleus, incus, Staples)

• Function: transmit sound vibrations from eardrum to inner ear

Inner ear: bony labyrinth

containing sensory organs for hearing and equilibrium

Inner ear: cochlea

central hearing apparatus

CN VII

vestibulocochiear nerve (inner ear is connected to)

Pathways of hearing: air conduction

normal, efficient pathway]

• external and middle ear

Pathways of hearing: bone conduction

skull bones vibrate

• vibrations transmits to inner ear

hearing loss: conductive loss (cause, examples)

• mechanical dysfunction of external/ middle ear

• partial loss, amplifying may help

• examples: foreign body, perforated eardrum, wax, fluid

hearing loss: senseorineural loss

• pathology of inner ear, CN VII, or cerebral cortex

• amplifying sound does not improve hearing

• examples: presbycusis (age related progression)

hearing loss: mixed loss

combination of sensorineural and conductive 

vertigo (cause)

cause by labyrinth inflammation, sending wrong locations to the brain

Tinnitus

ringing, buzzing (caused by lound noises)

Tx- asorin, lasix, antibiotics, NSAIDS

Otoscope exam positioning

• adults: pull pinna up and back

• young children: pull pinnadown and back

Otitis externa (definition and affect)

swimmers ear

• infection, pain with pinna/ tragus movement, swelling, drainage 

• external ear

Darwin’s tubercle

small bump on helix, harmless

• external ear

Tophi

uric acid nodules, sign of gout

• external ear

Chondrodermatits

painful red bump from pressure/ sun

• external ear

keloid

overgrowth of scar tissue

carcinoma

non- healing lesion, bleeding, often sun exposed

Palperbral fissure

space between eyelids

limbus

border between sclera and cornea

canthus

corners of eyes

caruncle

fleshy mass at inner canthus with sebaceous glands

conjunctiva 

• palperbral (lines lids)

• bulbar (covers eyeballs

What CN’s control extraocular muscles

III, IV, VI

Outer layer of eye (makeup)

• sclera

• cornea

Middle layer of eye makeup

• iris

• pupil

• lens

• anterior chamber

what CN controls the size of the pupil

CN III

Inner layer of eye makeup

retina- conversion light to nerve impulses

• optic disc, rerinal vessels, macula

Pupillary light reflex

• direct: same eye constricts

• consensual: other eye also constricts

visual accommodation

pupils constrict, eye's converge for near vision

cataracts

• aging eye changes

lens opacity, surgical removal 

glaucoma

• aging eye changes

increased intraocular pressure, damage to the optic nerve

macular degeneration

• aging eye changes

• affects central vision

• leading cause to blindness

Physical exam test: Snellen chart

distance vision (20/20 is normal)

Physical exam test: near vision

card is 14 inches from the patients face

• normal result is 14/14

Physical exam test: confrontation test

peripheral vision

Physical exam test: corneal light reflex

eye alignment

Physical exam test: cover test

strabismus check, lazy eye

Physical exam test: diagnostic positions test

6 cardinal gazes

eyelid disorders

• perior edema, exophthalmos, enophthalmos

• ptosis, ectopic, entropin

eye lesions 

blepharitis, dacryocystitis, chalazion, hordeolum (stye)

Pupil disorders

• anisocoria (unequal pupils)

• mydriasis (dilated/ fixed)

external eye disorders

conjunctivitis (pink eye)

Thoracic cage structure

• bony structure made of sternum

• 12 pairs of ribs

• 12 thoracic vertebrae

Diaphragm structure

forms the floor

• separates abdomen from thoracic cavity

suprasternal notch structure

U- shaped, abover sternum, between clavicles

sternum structure

breast bone with three parts:

• manubrium

• body

• xiphoid 

Manubriosternal angle

• AKA angle of louis

• between manubrium and body

costal angle

right and left of xiphoid process

• normal= 90 degrees

• angle increased when rib cage is chronically overinflated (ex.COPD)

vertebra prominens structure 

• C7

• flex head to chin

• bony protrusion at the back of the spine

Spinous processes structure

T1- T2 (top to bottom of spine

Inferior border of scapula structure

located symmetrically in each hemithorax

• aligns with 7th- 8th rib

Twelfth rib structure

midway between spine and side

Mid sternal line

exact middle (divides body into left and right)

Mid clavicular line

bisects center of each clavicle

Anterior axillary line 

runs down the front side of the body through the armpit 

vertebral line

runs down middle of the back (divides left and right(

scapular line

posterior version of the mid- clavicular line

Mid axillary line

• lateral reference 

• from the apex of axilla staright down the body

• splits anterior and posterior 

Anterior axillary line

runs down the front side of the lateral position

Posterior axillary line

runs down the back side of the lateral position

Mediastinum cavity

contains esophagus, trachea, heart, and great vessels

Lung borders and descriptions (3)

• Apex: highest point of lung tissue

• Base: lowest border; sits on diaphragm (around 6th rib)

• Posterior: lungs extend from T3 to T10

Right lung description

3 lobes

• shorter because of liver

• lobes are separated by fissures

left lung description

2 lobes

• narrower because of the heart

• no middle lobe

• lobes are separated by fissures

anterior chest lung POV

mostly upper and middle lobes

posterior chest POV

almost all lower lobe

Pleurae (makeup, cavity, negative pressure)

• thin slippery envelope between lungs and chest wall 

• inside of the envelope contains small amount of lubricating fluid 

• negative pressure: vacuum holds lungs tightly against the chest wall

Trachea description

• anterior to esophagus

• 10 cm long

• splits sternal angle into right and left main bronchi

Bronchi decription

• lined with goblet cells (secrete mucus) and cilia (sweep particles upward)

involuntary mechanisms are controlled by what

brain stem

inspiration

air rushes in, diaphragm expands

expiration

air is expelled as chest recoils

AP/ Transverse ratio (description and abnormalities)

The normal anteroposterior (AP) to transverse chest ratio is approximately 1:2, meaning the distance from front to back is half the distance from side to side

• barrel chest is a 1:1 ration

pigeon chest description

sternum bulging outward

Funnel chest description 

sternum is inward

Symmetrical chest expansion test (normal/ abnormalities during test)

hands on mid back, thumbs should move apart evenly

• asymmetry movement = pneumonia, trauma, collapsed lung, deformity

Tactile fremitus test (description and abnormalities)

• use ball of hand, have patient say 99

• avoid scapula; vibrations should be symmetrical

• decreased fremitus= emphysema

percussion of posterior chest

• non dominant hand on patient, strike with dominate hand (avoid scapula)

• move side to side, top to bottom 

• over lung= resonance, scapula= flat, liver= dullness

• Abnormal sounds: hyperresonance= too much air. dullness= increased density

ascultate posterior chest procedure

• have patient lean forward slightly, arms in lap

• breathe slowly through mouth, slightly deeper than normal

Breath sounds: bronchial

• inspiration< expiration

• loud, over trachea/larynx

• normal breath sounds

Breath sounds: bronchovesicular

• inspiration= expiration

• moderate, over major bronchi/ upper sternum

• normal breath sounds

Breath sounds: vesicular 

• inspiration> expiration

• soft pitched, over low lungs (rustling sound)

• normal breath sounds

decreased breath sounds means

collapsed lung or obstruction

Adventitious sound discontinuous description (crackles fine/course, rhonchi, pleural friction rub)

• Fine crackles- high pitched, collapsed air sacs reopening

• Coarse crackles- Velcro sound, coughing doesn’t clear, edema or pneumonia

• Rhonchi- low pitched snoring, fluid blocked airways, clear with cough

• pleural friction rub- rubbing leather sound, pleural inflammation

Adventitious sound continuous description (wheeze, stridor)

• wheeze- musical, high- pitched; mostly expiration (asthma, emphysema)

• stridor- high- pitched inspiration; swollen upper airway or obstruction (croup, epiglottis)

barrel chest (description, seen with..)

AP= transverse (1:1)

• horizontal ribs

• seen in asthma or emphysema

scoliosis (description, seen in...)

lateral spine curvature

• uneven shoulders/ scapula/ hips

• can limit lung capacity

• common in females

Kyphosis 

• hunchback; pain, reduced motion

• aging/ osteoporosis; may impair breathing

Tachypnea (description, seen in..)

greate than or equal to 24 breaths per minute

• anxiety, fever, infection, exercise

Bradypnea (description, seen in..)

• less than 12 breaths per minute

• CNS depression, coma, overdose

Cheyne- strokes (description, seen in..)

• alternating fast and slow breathing with apnea

• heart/renal failure, overdose, Increase ICP (intracranial pressure)

Asthma (definition, cause, symptoms, treatment)

• definition: chronic inflammatory airway disorder, causing airway construction and mucus production

• causes: allergens, exercise, cold air, infections, stress

• symptoms: wheezing, coughing, shortness of breath, chest tightness

• treatment: bronchodilators (Albuterol), avoiding triggers

COPD (definition, cause, symptoms, treatment)

chronic obstructive pulmonary disease

• definition: progressive airway obstruction due to chronic bronchitis or emphysema

• cause: smoking, air pollutants, genetic factors

• symptoms: chronic cough, sputum production, fatigue

• treatment: smoking cessation, oxygen therapy, bronchodilators

Pneumonia  (definition, cause, symptoms, treatment)

• definition: infection that inflates air sacs in one or both lungs

• cause: bacteria, virus, fungi

• symptoms: fever, cough, phlegm, chest pain, fatigue 

• treatment: antibiotics (for bacterial), rest, fluid, oxygen therapy if needed