Exam 3

Culture

A set of beliefs, values, artistic, historical, and religious characteristics; customs common to a community or nation

Spirituality

quality of being concerned with the human spirit or soul as opposed to material or physical things

Race

each of the major groupings into which humankind is considered (in various theories or contexts) to be divided on the basis of physical characteristics or shared ancestry

Dyspnea

Difficulty breathing

Tachypnea

Breathing fast

Bradypnea

Breathing slowly

Orthopnea

sensation of breathlessness while laying down, relieved by sitting or standing

Hypoventilation

Breathing that is too shallow or too slow to meet the body’s needs

Hyperventilation

Rapid or deep breathing

Crepitus

popping, clicking, or crackling sound in a joint

Fremitus

Sensation felt by a hand placed on a part of the body that vibrates during speech

Fine crackles

occur from the sudden opening of closed airways

Referred to as “dry” or “fine”

Coarse Crackles

result from fluid or secretions

“wet”

wheezes

whistling or rattling sound in the chest, as a result of obstruction in the air passages

Adventitious sounds

sounds heard in addition to the expected breath sounds

crackles, rhonchi, wheezes

retractions

area between the ribs and in the neck sinks in when a person attempts to inhale

sign someone is working hard to breathe

S1

First sound of a heart beat, louder at the apex

“LUB”

S2

Second sound of a heart beat, louder at the base of heart

“DUB”

Murmur

a blowing, whooshing, or rasping sound heard during a heartbeat

caused by turbulent blood flow through the heart valves or near the heart

Systole

phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries

Diastole

phase of the heartbeat when the heart muscle relaxes and allows chambers to fill with blood

bradycardia

slow heart beat

tachycardia

fast heart beat

Dysrhythmia

abnormality in a physiological rhythm (heart rhythm)

Angina

type of chest pain caused by reduced blood flow to the heart

symptom of coronary artery disease

squeezing, pressure, heaviness, tightness, pain

Diaphoresis

sweating, especially to an unusual degree as a symptom of disease or side effect of drug

Nocturia

need for patients to get up at night on a regular basis to urinate

Bruit

an sound heard through a stethoscope

hypoactive bowel sounds

reduction in the loudness, tone, or regularity of the sounds

<5 sounds per minute

Normoactive bowel sounds

5-30 bowel sounds per minute

hyperactive bowel sounds

bowl sounds cease to stop

30+ bowel sounds per minute

Borborygmus

rumbling or gurgling noise made by the movement of fluid and gas in the intestines

protuberant

protruding, bulging

Scaphoid

one of the carpal bones on the thumb side of the wrist, just above radius

Distention

the state of being distended, enlarged, swollen from internal pressure

Hematemesis

Bloody vomit

Emisis

vomit

Rebound tenderness

there is more pain when pressure on the tender area is released

occurs when the tissue that lines the abdominal cavity is irritated, inflamed, or infected

Flexion

act of bending or the condition of being bent

extension

increases the angle between two body parts; Ex: knee—> straightens the lower limb

Hyperextension

excessive movement of a joint in one direction (straightening)

Rotation

rotating of a joint

Lateral bending

bending neck so that your ear leans toward your shoulders

Adduction

movement of a limb toward the midline of the body

Abduction

moving limb away from the midline of the body

Pronation

the way your foot rolls inward for impact distribution upon landing

Supination

outward rolling that causes the foot to rise above the ground as you walk

Plantar flexion

the movement of the foot in a downward motion away from the body

Dorsiflexion

backward bending and contracting of your hand or foot

Tinnitus

Ringing or other noises in one or both of your ears

Dysphasia

difficulty speaking

Anesthesia

use of medicines to prevent pain during surgery and other procedures

Hyperaglesia

causes unusually severe pain in situations where feeling pain is normal, but the pain is more severe than it should be

Astereognosis/Stereognosis

mental perception of depth or three-dimensionality by the senses

have pt close eyes, put pen in hands, have pt identify object

Hyporeflexia

skeletal muscles have a decreased or absent reflex response

Hypereflexia

skeletal muscles have an increased or overactive reflex response

Thoracic Cage Includes

sternum

clavicles

ribs

vertebrae

Mediastinum

• middle section

• contains trachea, bronchi, esophagus, heart, & great vessels

Where does gas exchange occur

Alveoli

Apex of the lungs

• highest point

• extends 3-4 cm above clavicle

Base of lungs

at level of diaphragm, 6th rib-midclavicular line

Are the lungs symmetrical?

No :)

What is Pleura

Thin, double layered serous membrane

Left Lung

• narrower

• 2 lobes

  • upper

  • lower

Right Lung

• shorter

• 3 lobes

  • upper

  • middle

  • lower

Inspiration

• active process

• air rushes into lungs

• vertical direction lengthens

  • anteroposterior diameter increases

Expiration

• passive process

• air moves out of lungs

• vertical diameter shortens

• anteroposterior diameter decreases

Function of Respiratory System

• supply O2 to body=> energy production

• Remove CO2=> waste product

• maintain homeostasis => acid/base balance

• maintain heat exchange

Paroxysmal Nocturnal Dyspnea

awaken from sleep with SOB

Cheyne-Stokes

• increasing rate and depth (Crescendo-Decrescendo)

• Apneic Periods

• Most common abnormal - common in infants and aging persons during sleep

• caused by severe heart failure, renal failure, meningitis, drug overdose, increased cranial pressure

Resonance

• predominant in healthy lung tissue

• low pitched

• clear

• hollow sound

Hyperresonance

• lower-pitched

• caused by too much air present

• emphysema, pneumothorax

Dull

• soft, muffled thud

• caused by abnormal/increase density in lungs

• pneumonia, pleural effusion, atectasis, tumor

Stridor

• harsh, honking wheeze, high pitched, inspiratory, crowing sound

• originates in larynx or trachea causing upper airway obstruction

Developmental differences (aging adult)

• costal cartilage calcifies- less mobility

• respiratory muscle strength declines

• lower elastic properties in lungs- less distensible, less recoil, more rigid

• gradual loss of intraalveolar septa & number of aleoli

  • less surface area for gas exchange

• lower vital capacity

  • maximum amount of air expelled after filling lungs to maximum

Kyphosis

• forward rounding of back

• exaggerated rounding

Emphysema (COPD) pathophysiology

• loss of elasticity in lungs

• lower force of inspired air

  • lungs are hyperinflated

Emphysema (COPD) S&S

• “Silent Chest”- little air is moving in or out

• dyspnea, diminished breath sounds, barrel chest, cyanosis, possible clubbing

Bronchitis cause

• excessive mucus secretion

• inflammation of bronchi

• usually r/t smoking if chronic

Bronchitis S&S

hacking, rasping cough, productive of thick mucoid sputum

Chronic COPD- dyspnea, fatigue, cyanosis, possible clubbing

crackles over deflated areas, may have wheeze

Asthma Cause

• certain inhaled allergens (pollen)

• irritants (tobacco, ozone)

• microbes, stress, exercise

Asthma Pathophysiology

• bronchospasm and inflammation

• edema

• secretion of high viscous mucous into airways

Asthma S&S

• increased resp rate

• SOB with audible wheeze

• use of accessory neck muscles

• cyanosis

• apprehension

• retraction of intercostal spaces

• expiration labored, prolonged

• if chronic, may exhibit barrel chest

HF Physiology

pump failure with increasing pressure of cardiac overload

causes pulmonary congestion or increased amount of blood present in pulmonary capillaries

HF S&S

• high resp rate

• SOB on exertion

• orthopnea and paroxysmal nocturnal dyspnea

• ankle edema

• pallor in light skinned people

• skin moist, clammy

• crackles at lung bases

Lung Cancer Risk Assessment

• tobacco smoke

• asbestos

• radiation exposure

• personal or family history

Lung Cancer S&S

• persistent cough

• weight loss

• congestion

• wheezing

• hemoptysis

• labored breathing

• dyspnea

• lung sounds diminished over affected area

• percussion tones- dull over tumor

Sleep Apnea

• periods of breathing cessation during sleep

• results in poor quality of sleep

• serious life-long consequences

  • HTN, stroke, heart disease, accidents, diabetes, depression

Atrioventricular (AV) valves

Ventricle entrances

• tricuspid

• mitral

Semilunar Valves

ventricle exits

Electrical conduction of heart

• cardiac cycle

• sinoatrial node

• AV node

• AV bundle (bundle of his)

• purkinje fibers

• Measured by ECG

Cardiac Output (CO)

amount of blood pumped by ventricles during given period of time

Stroke Volume

amount of blood pumped from heart with each contraction

usually 70 mL

Factors that influence stroke volume

• degree of stretch of heart muscle

• pressure against heart muscle

• synergy of contraction

• compliance of ventricles

• contractility of force contractions

• autonomic nervous system

Carotid Artery

provides oxygenated blood to head and neck

• located in groove between trachea and sternomastoid muscle, medial to and along-side that muscle

Jugular Veins

empty unoxygenated blood into superior vena cava

Coronary Heart Disease

• narrowed vessels that cause MI, chest pain, stroke; arrhythmias; heart infections; heart defects; valve disease

Screening for CHD

• blood tests for cholesterol levels

• glucose

• BP

  • risk assessment

CHD Risk factors

Non-modifiable

• age (>65)

• gender (male)

• family history

• race (African American, Mexican American, Native American, Hawaiian, Asian)

Modifiable:

• smoking (or 2nd hand)

• HTN

• Inactivity

• obesity

• DM

• stress

• alcohol consumption

• diet

Heart Attack

MI

blood flow to heart is stopped

• feeling tight band around chest

• indigestion

• something heavy sitting on chest

• squeezing or heavy pressure