Health Assessment - Class 8 (Part 2)

The superior lateral corner of breast tissue, called the axillary ___, projects up and laterally into the axilla

tail of Spence

In the areola are small elevated sebaceous glands, called ___ glands

Montgomery’s

The suspensory ligaments, or ___ ligaments, are fibrous bands extending vertically from the surface to attach on chest wall muscles

Cooper’s

The lobes are embedded in ___ tissue

adipose

___ groups of axillary nodes are present

Four

____ are high up in the middle of the axilla, over the ribs and serratus anterior muscle. These receive lymph from the other three groups of nodes

central axillary nodes

Pectoral (anterior): along the lateral edge of the ___ major muscle, just inside the anterior axillary fold

pectoralis

Subscapular (posterior): along the lateral edge of the scapula, ___ in the posterior axillary fold

deep

Lateral: along the ___, inside the upper arm

humerus

From the central axillary nodes, lymph flows ___ to the infraclavicular and supraclavicular nodes

up

At birth, the only breast structures present are the ___ within the nipple

lactiferous ducts

At puberty, the ___ hormones stimulate breast changes

estrogen

Thelarche, the beginning of breast development, precedes ___ (beginning of menstruation) by about 2 years

menarche

After the fourth month of pregnancy, ___ may be expressed. This thick yellow fluid is the precursor of milk, containing the same amount of protein and lactose but practically no fat

colostrum

Milk production (lactation) begins ___ postpartum

1 to 3 days

After menopause, ovarian secretion of ___ decreases, which causes the breast glandular tissue to atrophy

estrogen and progesterone

"Orange peel" skin on the breast, also known as ___, is a condition that can be a symptom of inflammatory breast cancer (IBC), though it can also be caused by other conditions like a breast infection

peau d'orange

Feel this hollow U-shaped depression just above the sternum, in between the clavicles.

suprasternal notch

The ___, or “breastbone,” has three parts: (a) the manubrium, (b) the body, and (c) the xiphoid process

sternum

The ___, often called the angle of Louis, is the articulation of the manubrium and body of the sternum, and it is continuous with the second rib

sternal angle

The ___ is a useful place to start counting ribs, which helps localize a respiratory finding horizontally

angle of Louis

The right and left costal margins form an angle where they meet at the xiphoid process, called the ___

costal angle

Start at the base of your neck. Flex your head and feel for the most prominent bony protrusion there. This is the spinous process of ___

C7

Note that the spinous processes align with their same numbered ribs only down to __

T4

The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the level of the seventh or eighth rib. this is called…

inferior angle of scapula

In the anterior chest, the ___, or highest point, of lung tissue is 3 or 4 cm above the inner third of the clavicles.

apex

The ___, or lower border, rests on the diaphragm at about the sixth rib in the midclavicular line

base

The ___ lies anterior to the esophagus and is 10 to 11 cm long in the adult

trachea

The normal stimulus to breathe for most people is an increase of carbon dioxide in the blood, or ___

hypercapnia

A decrease of ___ in the blood (hypoxemia) also increases respirations but is less effective than hypercapnia

oxygen

In ___, increasing the size of the thoracic container creates a slightly negative pressure in relation to the atmosphere, and so air rushes in to fill the partial vacuum

inspiration

The major muscle responsible for this increase is the ___

diaphragm

During inspiration, ___ of the bell-shaped diaphragm causes it to descend and flatten

contraction

Expiration is primarily ___

passive

As the diaphragm ___, elastic forces within the lung, thoracic cage, and abdomen cause it to expand upward and form a dome

relaxes

at 32 weeks of life, ___, the complex lipid substance needed for sustained inflation of the air sacs, is present in adequate amounts

surfactant

Prenatal exposure to smoke results in chronic hypoxia and ___

low birth weight

The enlarging uterus ___ the diaphragm 4 cm during pregnancy

elevates

Respiratory muscle strength ___ after age 50 years and continues to decrease into the 70s

declines

In summary, the aging lung is a more ___ structure that is harder to inflate

rigid

older persons have a greater risk for postoperative atelectasis and infection as a result of a decreased ability to ___, a loss of protective airway reflexes, and increased secretions

cough

The number of reported cases of active TB disease has remained relatively ___ in Canada

stable

Indigenous people are ___ represented among reported cases of TB

disproportionately

Barriers to health services in remote Indigenous areas and chronic shortages and high turnover of health care personnel can result in ___ in diagnosis, initiation of airborne isolation precautions and treatment

delays

The ___ breath sounds are heard along the trachea or windpipe within the neck

bronchial

The bronchovesicular, BV sounds are marked between the spaces of the ___

upper ribs

The ___, V breath sounds are heard throughout the lungs and hence marked on both the lungs

vesicular

increased tactile fremitus occurs with conditions that increase the ___ of lung tissue (pleural effusion, pneumonia)

density

decreased tactile fremitus occurs when anything ___ transmission of vibrations (e.g., an obstruction in bronchus, pleural effusion or thickening, pneumothorax, and emphysema)

obstructs

___ is vibration felt when inhaled air passes through thick secretions in the larger bronchi. This may decrease somewhat after coughing

rhonchal fremitus

___ is produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid

Then the opposing surfaces make a coarse grating sound when rubbed together during breathing

pleural friction fremitus

pleural friction fremitus may sometimes be ___ and feels like two pieces of leather grating together

palpable

pleural friction fremitus is synchronous with respiratory excursion. Also called a ___

palpable friction rub

___ is the leading cause of conditions such as chronic bronchitis, emphysema, and lung cancer

smoking

Exposure to ___, chemical fumes, and occupational hazards like asbestos, silica, or coal dust can damage lung tissue over time

air pollution

Long-term exposure to ___ may also contribute to chronic inflammation of the airways

allergens

A sedentary lifestyle can decrease ___, while poor nutrition can weaken immune defenses and increase susceptibility to infection

lung capacity

Repeated respiratory infections may cause ___ and chronic changes to the lungs

scarring

Chronic Obstructive Pulmonary Disease (COPD) is a ___, irreversible lung disease characterized by airflow limitation that makes breathing difficult

progressive

COPD typically results from ___ or emphysema and is most often caused by smoking

chronic bronchitis

Common symptoms of COPD include ___, chronic cough, sputum production, and fatigue

shortness of breath

___ refers to a lateral, or side-to-side, curvature of the spine that may compress the lungs and reduce chest wall expansion, resulting in restrictive breathing

Scoliosis

Kyphosis, on the other hand, is an exaggerated ___ curvature of the thoracic spine—often called “hunchback.”

forward

The Lung Function Questionnaire is a ___ tool designed to identify individuals who may be at risk for COPD or other chronic respiratory diseases

screening

The LFQ assesses symptoms such as ___, sputum production, and shortness of breath, along with risk factors like smoking history or occupational exposure

chronic cough

The purpose of the LFQ is not to ___ disease but to determine whether further testing—such as spirometry—is warranted

diagnose

___ wheezes are high-pitched, musical sounds heard mainly during expiration and are usually caused by narrowed airways, as seen in asthma or COPD

Expiratory

Persistent fine crackles are soft, high-pitched crackling sounds typically heard late in inspiration and do not clear with coughing; they are often associated with interstitial fibrosis or ___

heart failure

General ___, sometimes called rales, are discontinuous popping sounds heard mainly during inspiration and are produced when air moves through fluid in the alveoli, such as in pneumonia, bronchitis, or congestive heart failure

crackles

__ is a harsh, crowing sound heard primarily during inspiration and indicates an upper airway obstruction, such as from croup or laryngeal edema

stridor

A ___ is a low-pitched, grating sound heard during both inspiration and expiration; it occurs when inflamed pleural surfaces rub against each other, as in pleuritis or pleural effusion

pleural friction rub

Cerebral hypoxia occurs when the brain receives insufficient ___, leading to confusion, restlessness, cyanosis, and in severe cases, loss of consciousness

oxygen

___ of the distal phalanx refers to a bulbous enlargement of the fingertips and is a sign of chronic hypoxemia, commonly seen in COPD, lung cancer, or cystic fibrosis

clubbing

Atelectasis is the ___ of alveoli, often following surgery or immobility, leading to diminished or absent breath sounds and decreased oxygen saturation

collapse

Lobar pneumonia is an ___ of a specific lobe of the lung, producing fever, productive cough with rusty sputum, and localized crackles over the affected area

infection

Bronchitis involves ___ of the bronchi, resulting in a productive cough, coarse crackles, and sometimes wheezing

inflammation

___, a form of COPD, involves destruction of alveolar walls, causing dyspnea, barrel chest, and diminished breath sounds

Emphysema

A ___ describes a rounded, bulging chest shape due to hyperinflation of the lungs, often seen in chronic emphysema

barrel chest

___ is a chronic inflammatory airway disorder marked by reversible airway constriction, wheezing, coughing, and shortness of breath, especially during attacks

asthma

Pleural effusion refers to the accumulation of ___ in the pleural space, which produces decreased or absent breath sounds and dullness to percussion on the affected side

fluid

___ is the presence of air in the pleural space, leading to lung collapse and causing sudden sharp chest pain, unequal chest expansion, and absent breath sounds on the affected side

Pneumothorax

Tuberculosis (TB) is a contagious infection caused by Mycobacterium tuberculosis, producing chronic cough, ___, weight loss, and hemoptysis

night sweats

___ occurs when a blood clot obstructs a pulmonary artery, causing sudden dyspnea, chest pain, tachycardia, and anxiety; it is a medical emergency requiring immediate attention

Pulmonary embolism

An abnormal sound more that is often heard on inspiration, rales.

crackles

Which of the following statements best describes the term wheeze?

A continuous high pitch musical sound that is heard on inspirations.

Intervals of apnea followed by a crescendo/decrescendo sequence of breathing that is often associated with dying.

cheyne-stokes

Sounds that occur ___ the respiratory tree, a grating sound is called friction rub

outside

During the chest assessment of a newborn, bowel sounds appear to be auscultated in the chest. What is the significance of this finding

indicates the potential of the presence of a diaphragmatic hernia

During a regular examination of a person who is 8 months pregnant, it is noted that the AP diameter is almost 1:1. Which of the following statements best describes this widened thoracic cavity?

normal finding with an advanced pregnancy

With which of the following conditions should a nurse on assessment expect the costal angle to be greater than 90 degrees? The presence of _____________.

Sternal and supraclavicular retraction with breathing

During percussion, the patient holds their arms in front in order to _____________.

expose maximum lung area