1215 Exam 2

fuck my ass

hypercapnia

increase of carbon dioxide in the blood

hypoxemia

decrease of oxygen in the blood

• increased respirations as well, but less effective than hypercapnia

white/clear mucoid

• colds

• bronchitis

• viral infections

Yellow or green sputum

• bacterial infections

rust colored sputum

• TB

  • pneumococcal PNA

Pink, frothy sputum

• pulmonary edema

  • some sympathomimetic medications have a side effect of pink tinged mucus

Mycoplasma PNA cough characteristic

• hacking

early heart failure characteristic cough

• dry

Croup cough characteristic

• barking

colds, bronchitis, PNA cough characteristics

• congested

Orthopnea

difficulty breathing when supine

• state number of pillows needed to achieve comfort

  • i.e. two pillow orthopnea

Pack years formula

years of smoking x ppd

AP (anteroposterior) to Transverse Diameter

• normal chest

  • transverse diameter (side-to-side) is greater than AP diameter (front-to-back)

  • normal ratio: 1:2

in COPD (esp. emphysema):

• Lungs are chronically overinflated with air

  • chest expands in all directions

• AP diameter increases until it almost equals transverse diameter

• ratio becomes closer to 1:1

Barrel Chest

used to describe when chest ratio of AP to transverse diameter is 1:1

• rounded, bulging chest

• ribs more horizontal

• seen in COPD

  • esp. emphysema

crepitus assessment and findings

crackling/grating sensation on palpation

subcutaneous crepitus causes

• trapped air

  • trauma

  • pneumothorax

Joint crepitus cause

• rough joint surfaces

  • arthritis

  • fracture

assessment findings for pulmonary embolism

• sudden SOB

• chest pain

• tachypnea

• tachycardia

• hemoptysis

  • coughing up blood

• hypoxemia

assessment findings for PNA

• sudden onset of fevers/chills

• productive cough

  • rust-colored, purulent

• pleuritic chest pain

• SOB

• fatigue

urgent findings from thorax palpation

• asymmetric chest expansion

• surface anomalies

  • lumps

  • masses

  • tenderness

• crepitus

Assessment findings of pleural friction rub

superficial, coarse, grating, low-pitched sound

• like leather rubbing together

• heard on both inspiration and expiration

• pleurae are inflamed and lose their normal lubricating fluid

  • surfaces rub together

Silent chest

Absence of breath sounds

• Indicates no air is moving in or out of the lungs.

• Considered an ominous sign

  • severe airway obstruction

  • status asthmaticus

  • end-stage respiratory compromise

Stridor

High-pitched, monophonic inspiratory crowing sound, louder in the neck than over the chest wall.

• Upper airway obstruction, due to:

  • swollen or inflamed tissues

  • lodged foreign body.

• Associated with:

  • croup, acute epiglottitis in children

  • foreign body aspiration

• Airway obstruction may be life-threatening

Absent or Decreased Breath Sounds with Distress

• Obstruction of bronchial tree, air, or fluid (pleural effusion) in pleural space.

• May indicate:

  • pneumothorax

  • large pleural effusion

tension pneumothorax

• absent sounds are accompanied by:

  • tracheal shift

  • unstable vital signs

• requires immediate intervention

Widespread, Severe Wheezing

Diffuse, high-pitched, musical squeaking sounds (polyphonic).

• Airflow obstruction

• often found in:

  • acute asthma

  • severe chronic emphysema

• Emergent Concern

  • Inability to move air effectively combined with respiratory distress or silent chest indicates respiratory failure risk

Chronic Bronchitis

a type of COPD with proliferation of mucus glands

• excessive mucus

• inflamed bronchi

• partial obstruction

Inspection findings of Chronic Bronchitis

• Hacking

• rasping productive cough

• dyspnea

• fatigue

• cyanosis

• possible clubbing of fingers.

palpitation findings of Chronic Illness

Tactile fremitus normal

• palpable vibrations

percussion findings for Chronic bronchitis

Resonant

Auscultation findings for chronic bronchitis

• Normal vesicular sounds

• prolonged expiration.

Adventitious sounds of Chronic Bronchitis

• Crackles over deflated areas

• wheezing during exacerbations

Emphysema

a type of COPD caused by destruction of pulmonary connective tissue

• permanent enlargement of air sacs distal to terminal bronchioles

Inspection findings for emphysema

• Barrel chest

• accessory muscle use

• tripod position

• shortness of breath

  • especially on exertion

• tachypnea

Palpation findings for Emphysema

Decreased tactile fremitus and chest expansion.

Percussion findings for Emphysema

Hyperresonant

Auscultation findings for Emphysema

• Decreased breath and voice sounds

• prolonged expiration

Adventitious sounds in Emphysema

Usually none, but occasional wheeze

Asthma

• (reactive airway disease)

• Allergic hypersensitivity to inhaled allergens

  • bronchospasm

  • inflammation

  • edema

  • mucus production

Inspection findings of Asthma

• Increased respiratory rate

• audible wheeze

• accessory muscle use

• cyanosis

• retraction of intercostal spaces

Palpation findings of Asthma

• Tactile fremitus decreased

• tachycardia

Percussion findings of Asthma

• Resonant

• may be hyperresonant during attack

Adventitious sounds of Asthma

• BL wheezing on expiration

• sometimes both inspiratory and expiratory

Normal Respiratory Pattern

• Rate: 10–20 breaths per minute

• Depth: 500–800 mL

• Pattern: Even, with occasional sighs that expand alveoli

Sigh (respiratory pattern)

• Occasional sighs are normal

• frequent sighs may indicate emotional dysfunction

  • can lead to hyperventilation

Tachypnea

• Rapid, shallow breathing (>24/min).

• Normal with fever, fear, or exercise.

• Also occurs with respiratory insufficiency, pneumonia, pleurisy, alkalosis, or lesions in the pons

Hyperventilation

Increased rate and depth

• Can be a normal response to exertion, fear, or anxiety.

• Leads to CO₂ loss (alkalosis)

-

• Seen in:

  • diabetic ketoacidosis

  • Kussmaul respirations

  • salicylate overdose

  • lactic acidosis

  • hepatic coma

  • midbrain lesions

Bradypnea

• Slow, regular breathing

  • <10/min

• Associated with:

  • drug-induced depression of the medulla

  • increased intracranial pressure

  • diabetic coma

Hypoventilation

• Irregular, shallow breathing.

• Caused by:

  • narcotic or anesthetic overdose

  • prolonged bed rest

  • chest splinting to avoid pain

Cheyne-Stokes Respiration

• Cycle of gradually increasing and then decreasing respirations

  • followed by 20 seconds of apnea

• Normal in infants and older adults during sleep

-

• Seen in:

  • severe heart failure

  • renal failure

  • meningitis

  • drug overdose

  • increased intracranial pressure

Biot Respiration

• Similar to Cheyne-Stokes, but is irregular

• Normal respirations (3–4) followed by apnea.

-

• Seen with:

  • head trauma

  • brain abscess

  • heat stroke

  • spinal meningitis

  • encephalitis

Chronic Obstructive Breathing (Air Trapping)

• Normal inspiration with prolonged expiration due to increased airway resistance.

-

• Seen in:

  • COPD, especially with exertion, leading to dyspnea because of incomplete expiration

Bronchial (tracheal)

• normal breath sounds

• Pitch:

  • high

• Amplitude:

  • loud

• Location:

  • Trachea and larynx

• Quality:

  • Harsh, hollow, tubular.

• Duration:

  • Expiration longer than inspiration.

Bronchovesicular

• normal breath sounds

• Pitch

  • moderate

• Amplitude:

  • moderate

• Location

  • Major bronchi

    • between scapulae posteriorly

    • between upper sternum anteriorly

• Quality:

  • Mixed

• Duration

  • Inspiration and expiration equal

Vesicular

• normal breath sounds

• Pitch:

  • low

• Amplitude:

  • soft

• Location:

  • Peripheral lung fields where air flows through smaller bronchioles and alveoli.

• Quality:

  • Rustling

    • like the sound of wind in trees.

• Duration:

  • Inspiration longer and louder than expiration

Crackles (Rales)

• Discontinuous, popping sounds heard mostly during inspiration.

• Caused by:

  • air colliding with secretions

  • sudden airway opening.

Fine crackles

high-pitched, short

Coarse crackles

• louder

• lower-pitched

• longer.

Atelectatic crackles

short-lived in sleeping or elderly patients when alveoli are partially collapsed

• not pathologic

Wheezes (Rhonchi)

Continuous musical sounds

• usually more prominent during expiration

High-pitched wheezes

• (sibilant)

• polyphonic, squeaky

Low-pitched wheezes (sonorous)

Snoring, moaning quality

Stridor

• High-pitched, crowing inspiratory sound.

• Louder in the neck than chest wall.

• Caused by upper airway obstruction (croup, epiglottitis, foreign body).

• Emergent finding

  • can be life-threatening

Assessment findings for meningitis

• severe HA

• n/v

• light sensitivity

• nuchal rigidity

  • neck stiffness

• fever

• AMS

• irritability

• confusion

• lethargy

• loss of balance

• blurred vision

Auscultation process for the thyroid

• Indication: If the thyroid gland is palpably enlarged during assessment

• Technique:

  • Place the bell of the stethoscope lightly over the thyroid gland.

  • Listen carefully for abnormal vascular sounds.

• Normal Finding: No sound should be heard.

• Abnormal Finding:

  • A bruit may be heard.

    • indicates accelerated or turbulent blood flow, often associated with hyperplasia of the thyroid, such as in hyperthyroidism

Tension Headaches

• BL

• dull

• bandlike

• stress-related

• milder

Migraine Headaches

• usually unilateral

• throbbing

• moderate-to-severe

• prodrome/aura phases

• triggered by:

  • hormones

  • foods

  • stress

cluster headache

• strictly unilateral

• excruciating

• short but recurrent in clusters

• autonomic symptoms and agitation

function of cranial nerve 11

Moves head and shoulders via sternomastoid and trapezius

function of cranial nerve 7

Controls facial expressions and maintains symmetry

assessment finding differences between Stroke and Bell's Palsy

• Stroke

  • Lower face paralysis only

  • can wrinkle forehead

• Bell’s Palsy

  • Complete half-face paralysis

  • cannot wrinkle forehead

Red Flag Sx for HA

• Thunderclap headache – sudden, severe pain reaching maximum intensity within minutes.

• New severe headache

  • particularly in individuals over 50 years of age.

• Headache triggered by Valsalva maneuvers

  • occurs with coughing, sneezing, straining, or sexual intercourse.

• Headache triggered by positional changes

  • e.g., moving from lying to standing.

• Significant change in prior headache pattern

  • worsening severity or persistence (“never goes away”).

• Headache with systemic symptoms

  • such as fever, rash, neck stiffness, weight loss, personality changes.

• First severe headache in an adult or child with no prior history

  • worst HA in my life

Temporomandibular Joint

• articulation of the mandible and temporal bone, located just anterior to the tragus of the ear

• enables chewing and speech through hinge and gliding movements

• Normal findings include:

  • smooth, pain-free motion

Inspection of TMJ

Observe the area for swelling or asymmetry.

• Muscle Testing: Evaluate strength by asking pt to move jaw against resistance

  • testing integrity of cranial nerve V

    • trigeminal

Palpitation of TMJ

• Place fingertips just anterior to the tragus and ask the patient to open and close the mouth.

  • Normal finding: smooth motion without limitation or tenderness.

Abnormal TMJ findings

• Crepitus or Clicking

  • May suggest joint derangement.

• Pain or Tenderness

  • Could indicate arthritis, infection, or TMJ disorder.

• Limited ROM

  • Seen in TMJ syndrome or with trauma.

ROM testing of TMJ

• Ask pt to open the mouth maximally

  • normal is 3–6 cm between upper and lower teeth

• Protrude and retract the jaw

• Move jaw side to side

  • normal is1–2 cm

Myxedema (Hypothyroidism)

• Slow metabolism

  • fatigue

  • weight gain

  • constipation

  • cold intolerance

  • puffy face

  • dry skin

  • slow reflexes.

Graves’ Disease (Hyperthyroidism)

• Fast metabolism

  • weight loss

  • heat intolerance

  • tachycardia

  • tremors

  • exophthalmos

  • sweating

  • hyperreflexia

Facial Assessment finding for Cushing syndrome

• round, swollen, moonlike face

  • often plethoric (red-tinged)

  • sometimes with acne

• accompanied by systemic features

  • truncal obesity

  • muscle wasting

clinical presentation of Acromegaly due to excessive growth hormone

• bony overgrowth of the skull, jaw, and facial structures

  • elongated head

  • prominent forehead and jaw

  • enlarged nose and lips

  • coarse facial features

Nerve that control facial muscles

cranial nerve 7

• controls facial expressions

Vertigo

true rotational spinning sensation

• Often results from labyrinthine-vestibular disorders in the inner ear

• linked to vestibular dysfunction rather than cerebral perfusion issues

objective vertigo

person perceives the room spinning

subjective vertigo

person feels as though they are spinning

Presyncope

light-headed, swimming sensation or feeling of impending fainting.

• Caused by:

  • decreased blood flow to the brain

  • cardiac irregularity that lowers cardiac output

• “I feel like I’m going to faint”

Disequilibrium

• reflects an issue with balance or coordination

  • not necessarily perfusion or vestibular spinning

• associated with musculoskeletal or neurologic disorders affecting gait and posture

• “I feel like I’m going to fall down.”

Sinoatrial (SA) Node landmark location

• Located near the superior vena cava

  • at the top of the right atrium.

• has intrinsic rhythm

• known as the pacemaker of the heart

Atrioventricular (AV) Node landmark location

• Positioned low in the atrial septum

  • between the atria and ventricles

• Impulse is delayed slightly here to allow the atria to contract and empty before ventricular contraction

Bundle of His (Atrioventricular Bundle) landmark location

• Extends from the AV node into the interventricular septum.

• Divides into the right and left bundle branches that travel down either side of the septum

Purkinje Fibers landmark location

• Spread out from the bundle branches through the ventricular walls.

• Carry impulses that stimulate the ventricular myocardium to contract

assessment findings for heart failure

• Subjective

  • fatigue

  • dyspnea

  • chest pain

• Objectively

  • jugular venous distention (JVD)

  • displaced or sustained apical pulse

  • S3 gallop

  • edema

  • cool extremities

  • weak pulses

  • irregular tachycardia.

significance of murmurs

provide clues to valvular heart disease and other abnormalities.

Midsystolic (Ejection) Murmurs

Caused by forward flow through semilunar valves.

• aortic stenosis

• pulmonic stenosis

Pansystolic (Regurgitant) Murmurs

Caused by backward flow of blood from higher to lower pressure

• mitral regurgitation

Diastolic Rumbles (AV Valve Disease)

Caused by abnormal filling

• mitral stenosis

Atrioventricular (AV) Valves function

• Open during diastole

  • allows ventricles to fill with blood.

• Close during systole

  • prevents regurgitation of blood back into the atria.

Types of AV valves

• Tricuspid valve

  • between the right atrium and right ventricle

• Mitral (bicuspid) valve

  • between the left atrium and left ventricle

AV valve support structures

• Their leaflets are anchored by chordae tendineae attached to papillary muscles

  • contract to ensure the valves close securely