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

crepitus causes

• subcutaneous

  • trapped air

    • trauma

    • pneumothorax

• Joint:

  • 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

• symmetric chest expansion

• surface anomalies

  • lumps

  • masses

  • tenderness

• crepitus

Assessment findings of pleural friction rub

superficial, coarse, grating, low-pitched sound

• like leather rubbing together

Timing

• heard on both inspiration and expiration

Cause

• when 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—seen in severe airway obstruction, status asthmaticus, or end-stage respiratory compromise

Stridor

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

• Cause: Upper airway obstruction due to swollen or inflamed tissues, or a lodged foreign body.

• Emergent Concern: Associated with croup, acute epiglottitis in children, or foreign body aspiration. Airway obstruction may be life-threatening

Absent or Decreased Breath Sounds with Distress

Diminished or absent sounds on auscultation.

• Cause: Obstruction of bronchial tree (mucus plug, foreign body), air (pneumothorax), or fluid (pleural effusion) in pleural space.

• Emergent Concern: May indicate pneumothorax or large pleural effusion. In tension pneumothorax, absent sounds are accompanied by tracheal shift and unstable vital signs, requiring immediate intervention

Widespread, Severe Wheezing

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

• Cause: Airflow obstruction, often in acute asthma or severe chronic emphysema.

• Emergent Concern: Inability to move air effectively, especially when combined with respiratory distress or a silent chest, indicates respiratory failure risk

Assessment findings of Chronic Bronchitis (COPD)

• Condition: Proliferation of mucus glands → excessive mucus, inflamed bronchi, partial obstruction.

• Inspection: Hacking, rasping productive cough; dyspnea; fatigue; cyanosis; possible clubbing of fingers.

• Palpation: Tactile fremitus normal.

• Percussion: Resonant.

• Auscultation: Normal vesicular sounds; prolonged expiration.

• Adventitious sounds: Crackles over deflated areas; wheezing during exacerbations

Assessment findings of Emphysema (COPD)

• Condition: Destruction of pulmonary connective tissue → permanent enlargement of air sacs distal to terminal bronchioles.

• Inspection: Barrel chest; accessory muscle use; tripod position; shortness of breath, especially on exertion; tachypnea.

• Palpation: Decreased tactile fremitus and chest expansion.

• Percussion: Hyperresonant.

• Auscultation: Decreased breath and voice sounds; prolonged expiration.

• Adventitious sounds: Usually none, but occasional wheeze

Asthma (Reactive Airway Disease)

• Condition: Allergic hypersensitivity → bronchospasm, inflammation, edema, mucus production.

• Inspection: Increased respiratory rate; audible wheeze; accessory muscle use; cyanosis; retraction of intercostal spaces.

• Palpation: Tactile fremitus decreased; tachycardia.

• Percussion: Resonant; may be hyperresonant during attack.

• Auscultation: Diminished air movement; decreased breath sounds; voice sounds decreased.

• Adventitious sounds: Bilateral 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, but frequent sighs may indicate emotional dysfunction and 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, and midbrain lesions

Bradypnea

• Slow, regular breathing (<10/min).

• Associated with drug-induced depression of the medulla, increased intracranial pressure, or diabetic coma

Hypoventilation

• Irregular, shallow breathing.

• Caused by narcotic or anesthetic overdose, prolonged bed rest, or chest splinting to avoid pain

Cheyne-Stokes Respiration

• Cycle of gradually increasing and then decreasing respirations, followed by apnea (20 seconds).

• Seen in severe heart failure, renal failure, meningitis, drug overdose, or increased intracranial pressure.

• Normal in infants and older adults during sleep

Biot Respiration

• Similar to Cheyne-Stokes but irregular.

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

• Seen with head trauma, brain abscess, heat stroke, spinal meningitis, or 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 than inspiration.

Bronchovesicular

• normal breath sounds

• Pitch: moderate

• Amplitude: moderate

• Location: Major bronchi (between scapulae posteriorly; upper sternum anteriorly).

• Quality: Mixed.

• Duration: Inspiration and expiration equal in length

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 or by sudden airway opening.

Fine crackles

high-pitched, short

Coarse crackles

louder, lower-pitched, longer.

Atelectatic crackles

• not pathologic

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

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 (a soft, pulsatile, whooshing, or blowing sound) may be heard.

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

Tension Headaches

bilateral, dull, bandlike, stress-related, milder

Migraine Headaches

usually unilateral, throbbing, moderate-to-severe, with prodrome/aura phases, triggers like hormones, foods, and stress

cluster headache

strictly unilateral, excruciating, short but recurrent in clusters, with 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; forehead spared.

• Bell’s Palsy: Complete half-face paralysis; forehead involved

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

Temporomandibular Joint

The TMJ enables chewing and speech through hinge and gliding movements. Assessment involves inspection, palpation, ROM testing, and muscle strength evaluation. Normal findings include smooth, pain-free motion, while crepitus, pain, or restricted movement signal possible TMJ dysfunction.

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, tremor, exophthalmos, sweating, hyperreflexia.

Facial Assessment finding for Cushing syndrome

round, swollen, moonlike face, often plethoric (red-tinged), sometimes with acne, and accompanied by systemic features such as truncal obesity and muscle wasting.

clinical presentation of Acromegaly due to excessive growth hormone

bony overgrowth of the skull, jaw, and facial structures, creating an elongated head, prominent forehead and jaw, enlarged nose and lips, and coarse facial features

Nerve that control facial muscles

cranial nerve 7

• controls facial expressions

Vertigo

• Defined as a true rotational spinning sensation.

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

• With objective vertigo, the person perceives the room spinning; with subjective vertigo, the person feels as though they are spinning.

• It is linked to vestibular dysfunction rather than cerebral perfusion issues

Presyncope

• Described as a light-headed, swimming sensation or feeling of impending fainting.

• Caused by decreased blood flow to the brain or a cardiac irregularity that lowers cardiac output.

• Patients often say, “I feel like I’m going to faint”

Disequilibrium

• Reported as the feeling, “I feel like I’m going to fall down.”

• It reflects an issue with balance or coordination, not necessarily perfusion or vestibular spinning.

• Often associated with musculoskeletal or neurologic disorders affecting gait and posture

landmark location for heart conduction system components

• SA node → superior vena cava/right atrium junction.

• AV node → low atrial septum.

• Bundle of His → interventricular septum.

• Purkinje fibers → ventricular walls.

assessment findings for heart failure

fatigue, dyspnea, and chest pain. Objectively, you may find jugular venous distention, displaced or sustained apical impulse, S3 gallop, edema, cool extremities, weak pulses, and irregular tachycardia.

significance and cause of the murmur

can be harmless or signal serious cardiac pathology. Their significance lies in differentiating these conditions, while their causes are rooted in turbulent blood flow due to stenosis, regurgitation, or increased flow across normal valves.

Atrioventricular (AV) Valves

• types:

  • Tricuspid valve – between the right atrium and right ventricle.

  • Mitral (bicuspid) valve – between the left atrium and left ventricle.

• Function:

  • Open during diastole to allow ventricles to fill with blood.

  • Close during systole to prevent regurgitation of blood back into the atria.

• Support structures: Their leaflets are anchored by chordae tendineae attached to papillary muscles, which contract to ensure the valves close securely

Semilunar (SL) Valves

• Types:

  • Pulmonic valve – between the right ventricle and pulmonary artery.

  • Aortic valve – between the left ventricle and aorta.

• Function:

  • Open during systole to allow blood to be ejected from the ventricles into the pulmonary and systemic circulation.

  • Close at the end of systole to prevent backflow into the ventricles.

• Structure: Each has three cusps shaped like half-moons, hence the name semilunar

thrill

A thrill is a key palpatory finding that signals significant cardiac pathology. While its presence confirms abnormal turbulent blood flow, further auscultation and diagnostic evaluation are needed to determine the exact cause.

• cat purr throat

Cardinal Heart Sounds and Their Landmarks

• Aortic valve area – Right 2nd intercostal space at the right sternal border.

• Pulmonic valve area – Left 2nd intercostal space at the left sternal border.

• Tricuspid valve area – Left 4th to 5th intercostal space at the left lower sternal border.

• Mitral (apical) area – 5th intercostal space at or just medial to the left midclavicular line

Describe cardiac cycle difference between systole (pumping phase) and diastole (filling phase)

• Diastole = filling phase (ventricles relaxed, blood enters).

• Systole = pumping phase (ventricles contract, blood ejected).

S1 – First Heart Sound

• “lub”

• Produced by the closure of the atrioventricular (AV) valves — the mitral and tricuspid valves.

S2 – Second Heart Sound

• “dub"

• Produced by the closure of the semilunar (SL) valves — the aortic and pulmonic valves.

Assessing the cause for Jugular vein distention

Jugular vein distention reflects elevated right atrial pressure. The primary cause is right-sided heart failure, but it can also result from valvular disease, pericardial constriction, or venous obstruction. Recognizing JVD during assessment is key to identifying underlying cardiac dysfunction.

Use of Stethoscope for Carotid Bruits

• Use the bell of the stethoscope.

• Place it at the angle of the jaw, at the midcervical area, and at the base of the neck over the carotid artery.

• Ask the patient to take a breath, exhale, and hold briefly while you listen. This reduces tracheal breath sounds that may mimic a bruit

Carotid Bruits

a blowing, swishing sound heard over the carotid artery.

• Cause: It is produced by turbulent blood flow due to local vascular disease, such as atherosclerotic narrowing of the carotid artery.

• Clinical importance:

  • Presence of a bruit signals increased risk of transient ischemic attack (TIA) or ischemic stroke.

  • Absence of a bruit does not rule out carotid stenosis, especially if the artery is completely occluded (no flow = no sound)

Assessment technique and significance for orthostatic hypotension

• Technique: Measure BP/pulse supine, sitting, standing → look for ≥20 mm Hg systolic or ≥10 mm Hg diastolic drop with pulse rise ≥20 bpm.

• Significance: Suggests volume depletion or autonomic dysfunction and increases risk of dizziness, falls, and syncope.

procedure for assessing, auscultating and palpating carotid pulse and bruits

• Palpate: One side at a time, gentle pressure, assess amplitude/contour/symmetry.

• Auscultate: Use bell at jaw, midcervical, base; patient exhales and holds breath.

temperature in older adults

usually lower

• ~36.2 C

how long to measure radial pulse if irregular rhythm?

1 full minute

normal vitals for athletic people

• normal temperature

• BPM lower than 50

• breaths 12-16

• BP 100/70

If pt asks what blood pressure numbers mean

• Systolic is max pressure felt on artery during left ventricular contracture/systole

  • Top number

• diastolic is elastic recoil, resting pressure that blood constantly exerts between each contraction

  • Bottom number

• Should talk to pt in 5th grade level

race with highest blood pressure

black

what happens to BP reading if obese is measured with standard cuff

• false high reading

auscultatory gap

• occurs in 5% of population

• mostly in those with HTN caused by noncompliant artery system

older pt is having their blood pressure measured, how to proceed?

• check for auscultatory gap

  • make sure to measure 30mm Hg more when palpable pulse disappears

pulse pressure formula

systolic minus diastolic

• top - bottom

pt has fainting spells for a week, how will BP be measured

• with pt lying, sitting and standing

if nurse suspects volume depletion, HTN, antidepressants, Hx of pain

• take orthostatic vitals

Orthostatic hypotension

• Drop 20 systolic

• Drop 10 diastolic

At risk for orthostatic hypotension

• Prolonged bedrest

• Older

• Hypovolemic

• Certain meds

False high BP readings

• Supporting arm during arm

• narrow/loose cuff

• Legs crossed