Guided Questions Module 3 6700 Module 3

1. Label the following items on the diagram:

  • Suprasternal notch: This is the U-shaped dip at the top of the sternum (manubrium).

  • Angle of Louis: Located where the manubrium meets the body of the sternum, typically at the level of the second rib.

  • Point of maximal impulse (PMI): Typically located at the 5th intercostal space at the midclavicular line, where the apex of the heart contacts the chest wall.

  • Stethoscope placements:

    • Aortic: Right 2nd intercostal space near the sternum.

    • Pulmonic: Left 2nd intercostal space near the sternum.

    • Tricuspid: Lower left sternal border at the 4th intercostal space.

    • Mitral: Left 5th intercostal space, midclavicular line (also where PMI is found).

2. Positioning of the lungs within the thorax:

  • The right lung has three lobes: upper, middle, and lower, while the left lung has two lobes: upper and lower (due to space occupied by the heart). The lungs extend from just above the clavicles down to the diaphragm. The apex of the lung is slightly higher than the clavicle, and the base of the lungs is located around the 6th rib anteriorly and the 10th rib posteriorly.

3. Functions:

  • Pleurae: The pleurae are thin membranes that line the lungs and the chest cavity, creating a fluid-filled space (pleural space) to reduce friction during respiration.

  • Trachea: The trachea (windpipe) conducts air from the larynx into the bronchi.

  • Bronchi: These are the two main airways that branch from the trachea into the lungs, dividing into smaller bronchioles, which deliver air to the alveoli.

  • Alveoli: The small air sacs where gas exchange occurs—oxygen enters the blood, and carbon dioxide is removed.

4. Pregnant women, tidal volume, and chest circumference:

  • During pregnancy, hormonal changes (increased progesterone) cause relaxation of the chest wall ligaments, allowing for an increase in chest circumference. The growing uterus also pushes the diaphragm upward, leading to increased tidal volume to meet the oxygen demands of both the mother and the fetus.

  • Physiologic dyspnea refers to shortness of breath experienced during pregnancy, which is common due to increased oxygen consumption and changes in lung capacity.

5. Risk factors for asthma:

  • Genetics, exposure to allergens or pollutants, smoking, obesity, respiratory infections in early childhood, and occupational hazards can all increase the risk of asthma.

6. Important subjective questions for SOB (Shortness of Breath):

  • When did the shortness of breath start?

  • What were you doing when it began?

  • Is it constant or intermittent?

  • What makes it better or worse?

  • Are there any associated symptoms (cough, chest pain)?

  • Do you have a history of asthma, COPD, or heart disease?

7. Definitions:

  • Fremitus: A vibration felt on a patient’s chest during speech or breathing, indicating changes in lung tissue.

  • Resonance: The normal sound heard during percussion of the lungs, indicating air-filled lung tissue.

  • Crepitus: A crackling or popping sound under the skin, indicating air in subcutaneous tissues.

  • Hyperresonance: An abnormally loud, low-pitched sound heard during percussion, usually due to excess air in the lungs (e.g., pneumothorax).

8. Sounds of the lungs:

  • Bronchial: Loud, high-pitched sounds heard over the trachea. The expiratory phase is longer than the inspiratory.

  • Bronchovesicular: Medium-pitched sounds heard over major bronchi. The inspiratory and expiratory phases are equal.

  • Vesicular: Soft, low-pitched sounds heard over most of the lung fields. The inspiratory phase is longer than the expiratory phase.

9. Strategies for respiratory assessment in infants and children:

  • Use distractions, such as toys or games, to reduce anxiety.

  • Observe the child's breathing pattern and respiratory rate before starting the physical exam.

  • Make sure the child is calm and resting, as crying or distress may alter the respiratory rate.

  • Use a stethoscope with a smaller diaphragm for better auscultation.

10. Auscultation findings:

  • Atelectasis: Decreased or absent breath sounds.

  • Lobar Pneumonia: Crackles and sometimes bronchial breath sounds over the area of consolidation.

  • Acute Bronchitis: Rhonchi and wheezing.

  • Pneumothorax: Absent breath sounds on the affected side.

  • Heart Failure: Crackles at lung bases due to fluid accumulation.

11. Neurologic and cardiovascular signs of respiratory distress/failure:

  • Neurologic signs: Confusion, agitation, restlessness, lethargy, and in severe cases, loss of consciousness.

  • Cardiovascular signs: Tachycardia, cyanosis, cool extremities, and in severe cases, hypotension or shock.

12. Difference between hypoxia and hypoxemia:

  • Hypoxia: A deficiency in oxygen reaching the tissues.

  • Hypoxemia: Low levels of oxygen in the blood.

13. Flow of blood through the heart:

(I'll describe this since I can't draw it here)

  • Right atrium → tricuspid valve → right ventricle → pulmonary valve → pulmonary arteries → lungs → pulmonary veins → left atrium → mitral valve → left ventricle → aortic valve → aorta → body.

14. Diastole and systole:

  • Diastole: The phase of the cardiac cycle when the heart muscle relaxes and the chambers fill with blood.

  • Systole: The phase when the heart contracts and pumps blood out of the chambers.

15. Review of the cardiac cycle (Page 462 in 9th edition):

I can't access this directly but can provide an overview of the cardiac cycle, which includes atrial and ventricular contraction (systole) and relaxation (diastole).

16. Heart sounds (S1, S2, S3, S4):

  • S1: The "lub" sound, caused by the closure of the mitral and tricuspid valves.

  • S2: The "dub" sound, caused by the closure of the aortic and pulmonic valves.

  • S3: May indicate heart failure, heard after S2.

  • S4: Indicates a stiff or hypertrophic ventricle, heard before S1.

17. ECG Waveforms:

  • P wave: Atrial depolarization.

  • PR Interval: The time between atrial depolarization and the start of ventricular depolarization.

  • QRS complex: Ventricular depolarization.

  • T wave: Ventricular repolarization.

18. Arteries assessed during a head-to-toe exam:

  • Carotid, radial, brachial, femoral, popliteal, posterior tibial, dorsalis pedis.

19. Expected amplitude of arteries:

  • Normal amplitude is rated as 2+, indicating a brisk, normal pulse.

20. Questions for a patient with chest pain:

  • When did the pain start?

  • What does the pain feel like (sharp, dull, pressure)?

  • Does it radiate to any other areas?

  • What makes it better or worse?

  • Do you have any other symptoms, like shortness of breath, nausea, or sweating?

21. Education for patients with cardiac risk factors:

  • Encourage lifestyle changes like smoking cessation, a healthy diet, regular exercise, weight management, and medication adherence for hypertension or diabetes.

22. Palpation of apical impulse:

  • The most effective way is to palpate at the 5th intercostal space, midclavicular line.

23. Nursing diagnoses related to oxygenation alterations:

  • Ineffective breathing pattern, impaired gas exchange, and activity intolerance.

24. Diagnostic tests for cardiopulmonary functioning:

  • Chest X-ray, ECG, spirometry, pulse oximetry, arterial blood gases, echocardiogram.