Type of respirations that is like tachypnea but deeper?
kussmauls
Type of respirations that come with brainstem injury?
Biots
DKA can be seen with what type of respiration?
Kussmauls
Orthopnea
Difficulty breathing when supine
Paroxysmal nocturnal dyspnea
Awakening from sleep short of breath and needing to be upright to achieve comfort
normal costal angle?
90 degrees
What is sternal angle?
Junction between the manubrium and sternal body (manubriosternal joint). Also called “angle of Louis”.
What do you ask people with orthopnea?
How many pillows do you use?
What type of sound can be heard when percussing over an air filled cavity?
Tympany
What type of sound can be heard when percussing over lung fields (normal lung tissue)?
Resonance
What type of sound can be heard when percussing over the liver?
Dullness
What type of sound can be heard when percussing over muscle?
Flatness
What is the one way we will palpate the thorax?
Check for symmetry of respiratory excursion
What type of breath sounds do we hear over the lungs?
Vesicular
What type of breath sounds do we hear over the trachea?
Bronchial
Which is lower pitched, vesicular or bronchial breath sounds?
Vesicular
Inward movement of the area between the ribs; associated with increased respiratory effort
Subcostal retraction
Indrawing of the abdomen just below the sternum
Substernal retraction
Indrawing between the ribs
Intercostal retraction
When tissues are drawn in above the clavicle (shoulder girdle).
Suprasternal Retraction
In what type of respirations do the chest and belly alternate?
see-saw respirations
A posture that uses three points of support, typically used by patients with pulmonary problems as they lean forward, use their arms for support, and lift the chest to increase breathing capacity
tripod position
How should we auscultate the lungs? Compare _____ to _____.
Side to Side
What makes a sound discontinuous?
Very short. Not at all musical. Ex: bubble wrap or crack
What are the 2 discontinuous lung sounds?
Crackles
Pleural friction rub
What are the 3 continuous lung sounds?
Wheeze
Rhonchi
Stridor
Which type of lung sound has a more musical nature?
Continuous
What is head bobbing in a baby a sign of?
Respiratory Distress
What is grunting in a child a sign of?
Respiratory Distress
Crackles are usually heard only on:
inspiration
Newborns are Obligate nose breathers until __ months.
3
Breath sounds loud and harsh is normal for:
infants
Anterior transverse diameter = __:__ so it is _______ as wide as it is deep).
1:2, twice
What sounds are:
- Relatively high pitched (easy to hear)
- Expiratory phase is long (at least as long as inspiratory if not longer)
- Tiny gap between inspiration and expiration
Bronchial breath sound
Aair filled bubble =
vesicle
What sounds are:
- Lower in frequency
- No silent pause
- shorter expiratory phase
Vesicular breath sounds (lungs)
Our ears are designed to hear 1000-5000 hertz but lung sounds are less than ___ hertz this is why we have to listen directly to the skin.
500
How do we auscultate the heart sounds?
Aortic Pulmonic Erbs point (s1 and s2 same loudness) Tricuspid Mitral Then Gently listen with bell in reverse
What do we hear at: Right chest wall 2nd intercostal space
Aortic Valve
What do we hear at: Left sternal border intercostal space
pulmonic
What do we hear at: 3rd intercostal space left sternal border
Erbs
What do we hear at: t5h intercostal space right sternal border
Tricuspid
Where is the PMI?
5th intercostal space mid-clavicular line
What doe we hear at: 5th intercostal space mid-clavicular line
PMI
When is S1
Closure of AV valves
When is S2
Closer of semilunars
Which sound is systole?
S1
Which sound is diastole?
S2
Best place to hear S1
Apex
Where is S2 loudest?
Base of the heart
Where can you hear both heart sounds equally?
Erb’s Point
Turbulent blood flow causes:
Murmurs
What can make blood flow in the heart turbulent?
Stenosis of valves
Where can S3 be heard?
After S2
What extra heart sound comes after S2
S3
Where would you expect to hear S4?
Before S1
Murmurs can be _____ or _____?
Systolic of diastolic
Bruit
Sounds that you hear when you are not listening to the heart. Anywhere there is turbulent blood flow outside the heart.
Thrill
You can feel a thrill. Turbulent blood flow you can feel.
How can you tell if Friction Rub is cardiac or respiratory?
Ask patient to hold breath
Which part of the stethoscope would you use to hear a bruit?
Bell
If you are listening for a bruit what do you use?
Bell
You can hear a _____ and you can feel a _____
Bruit
Thrill
Pulse deficit
Ex: Even though you can hear a heart rate of 88 you can only feel a pulse of 75
Apical Impulse is easier to see in:
Children
Where would you see a heave in the Right ventricle?
At sternal border
Is the JVP palpable?
No
Should you palpate both carotid arteries at once?
no
How many fingers do you use to palpate the apical pulse?
1 finger pad
What do you ask the client to do when you are palpating the apical pulse?
Exhale and hold
What makes it hard to find an apical pulse?
Obesity and thick chest walls
What do we use to palpate the precordium?
Palmer aspect of fingers
What 3 paces on the precordium do we palpate?
Apex
Left sternal border
Base
Where to we auscultate the heart?
Aortic Pulmonary Erb's Tricuspid Mitral
When auscultating the heart start wit what part of the stethoscope?
Diaphragm
Tricuspid and Mitral valve closes during:
Systole
Pulmonary and aortic valves open during:
Systole
Pulmonary and aortic valves close during
Diastole
Tricuspid and mitral valves open during
Diastole