Lungs and Thorax
what is barrel chest ratio and which pts do you see it in
1:1
COPD - Emphysema
JVD is what and a sign of what
jugular vein distention - sign of FO and HTN
if pt is dehydrated expect JVD - flat neck veins
when a pt has left ventricular hypertrophy where would you expect to find apical impulse
6th ICS lateral to MCL
List subjective data when taking a nutritional assessment
24 hr diet recall
diet hx
health hx
most common area for breast cancer to develop
upper outer quadrant
What is crepitus and fremitus
when you palpate the lungs
crepitus; palpable or audible popping, crackling - air is pushed through the chest; subq emphysema and pneumothorax
fremitus; pt says 99 - vibrational in the bronchial tubes, assess for areas of symmetry, normal - decrease in vibrations as examiner moves down; abnormal - no vibration (fluid / mucus)
what are the 3 types of abd contour
Flat
Distended
Scaphoid
what is a pulse deficit and when is it important check for one
radial pulse falls below the apical rate - indicative of weak, ineffective contractions of left ventricles
HR and rhythm are irregular
Differences b/w acute and chronic pain
Acute; caused by injury or disease, rapid onset, subsides once injury is healed
Chronic; 6 mths or more, remissions and exacerbations
Explain testicular self exam and why its important
Should be done monthly; important for early dx and tx of testicular cancer, primary cause of cancer death in men 15-34; 90% cure rate if caught early
What are the 3 areas of auscultation
bronchial - tracheal; exp > inspir, loud and high pitch
vesicular - lateral portion of chest - inspir > expir, low and soft
bronchovesicular - 2nd and 3rd ICS equal insp and expir, intermediated tones and pitch
sequence for abd assessment
inspect
auscultate
percussion
palpation
Explain S1 and S2
normal heart sounds
S1 - closure of mitral and tricuspid valve; best heard at apical, 5th ICS MCL - systole and first heart sound
S2 - second heart sound, diastole, closure of the aortic and pulmonic valve, best heart at 2nd ICS left
what pain scale would you used for a child or adult with impaired cognition and communication
FACES - Wong Baker
what are the BMI ranges
< 18.5 underweight
> 24.5 overweight
> 30 Obese
describe the 3 sounds to listen for
bronchophony - pt says 99; normal - 99 muffled, abnormal - 99 clear
egophony - pt says "E"; normal - E muffled, abnormal - A
whispered pectoriloguy - pt says 123; normal - 123 muffled, abnormal - 123 clear
heart murmurs are normally heard in what
valvular disease - narrow and floppy valve, two most common are mitral and aortic
what are the abnormal heart sounds and how do you listen
S3 - early systole right after S2, ventricular gallop - pts HF and FO
S4 - late diastole, right before S1, atrial gallop - pts LVH, HTN
carbohydrates are important for which diet and list two types and how they differ
diabetic pts
simple - fast acting; raise blood sugar quickly, not stored
complex; slowly convert to energy, do not cause rapid rise is BG
abd is protuberant, peristalsis is visible
1st urine - odorless
1st stool - meconium
List and describe the 5 adventitious lung sounds
Ronchi - mostly expir. can clear w/ cough, snoring, pneumonia
wheeze - asthma, sonorous - low pitch (may clear), sibilant - high pitch, acute asthma, will not clear w/ cough
stridor - harsh honking, compromised airway, croup
pleural rub - creaking both inspir and expir. pnemonia and tb
explain Allens test and Homans sign
Allens - ulnar circulation
Homans - DVT, pt dorsiflexes the foot; if painful - DVT
Aortic - 2nd ICS RSB
Pulmonic - 2nd ICS LSB
Erbs Point - 3rd ICS LSB; pericardial friction rub
Tricuspid - 4th ICS LSB
Mitral - 5th ICS MCL; apical rate, point of maximum impulse
Nutrient that is essential for growth, repair and maintence, and affect they way wounds heal
proteins
name of the lymph node on the interior aspect of upper arm; and what does it mean if its palpable
Epitrochlear and infection in hand or lower arm