Lung sounds
A harsh high-pitched sound on inspiration in the larynx or trachea due to airway obstruction.
stridor
Silent period between S1 and S2
systole
What techniques do you use to assess a patient's breathing
z-track
Breathing that falls within the excepted respiratory range of 12-20 bpm
Eupnea
A thrombus that originated in the legs or pelvis that detached and traveled to the lungs to form in the pulmonary vessels
pulmonary embolism
Crackling and popping sounds while breathing
crackles
Higher pitched sound or "dub"
S2
This is the correct placement to hear the PMI.
between 5th and 6th intercostal space.
Breathing pattern of cycles that begin with rapid, shallow breaths, increase to deep breaths, ending with periods of apnea
cheyne stokes breathing
ulcers occur at the medial or lateral ankle
venous ulcer
High pitched whistling sound while breathing
wheezes
blowing or whooshing sounds created by turbulent blood flow through the heart.
murmur
Assess only 1 of these pulses at a time due to possible syncopal episodes.
carotid pulses
Leaning forward withthe arms braced against the knees, a chair, or a bed
tripod position
ulcers occur at the end of toes
arterial ulcers
Coarse, low-pitched, rumbling sound while breathing
rhonchi
Dull, low-pitched sound or "lub"
S1
This is the Acronym used to designate the correct heart valve assessment
a pattern of rapid, deep breathing at a rate of greater than 24 breaths per
minute. It is often related to a disease process or extreme exertion. This can lead to manifestations such as lightheadedness or dizziness, sighing, and numbness and tingling of the extremities.
hyperventilation
Obtain additional information such as location and or radiation of the pain, take vital signs, and call rapid response if needed.
chest pain
A low-pitched, coarse, grating tone like rubbing two pieces of leather together, is heard on inspiration and expiration. It is caused from inflammation of the pleura and is very painful.
pleural friction rub
Silent period between S2 and the next S1
diastole
When seen on inspection the nurse will press down on the extremity and record the depth of the indentation.
edema
a pattern of irregular, shallow respirations, often at a rate that is less than the expected reference range.
hypoventilation/bradypnea
obtain further information such as aggravating factors
and patients' ability to complete a full sentence. , measure O2, RR, and temp, and assess nail beds and mucous membranes
SOB