Health Assessment study guide exam 3 PDF

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Susan Hardner...

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Health Assessment Exam 3 Blue Print and Study Guide

Blueprint System Peripheral Vascular and Lymphatic Thorax and Lungs Abdomen Total

Number of Questions 17 20 13 50

Study Guide Peripheral Vascular and Lymphatic 

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Identify the arterial pulses, where located, and how to assess for them o Temporal artery: palpated in front of ear o Carotid artery: palpated in groove between sternomastoid muscle and trachea o Radial artery: o Brachiocephalic artery: o Dorsalis pedis artery: Lateral to the extensor tendon of the great toe  top of the foot o Aortic artery: o Femoral artery: just below the inguinal ligament halfway between pubis and anterior superior iliac spines o Popliteal: behind the knee o Posterior tibial: below the ankle bone = curve fingers around medial malleolus Understand how to grade the force of the pulse and what the results indicate. o Grade force = amplitude o Pulsus Paradoxus = a very large decrease in systolic blood pressure during inhalation o 3+: increased, full, bounding o 2+: normal o 1+ weak, “thready” pulse o 0: absent Describe the characteristics of the arterial system o High pressure system o Walls are strong, tough, and tense to withstand pressure demands o Elastic fibers allow walls to stretch with systole and recoil with diastole o Muscle fibers allow control of amount of blood delivered to tissues o Contracts and dilates to change diameter of arteries to control the rate of blood flow o Expand, then recoil o Pressure wave created by heartbeat  can feel where arteries lie close to skin or over a bone o Supplies oxygen and essential nutrients to tissues

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Venous blood flow o Drain deoxygenated blood and waste products to return it to the heart o Superficial veins (found in subcutaneous tissue) are responsible for most of the venous return in the arm o Veins have a larger diameter and are more distensible than arteries o Veins can expand and hold more blood when blood volume increases  reduces stress on the heart o Called capacitance vessels because of their ability to stretch o *** efficient venous return is dependent on the CONTRACTION OF SKELETAL MUSCLES, VALVES IN VEINS AND PATENT LUMEN o 1: contracting muscles return blood toward heart o 2: pressure gradient caused by breathing  inspiration decreases thoracic pressure, increases abdominal pressure o 3: Intraluminal valves ensure unidirectional flow to prevent backflow of blood o In the legs, this is called “calf pump” or “peripheral heart” because it pumps it back up to the body Know chronic and acute symptoms of arterial insufficiency o Acute:  May involve entire leg  Throbbing pain  Sudden onset  6 P’s  acute VENOUS symptoms o Chronic:  Deep muscle pain, usually in calf  Cramping, numbness, tingling  Chronic pain  Worse with activity (walking, stairs)  Cool, pale skin  Chronic venous symptoms o Claudication o Smooth shiny skin  no hair o Decreased pedal pulses o Cap refill time > 3 seconds o Coolness, pallor, dependent rubor, decreased pulses o Arterial ulcers o ISCHEMIA: deficient supply of oxygenated arterial blood to tissue caused by obstruction of blood vessel o Complete blockage leads to death of distal tissue o Partial blockage creates insufficient supply  ischemia may be apparent only at exercise when oxygen needs to be increased o 6 P’s of acute arterial occlusion  Pain  Paresthesia  Paralysis

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 Pallor  Pulselessness  Poikilothermy o PAD = strongest risk is smoking, blood flow does not match demand, claudication, diabetes Know chronic and acute symptoms of venous insufficiency o Acute:  Calf  Intense, sharp pain  Sudden onset  Pain may increase with sharp dorsiflexion of foot  Red, warm, swollen leg o Chronic:  Calf, lower leg  Aching, tiredness, feeling of fullness  Chronic pain, increases at the end of the day  Worse with prolonged standing, sitting Define claudication, lymphedema, deep vein thrombosis, Raynaud disease, varicose veins o Claudication:  Pain/cramping in the lower leg due to inadequate blood flow to the muscles o Lymphedema:  High protein swelling (due to breast cancer treatment, damage to lymph nodes/vessels)  Tired, thick, heavy arm sensations  Unilateral swelling, non-pitting edema  if suspected, measure circumference of ankle, distal calf, knee, and thigh o Raynaud’s Phenomenon:  Episodes of abrupt, progressive tricolor change in response to cold, vibration, or stress  extremities feel numb and cool from temperatures and/or stress. Common with color change. Blood flow cut off  low oxygen  oxygen returns o Varicose veins:  “Venous pooling”  Create incompetent valves, wherein the lumen is so wide that the valve cusps cannot approximate  Increases venous pressure, which dilates the vein  Genetics, obesity, multiple pregnancies o Deep vein thrombosis:  Deep vein occluded by thrombosis: inflammation, cyanosis, edema, blocked venous return  Sudden onset of intense, sharp, deep muscle pain, increased warmth, swelling, redness, tender to palpation  If suspected, measure calf circumference with non-stretchable tape measure

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Risk factors: pregnancy, 60+ years old, overweight, birth control pills, hormone therapy, central venous catheter in vein, any condition increasing blood clots, low blood flow to deep veins  Venous stasis suspected after (aching pain in calf or lower leg, worse at the end of the day, edema, thickened skin, normal pulses, brown pigment discoloration, dermatitis) Describe arterial ischemic and venous stasis ulcers o Arterial ischemic:  Buildup of fatty plaques on intima, hardening, calcification of arterial wall  Round or punched appearance  Dry necrotic base – no bleeding  Occurs at toes, metatarsal heads, heels, lateral ankle  Pale, ischemic base, well defined edges, no bleeding o Venous stasis ulcers:  Edema  Thickened skin  Normal pulses  Brown pigment discoloration  Petechiae Modified Allen test o Evaluates collateral circulation prior to cannulating radial artery o Depress radial and ulnar arteries  person makes fist several times  open hand  release ulnar artery  see hand flush… o adequate circulation indicated by color back in the hand in 2-5 seconds o simple and useful but subject to error Bruits o Should pulses be weak or diminished, auscultate site for a bruit o Capillary refill o Hold hand near heart level, an index of peripheral perfusion and cardiac output o Normal if color returns in less than 3 seconds

Review Tables 20-2, 20-3, 20-4, and 20-5 Thorax and Lungs 

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Normal anatomy of thorax and lungs o Thorax: sternum, 12 pairs of ribs, and 12 thoracic vertebrae o Lungs: thyroid cartilage, cricoid, trachea, bronchial tree, alveolar sac, parietal pleura Know the proper technique to use when auscultating lung sounds o Symmetry, audibility, patient position, mode of breathing, rate o Hypercapnia: increase of carbon dioxide in the blood o Hypoxemia: decrease of oxygen in the blood (less effective than hypercapnia in increasing respirations)

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Be able to identify normal breath sounds and where you can expect to find them. o Diaphragm held firmly on chest wall, listen to at least one full respiration in each location, side to side comparison is most important o Be careful of: examiner breathing on stethoscope tubing, stethoscope tubing bumping together, shivering, hairy chest, rustling of paper gown o Posterior placement: posterior from the apices at C7 to the bases around T10 and laterally from the axilla down to the 7th or 8th rib o Characteristics:  Bronchial (tracheal): high, loud  Bronchovesticular: moderate, moderate  Vesicular: low, soft  Automatic, effortless, regular, even, produces no noise Define resonance, hyperresonance, and dull as they relate to percussing the lungs and be familiar with lung diseases associated with these sounds o Resonance: low pitched, clear, hollow sound that predominates in healthy lung tissue in the adult – may be dull in an athlete or obese adult o Hyperresonance: lower-pitched, booming sound found when too much air is present  emphysema, pneumothorax o Dull: soft, muffled thud  abnormal density in the lungs such as pneumonia, pleural effusion, atelectasis, or tumor o ** asymmetry of dullness or marked Hyperresonance indicates underlying disease Adventitious sounds, what causes them, what they sound like, and the diseases associated with them o Added sounds that are not normally heard in the lungs o If present, they are heard as being superimposed on breath sounds o Caused by: moving air colliding with secretions in the tracheobronchial passageways or by the popping open of previously deflated airways o crackles (rales): fine and coarse crackling  pneumonia, heart failure and interstitial fibrosis, chronic bronchitis, asthma, emphysema o pleural friction rub: coarse and low pitched, like two pieces of leather rubbing together  pleuritis disease Color of sputum o Color? Odor? Amount? Consistency? o White/clear- normal o Yellow/green- bacterial o Rust- indicator of TB o Pink frothy- pulmonary edema o Hemoptysis- blood streaks Signs and symptoms can you expect for a person with COPD o Tripod position, pallor skin color, cyanosis (tissue hypoxia), barrel chest (from hyperinflation of the lungs), neck muscles hypertrophied (from aiding in forced respirations across obstructed airways) Understand pulmonary consolidation and how to assess for it o Positive whispered pectoriloquy (clearly heard the whisper, 1-2-3) o Increased breath sounds

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o Increase fremitus Identify the voice sounds, normal and abnormal findings o Normal voice: soft, muffled, and indistinct, hear sound but cannot distinguish what is being said o Testing for:  Bronchophony: abnormal transmission of sounds from the lungs  Normal: soft, muffled, indistinct  Abnormal: words are more distinct than normal and sound close to your ear  Egophony: increased resonance of voice sounds caused by lung consolidation and fibrosis  Normal: “eeeeeee”  Abnormal: “aaaaa”  Whispered pectoriloquy: increased loudness of whispering noted during auscultation  Normal: faint, muffled, almost inaudible  Abnormal: whispered voice is very clear, almost like hearing “onetwo-three” Define tactile fremitus, know normal and abnormal findings and assessment for it o Tactile fremitus: a palpable vibration o Palmar base of fingers on back and say “99” to generate strong vibrations o Normal: symmetric on both sides, strong vibrations o Abnormal: on one side, no vibration Describe the different respiratory patterns and conditions they are associated with o Normal: 10-20 breaths per minute, even, 500-800 mL depth, o Tachypnea: rapid, shallow breathing, increased rate >24, normal response to fever, fear, exercise, respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons o Hyperventilation: increase in rate and depth, extreme exertion, fear, or anxiety, diabetic ketoacidosis (kussmaul), hepatic coma, salicylate overdose, lesions in the midbrain, and alternation in blood gas concentration o Bradypnea: slow breathing, drug induced depression of respiratory center in the medulla, increased intracranial pressure, and diabetic coma o Hypoventilation: an irregular shallow pattern caused by an overdose of narcotics or anesthetics, may occur with prolonged bed rest or conscious splinting of the chest to avoid respiratory pain o Cheyne-Stokes: the wax and wane in a regular pattern, increasing in rate and depth and then decreasing, lasting 30 to 45 seconds, with periods of apnea alternating the cycle  severe heart failure, renal failure, meningitis, drug overdose, increase intracranial pressure. Normally in infants and aging persons during sleep o Biot: similar to Cheyne-stokes except that the pattern is irregular o Chronic obstructive breathing: normal inspiration and prolonged expiration to overcome increased airway resistance  exercise may lead to a dyspneic episode (air trapping) because the person does not have enough time for full expiration

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Identify the signs and symptoms of a pulmonary embolism, asthma, tuberculosis o Pulmonary embolism: deflated alveoli beyond embolus, chest pain, worse on deep inspiration, dyspnea, restless, anxiety, mental status changes, 5 cm is palpable, feels like pulsating mass in the upper abdomen just left of midline, will hear a bruit, femoral pulse decreased but present Hernias o Umbilical hernia: protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical ring, common in premature infants, resolve spontaneously by 1 year, adult with pregnancy, chronic ascites, or chronic intrathoracic pressure o Incisional hernia: bulge near an old operative scar visible when person increases intra-abdominal pressure by a sit-up, standing, or Valsalva maneuver o Epigastric hernia: protrusion of abdominal structures presents as a small, fatty nodule at the midline, through linea alba, feel > observe o Diastasis recti: separation of the abdominal rectus muscles, ridge is revealed when the pressure is increased by raising head while supine, result of pregnancy or marked obesity – not clinically significant Pain: o Visceral: from organ o Parietal: sharp, localized o Chronic ulcer pain: pain on empty stomach o Acute pain/referred: appendicitis, GB, bowel obstruction...