NURS 212 Exam 1

When performing a physical assessment, the first technique the nurse will always use is: A. Palpation. B. Inspection. C. Percussion. D. Auscultation. - Inspection Which of these techniques uses the sense of touch to assess texture, temperature, moisture, and swelling when the nurse is assessing a patient? A. Palpation B. Inspection C. Percussion D. Auscultation - Palpation When performing a physical examination, safety must be considered to protect the examiner and the patient against the spread of infection. Which of these statements describes the most appropriate action the nurse should take when performing a physical examination? A. Washing one's hands after removing gloves is not necessary, as long as the gloves are still intact. B. Hands are washed before and after every physical patient encounter. C. Hands are washed before the examination of each body system to prevent the spread of bacteria from one part of the body to another. D. Gloves are worn throughout the entire examination to demonstrate to the patient concern regarding the spread of infectious diseases. - B. Hands are washed before and after every physical patient encounter. Write down the color that best describes the following medical terms. A. Erythema___________ B. Cyanosis____________ C. Jaundice____________ D. Pallor______________ - A. redness B. blueness C. yellowness D. paleness Which part of the hand is used to check the temperature of skin? A. palm B. dorsum C. fingertips D. mid-finger - Dorsum When assessing the range of motion of the knee the nurse hears a grating sound. This is known as: A. partial range of motion B. crepitation C. subluxation D. ankyloses - Crepitation To supinate the palm, the patient should: A. touch the thumb to the base of the 5th finger B. turn the palm downward C. turn the palm upward D. flex all fingers - Turn the palm upward The nurse asks the client to perform eversion of the foot. The client should turn his/her foot: A. outward, so that the sole of the foot faces outward B. inward, so that the sole of the foot faces inward C. so that the toes are higher than the heel D. so that the heel is higher than the toes - Outward, so that the sole of the foot faces outward The assessment technique used to determine if underlying structures are air filled, fluid filled or solid is called: A. palpation B. percussion C. auscultation D. inspection - percussion An example of circumduction is: A. Throwing a ball B. Jumping rope C. Bending forward D. Climbing up stairs - Jumping rope Define alopecia - baldness; hair loss "a-" = without ; without hair Define annular - circular shape to a skin lesion (anulus in latin = little ring) Define Bulla/Vesicle - Bulla: elevated cavity containing free fluid larger than 1 cm in diameter Vesicle: only UP TO 1 cm diameter (EX: shingles, early chicken pox, herpes simplex, contact dermatitis) Define confluent - skin lesions that run together ("con-" = with ; "-flu-" to flow) skin lesions flowing together Define crust - thick, dried out exudate left on skin when vesicles/pustules burst or dry up Define erosion - -scooped-out, shallow depression in skin -wearing away, gradual destruction of a surface caused by inflammation, injury or other causes Define excoriation - Self-inflicted abrasion on skin due to scratching Define fissure (of the skin) - -linear crack in the skin extending to dermis Ex) super dry heels Define furuncle - infected hair follicle that inflames into a boil Define lichenification - -You scratch constantly and the *skin becomes thickened* and you see the wrinkle lines -tightly packed set of papules that tickens skin; caused by prolonged intense scratching What is Vitiligo? - hypopigmentation- melanin is missing Michael Jackson had this presence as white patches on skin What is cherry angioma? - -collection of small red blood vessels give it it's red appearance -red moles -no clinical significance What is a macule/patch? - a flat lesion that differs in color from surrounding skin (1 cm in diameter) (Ex: freckles, flat nevi, hypopigmentation) What is a papule/plaque? - -a palpable skin lesions smaller than 1 cm in diameter -thickened dermis; solid, palpable, elevated, circumscribed (Ex: wart/mole) What is a wheal/urticaria? - -Raised red skin lesion due to interstitial fluid -Superficial, raised, inflamed, edematous, irregular shape (EX: allergic reaction, bee/mosquito bite) What is a pustule? - -Elevated cavity containing thick, turbid fluid (pus) -superficial cyst, circumscribed and elevated (EX: acne, impetigo) What is skin turgor/mobility assessed for? - -Hydration status -Pinching of the skin should bounce back If skin tents up-lacking hydration or subcutaneous tissue(more common in elders) -decreased skin mobility=edema What are the three types of sweat glands and their differences - 1)Sebaceous: produce sebum secreted via hair follicles; lubricates; everywhere except palms/soles 2)Eccrine: coiled tubes, sweat 3)Apocrine: thick/milky secretion; mainly in axillae, anogenital, nipple, navel area; secretion occurs with emotional/sexual stimulation; function decreases with age How many sections is the hair separated in when inspecting - 4 sections How does hyper/hypothyroidism effects texture of skin? - Hyper: skin is softer/smooth like velvet Hypo: rough How does thyrotoxicosis effects moisture of skin? - Diaphoresis (sweating) What is a mongolian spot? - blue/gray macula larger than 1 cm diameter color change- hyperpigmentation common in infant skin What is a cafe au lait spot? - coffee color/ light brown pigmentation large round/oval spot common in infant skin what is erythema toxicum? - common rash tiny dots, red macules/papules common in 3-4 days of life what is cutis marmorata - transient blotches in trunk/extremities red/blue color skin appears marbled in babies what are Milia - tiny white papules on cheeks/forehead and across the nose/chin caused by sebum What are white linear markings that are normally visible through the nail and on the pink nail bed? - Leukonychia striata Leuk- white onych- nail striata- linear markings (straight) Describe lentigines - "liver spots" small, flat brown macules common in aging adult skin Describe seborrheic keratosis - Benign Hyperpigmented lesions in elderly "Stuck-on" appearance Common on face, shoulders, chest, and back dark/greasy looking common in aging adult skin Describe actinic keratosis - red/tan scaley plaques common in aging adult skin Describe acrochordons - -aka skin tags -overgrowths of normal skin ("acro-": top ; "-chord-": string) common in aging adult skin Describe sebaceous hyperplasia - Raised yellow papules with central depression ("hyper-":above/excess; "-plasia-" formation, development, a growth) Define pupura - red-purple skin lesion due to blood in tissues from breaks in blood vessels Differentiate among these purpuric lesions: petechiae, bruise, hematoma - 1) Petechiae: extravasated blood, macule color change 2) Bruise: hemorrhage into tissue, skin intact 3) Hematoma: bruise you can feel, elevates skin and seen as swelling How do measles (rubeola) appear on skin - red/purple blotchy skin first appears behind ears then spreads How do german measles appear on skin ? - pink/papular rash, first appears on face How do chicken pox appear on skin - small/tight vesicles/bulla (fluid filled) 4 stages of pressure ulcer development - 1) skin red, but unbroken 2)partial thickness skin erosion, loss of epidermis 3)full thickness ulcer into subq layer 4) involves all skin layers, exposes muscle/tendon/bone Define ulcer - deeper depression extending into dermis What should the angle between nail bed and cuticle be in a normal nail? - 160 degrees What do clubbing of nails indicate? - Pulmonary disease What does the schamroth sign indicate? - clubbing of the nails, 180 degrees What are the ABCDE of skin cancer? - Asymmetry Border Color Diameter Evolution Select the best description of the secretion of the eccrine glands. A) Thick, milky B) Dilute saline solution C) Protective lipid substance D) Keratin - B. dilute saline solution To assess for early jaundice, you will assess: A) Sclera and hard palate B) nail beds C) lips D) all visible skin surfaces - A. sclera and hard palate An area of thin, shiny skin w/decreased visibility of normal skin markings is called: A) lichenification B) plaque C) atrophy D) keloid - C. atrophy Flattening of the angle between the nail and its base is: A. found in subacute bacterial endocarditis. B. a description of spoon-shaped nails. C. related to calcium deficiency D. described as clubbing - D. described as clubbing A configuration of individual lesions arranged in circles or arcs, occurs with ringworm, is described as: A. linear lesion B. clustered lesion C. annular lesion D. gyrate lesion - C. annular lesion A risk factor for melanoma is: A. brown eyes B. darkly pigmented skin C. Skin that freckles or burns before tanning D. use of sunscreen products - C. skin that freckles or burns before tanning Herpes zoster infection (shingles) is characterized by: A. a bacterial cause B. lesion only on one side of the body; does not cross midline C. absence of pain or edema D. pustular, umbilicated lesions - B. lesion only on one side of the body; does not cross midline (This is because each nerve runs from one side of the spine in the back to the middle of the front of the body and does not cross this midline. This is important when considering the rash of shingles. The rash will occur in a dermatome and will not cross the midline of the body either in the front or the back) Where is the basal cell layer located - epidermis what layer of the skin aids in protection by cusioning - subq what layer of the skin contain collagen - dermis what layer of the skin is uniformly thin - epidermis in which layer of skin is the stratum corneum located - epidermis what layer of skin is elastic tissue found - dermis Lower half of body turns red, upper half blanches - Harlequin Transient mottling on trunk and extremeties - Cutis marmorata Bluish color around lips, hands fingernails, feet and toenails - Acrocyanosis ("acro-" : extremeties) Yellow-orange color in light-skinned persons from large amounts of foods containing carotene - Carotenemia What can excess amounts of bilirubin cause? - jaundice How are joints classified? - By the type of material between them (fibrous, cartilaginous, or synovial) and by their degree of movement (synathrotic/amphiarthrotic/diarthrotic) "-arth-" : joint What are fibrous synarthrotic joints? - Fibrous joints contain fibrous connective tissue and cannot move; fibrous joints include sutures, syndesmoses, and gomphoses (EX: bones connecting the skull- suture) "syn-": together "-arth-" : joint What are cartilaginous amphiarthrotic joints? - -slightly movable joints -a joint that has limited mobility. An example of this type of joint is the cartilaginous joint that unites the bodies of adjacent vertebrae. Filling the gap between the vertebrae is a thick pad of fibrocartilage called an intervertebral disc (EX: pubic symphysis, spine) "amphi-" : on both sides "-arth-": joint joints on both sides of cartilage in this sense: so discs of cartilage on both sides of individual vertebrae Why are cartilaginous amphiarthrotic joints important for athletes? - these joints are designed for strength and limited flexibility What are synovial diarthrotic joints? - A synovial joint, also known as a diarthrosis, is the most common and most movable type of joint in a mammal's body. Diarthroses are freely movable articulations. In these joints, the contiguous bony surfaces are covered with articular cartilage and connected by ligaments lined by synovial membrane. what medical condition may occur from break down of cartilage in synovial diarthrotic joints? - osteoarthritis; bone-to-bone What is the difference between synovial and nonsynovial joints? - -Synovial: freely moveable because have bones that are separated from one another -Nonsynovial: bones united by a fibrous tissue/cartilage 4 signs of acute inflammation - 1. Redness 2. Heat 3. Swelling 4. Pain What is dislocation of a joint - -somewhere it's not supposed to be -complete loss of contact between 2 bones and a joint What is subluxation of a joint - 2 bones of a join stay in contact, but their alignment is off What is contracture of a joint - shortening of a muscle leading to limited ROM of a joint What is ankylosis of a joint - stiffness or fixation of a joint due to fusion of the bones "ankyl-" : crooked, stiff, bent What is the difference between active and passive ROM - -Active: pt. performs ROM without assistance -Passive: pt's muscle relaxed while nurse moves body part How does one measure leg length? - measure between "fixed" points What does the Ortolani maneuver test for? - hip dysplasia in growing infants, dislocation "dys-" difficult, labored, painful, abnormal "-plasia-" formation, development, a growth What is swan neck deformity? - hyperextension of PIP (proximal interphalangeal joint ... the wrinkly part of the knuckle) and flexion of DIP (distal interphalangeal joint... joint closest to finger nail) What is boutonniere deformity? - flexion of PIP (proximal interphalangeal joint... wrinkly part of the knuckle) and hyperextension of DIP (distal interphalangeal joint... knuckle closest to fingernail) -knuckles looks like it is being pushed through a button hole What are bouchard's nodes in osteoarthritis? - bony overgrowths ( osteophytes) proximal interphalangeal joints (the wrinkly part of the knuckles) -less common What are Heberden's nodes in osteoarthritis? - Bony overgrowths (osteophytes) of distal interpharangeal joints (knuckle closest to fingernail) What are osteophytes? - a bony outgrowth associated with the degeneration of cartilage at joints. During the assessment of the spine, the patient would be asked to: A. adduct and extend B. supinate, evert and retract C. extend, adduct, invert and rotate D. flex, extend, abduct and rotate - D. flex, extend abduct and rotate pronation and supination of the hand and forearm are the result of the articulation of the: A. scapula and clavicle B. radius and ulna C. patella and condyle of fibula D. femer and acetabulum - B. radius and ulna Anterior and posterior stability are provided to the knee joint by the: A. medial and lateral menisci B.patellar tendon and ligament C.medial collateral ligament and quad muscles D. anterior and posterior cruciate ligaments - D. anterior and posterior cruciate ligaments (cruciate ligament= either of a pair of ligaments in the knee that cross each other and connect the femur to the tibia.) What is ataxia - inability to perform coordinated movements "a-" without/absence of "-tax-" coordination What is a bursa - -fluid filled sac -enclosed sac filled with viscous fluid located in joint areas of potential friction What is crepitation? - dry crackling sound or sensation due to grating of the ends of damaged bone What is a ganglion? - - round, cystic, nontender nodule overlying a tendon sheath or join capsule, usually on dorsum of wrist -a structure containing a number of nerve cell bodies, typically linked by synapses, and often forming a swelling on a nerve fiber. What is hallux valgus? - lateral/outward deviation of the great toe Define kyphosis - -outward or convex curvature of the thoracic spine -age related -hunchback "kyph-" : hump Define lordosis - inward or concave curvature of lumbar spine "lord-": curve l...lord...l...lumbar curve of lumbar Define sciatica - -inflammation of the sciatic nerve -nerve pain along the course of sciatic nerve that travels down from the back or thigh through the leg and into the foot What is scoliosis? - S-shaped curvature of the throracic spine "scoli-" crooked, curved What is torticollis? - wryneck; contraction of the cervical neck muscles, producing torsion/twisting of the neck A 70-year-old woman has come for a health examination. Which of the following age-related change in the curvature of the spinal column? A. lordosis B. Scoliosis C. Kyphosis D. lateral scoliosis - C. kyphosis Examination of the shoulder includes 4 motions. These are: A. forward flexion, internal rotation, abduction and external rotation B. abduction, adduction, pronation, supination C. circumduction, inversion, eversion and rotation D. elevation, retraction, protraction, and circumduction - A. forward flexion, internal rotation, abduction and external rotation The bulge sign is a test for: a) swelling in the suprapatellar pouch b) carpal tunnel syndrome c) Heberden's nodes d) olecranon bursa inflammation - A. swelling in the suprapatellar pouch bulge sign: an assessment maneuver used to identify a joint effusion, esp. at the knee. A 2-year-old child comes to the clinic for a health examination. A common finding for this age group is: A. kyphosis B. lordosis C. scoliosis D.No deviation is normal - B. lordosis A positive Phalen test and Tinel sign are found in a patient with: A. torn meniscus B. Hallux valgus C. carpal tunnel syndrome D. Tennis elbow - C. carpal tunnel syndrome -Phalen's Test is also known as Wrist Flexion Test and is an orthopedic special test used to help diagnose injury to the median nerve in the wrist especially as it relates to the carpal tunnel. -Tinel's sign: The sign that a nerve is irritated. Tinel's sign is positive when lightly banging (percussing) over the nerve elicits a sensation of tingling, or 'pins and needles,' in the distribution of the nerve. When assessing an infant, the examiner completes the Ortolani maneuver by: A. lifting the newborn and noting a C-shaped curvature of the spine B. gently lifting and abducting the infant's flexed knees while palpating the greater trochanter with the fingers C. comparing the height of the tops of the knees when the knees are flexed up D. palpating the length of the clavicles - B. gently lifting and abducting the infant's flexed knees while palpating the greater trochanter with the fingers Hematopoiesis takes place in which of the following? A. liver B. spleen C.kidneys D. bone marrow - D. bone marrow "Hemat-" : blood "-poiesis" : formation BLOOD FORMATION Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called: A. bursa B. tendons C. cartilage D. ligaments - D. ligaments Define tendon - Connects muscle to bone Define ligament - -Connects bone to bone -fibrous band running directly from one bone to another bone that strengthens the joint What is firm muscle tone? - due to partial contraction of muscle even at rest What is common in infants? (musculoskeletal wise) - -screen for congenital hip dysplasia -bowlegged (genu varum) and Knock knees (genum valgum) is normal and resolves with maturity -Scoliosis ( lateral curvature of spine) screened for in middle schools What is common in older adults? (musculoskeletal wise) - -decreased height -evident kyphosis (hunch back) -degenerative changes in joints How is muscle strength evaluated/graded? - -0-5 scale 0= no contraction 1= slight contraction 2= full ROM with gravity eliminated 3= full ROM against gravity, no resistance 4= full ROM against gravity, some resistance 5= full ROM against gravity, full resistance Who is at risk for osteoporosis and how could one decrease the risk? - - postmenopausal women -promote exercise, calcium and vitamin D intake, stop smoking and reduce alcohol consumption Techniques of communication: 1)facilitation 2)reflection 3)empathy 4)clarification 5)confrontation - 1) examiner's response that encourages the patient to say more, continue with story (EX: nodding of head, mhm, go on, i'm listening) 2) examiner's response that echoes the patient's words 3) responding to pt. in a way that shows understanding/acceptance 4) use when pt. statement is unclear 5) use when pt. story is inconsistent You conduct an admission interview. Because you are expecting a phone call, you stand near the door. Which would be a more appropriate approach? A) arrange to have someone page you so you can sit on the side of the bed B) have someone else answer the phone so you can sit facing the patient C) use this approach given the circumstances D) arrange for a time free of interruptions after the initial physical examination is complete - B) have someone else answer the phone so you can sit facing the patient Which statement best describes interpretation as a communication technique? A) interpretation is the same as clarification B) interpretation is a summary of a statement made by the patient C) interpretation is used to focus on a particular aspect of what the patient has just said D) interpretation is based on the interviewer's inference from the data that have been presented - D) interpretation is based on the interviewer's inference from the data that have been presented Which demonstrates a good understanding of the interview process? A) nurse stops the pt each time something is said that is not understood B) the nurse spends more time listening to pt than talking C) the nurse is consistently thinking of his/her next response so the pt will know he or she is understood D) the nurse uses "why" questions to seek clarification of unusual symptoms or behavior - B) the nurse spends more time listening to pt than talking For what or with whom should be used during the interview? a. Only with individuals from a Western culture b. As a routine way of establishing contact with the person and communication empathy c. Only with patients of the same gender d. Only if the interviewer knows the person well. - D) Only if the interviewer knows the person well. Children usually come for health care with a parent. At about what age should the interviewer begin to question the child himself or herself regarding presenting symptoms? A) 5 years B) 7 years C) 9 years D) 11 years - B) 7 years Because of adolescents' developmental level, not all interviewing techniques can be used with them. Which techniques should be avoided? A) facilitation and confrontation B) confrontation and explanation C) empathy and interpretations D) silence and reflection - D) silence and reflection Mr. B tells you, "Everyone here ignores me." You respond, "Ignores you?" This technique is best described as: A) clarification B) selective listening C) reflecting D) Validation - C) reflecting How does one do an analysis of symptoms? - -OLD CARTS (onset, location, duration, character, aggravating factors, relieving factors, timing, severity) -PQRSTU (proactive or palliative, quality or quantity, region or radiation, severity scale, timing, understand pt. perception of problem) What are the review of systems? - the presence or absence of symptoms with each body system what is G/FPAL - in pregnancy -G: gravity (number of pregnancies) -F: full term (37 weeks) -P: preterm (20-36.6 weeks) -A: abortions (includes miscarriage) -L: currently living children The statement "reason for seeking care" has replaced the "chief complaint" this change is significant because: A) The CC is really a diagnostic statement B) The newer term allows another individual to supply the necessary information C) the newer term incorporates wellness needs D) the "reason for seeking care" can incorporate the history of the present illness - C) the newer term incorporates wellness needs What is the best description of "review of system" as a part of the health history? A) the evaluation of past/present health state of each body system B) documentation of the problem as described by the patient C) the recording of the objective findings of the practitioner D) statement that describes the overall health state of the patient - A) the evaluation of past/present health state of each body system Functional assessment measures how a person manages day-to-day activities. The impact of adoption on the daily activities of a child is referred to as: A) developmental history B) instrumental activities of daily living C) reason for seeking care D) interpersonal relationship assessment - D) interpersonal relationship assessment While assessing a man for allergies, he states he is allergic to penicillin. Which response is best? A) are you allergic to any other drugs B) how often have you received penicillin C) ill write your allergy on your chart so you don't receive any D) please describe what happens to you when you take penicillin - D) please describe what happens to you when you take penicillin Define mental disorder - -an illness that affects the mind and reduces a person's ability to function, to adjust to change, or to get along with others -apparent when a person's response is much greater than the expected reaction to a traumatic life event What is the difference between organic brain disorder and psychiatric mental disorder? - -Organic brain disorder: caused by a brain disorder of a known specific cause (dementia, alcohol intox) -Psychiatric mental disorder: organic etiology has not yet been established (anxiety) Which mental function is the Four Unrelated Words Test intended to test? - -new learning -say 4 words and later ask to recall Levels of consciousness: -obtunded -stupor/semicoma -coma -delirium - -Obtunded: sleeps most of the time; needs loud shouts or shake -Stupor/semicoma: spontaneously unconscious -Coma: completely unconscious -Delirium: clouding of consciousness; inattentive; incoherent convo. Although a full mental status examination may not be required for every patient, the health care provider must address the four main components during a health history and physical examination. The four components are: A) memory, attention, thought content, and perceptions. B) language, orientation, attention, and abstract reasoning. C) appearance, behavior, cognition, and thought processes. D) mood, affect, consciousness, and orientation. - C) appearance, behavior, cognition, and thought processes. ABCT of mental health You are assessing short-term cognitive function. Which assessment shows the ability to lay down new memories? A) noting whether the patient completes a though without wandering B) test of general knowledge C) description of past medical history D) Use of the Four Unrelated Words Test - D) Use of the Four Unrelated Words Test What is aphasia? - loss of ability to understand or express speech, caused by brain damage "a-": without/ absence of "-phas-": speech What is abstract reasoning? - pondering a deeper meaning beyond the concrete and literal What is delirium? - -Acute confusional change or loss of consciousness and perceptual disturbance -may accompany acute illness -usually resolves when the underlying cause is treated What is dementia? - Gradual progressive process, causing decreased cognitive function -not reversible What is thought content? - WHAT the person thinks- specific ideas, beliefs, the use of words What is thought process? - the WAY a person thinks, the logical train of thought Routine universal screening for intimate partner violence includes: A) asking all women each time they come to the health care system if they are abused B) asking women who have injuries if they are abused C) asking women who have symptoms of depression and PTSD if they are abused D) asking women ages 18-30 if they are abused - A) asking all women each time they come to the health care system if they are abused Patients are at high risk for which mental health problem associated with intimate partner violence? A) hallucinations B) suicidality C) schizophrenia D) ADHD - B) suicidality Which gynecologic problem is not usually associated with intimate partner violence? A) pelvic pain B) ovarian cysts C) STIs D) vaginal tearing - B) ovarian cysts Risk factors for intimate partner homicide include: A) abuse during pregnancy B) victim substance abuse C) victim unemployment D) history of victim childhood sexual assault - A) abuse during pregnancy Bruising on a nonwalking or noncruising child: a. Is a common finding from normal infant activity b. Needs to be further evaluated for either an abusive or medical explanation c. Is commonly seen on the buttocks d. Cannot be reported until after a full medical evaluation - b. Needs to be further evaluated for either an abusive or medical explanation Which is a forensic term that is related to "purpura" but is not related to blunt force trauma? A) wound B) incision C) ecchymosis D) bruise - C) ecchymosis Which should be routinely included in evaluating a case of elder abuse? A) corroborative interview from caregiver B) baseline laboratory tests C) testing for STIs D) TB testing - B) baseline laboratory tests During an interview, a woman has answered "yes" to 3 of the Abuse Assessment Screen questions. How should you proceed? A) ask the patient if she has filed a restraining order B) proceed by asking more questions about the items she answered "yes" C) respond by confirming that the patient was abused D) interviews the woman's partner and compares notes - B) proceed by asking more questions about the items she answered "yes" Which clinical situation would require the examiner to report to the proper authorities? A) statements from the victim B) statements from witnesses C) proof of abuse and/or neglect D) suspicion of elder abuse and/or neglect - D) suspicion of elder abuse and/or neglect Which would you include on the chart of the patient who has been the victim of abuse? A) Photographic documentation of injuries B) A summary of the abused patient's statements C) verbatim documentation of every statement made D) a general description of injuries in the progress notes - A) Photographic documentation of injuries How many lobes does the left and right lung have? - Right: 3 Left: 2 What are the 4 major functions of respiration - -suppling oxygen to the body -removing carbon dioxide -maintaining homeostasis- acid/base balance -maintaining heat exchange What is the normal stimulus to breathe? - an increase of carbon dioxide in the blood (hypercapnia) What rate of breathing causes CO2 retention? - hypoventilation What is the humoral regulation of breathing? - brainstem; medulla/pons When does surfactant really begin to be produced by the fetal lungs? - 32 weeks gestation What is lung surfactant? - -monolayer of phospholipid molecules at air-liquid interface in the alveoli -Its main function is to reduce the surface tension at the air/liquid interface in the lung True or False: Respiratory development continues throughout childhood - True In infants and children, how many URI (upper respiratory tract infection) are expected per year? - 6 True or false: Respiratory system does not function until birth - True During pregnancy, what happens to the diaphragm? - Elevates due to increasing uterine size True or false: tidal volume decreases during pregnancy - False: tidal volume increases during pregnancy True or false: frequent dyspnea is common in pregnancy - True In an aging adult, what happens to the costal cartilages of the ribs? A) calcification B) Nothing C)Degrades D) Consolidation - A) calcification: can't expand lungs as well In an aging adult, what happens to the rhythm of breathing when respiratory muscle strength decreases? - Breathing becomes more shallow In an aging adult, the decreased elasticity would cause what to happen? - Lungs aren't able to expand and recoil properly True or false: aging adult lungs are more flaccid and easier to inflate - False: aging adult lungs are more rigid and harder to inflate Describe the pleura and its function - - Thin, slippery pleura form an envelope between the lungs and chest wall - Outside layer of lungs= visceral; inside layer of chest wall and diaphragm=parietal - Function: form cushion for lungs - Pleural cavity has negative pressure or vacuum which holds the lungs tightly against chest wall - Helps lungs slide smoothly What are the structures that compose respiratory dead space - -it is space that is filled with air but it is not available for gas exchange -Trachea and bronchi -In equilibrium with the environment and lung parenchyma (portion of lung involved in gas exchange-alveoli) What is barrel chest and what is its significance? - -Ribs are horizontal instead of the normal downward shape -Associated with normal aging, also with chronic emphysema and asthma as a result of hyperinflation of lungs What is pectus excavatum? - -sunken sternum and adjacent cartilages -depression begins at 2nd intercostal space "pector-" : chest exCAVatum= cave chest turns to cave What are the 3 types of normal breath sounds? - 1. Bronchial: high pitched, loud amplitude, loud over trachea; duration of inhalation shorter than expiration 2. Bronchovesicular: moderate pitch, moderate amplitude; heard on either side of the spine; duration of inhalation and expiration is equal 3. Vesicular: low pitch, soft amplitude; heard over intercostal spaces; duration of inhalation is longer than expiration What is a pleural rub? - -quack -sounds like 2 pieces of rubber -superficial, coarse and low pitched -common in inflammation of pleura What is a stridor? - -a harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx. -high pitched, inspiratory -louder in neck -asthma What are crackles (rales)? - -Fine, moist crackling sounds associated with fluids in the lower airways -caused by secretions -discontinuous, high pitched, short crackling or popping sounds -categorized as COURSE or FINE -caused by numerous of illnesses: pulmonary edema, obstructive disease, asthma, heart failure) What are wheezes? - -result from narrowed airways -musical, squeaking sounds -predominant in expiration -can be high or low pitched -low pitches (rhonchi) may clear with coughing -common in asthma/emphysema What is another name for the manubriosternal angle and why is it a useful landmark? - -Angle of Louis -marks the site of tracheal bifurcation (separation of left and right bronchi) -palpable and useful to start counting ribs "bi-": two "-furc-": fork How many degrees is the normal costal angle? - 90 or less True or false: Anteroposterior diameter is less than the transverse diameter - True What is resonance and when is it assessed in lungs? - -low pitched clear hollow sound -heard when percussing over normal lung tissue What is diaphragmatic excursion and what are normal findings of resonance? - -the level the diaphragm separating the lungs from abdominal viscera -he movement of the thoracic diaphragm during breathing -normal diaphragmatic excursion should be 3-5 cm -resonance: dull as you go down, equally bilateral The manubriosternal angle is: A) the articulation of the manubrium and the body of the sternum B) a hollow U-shaped depression just above the sternum C) also known as the breastbone D) a term synonymous with costochondral junction - A) the articulation of the manubrium and the body of the sternum What is asthma? - respiratory condition associated with allergic hypersensitivity to certain inhaled allergens -categorized by inflammation, bronchospasm, wheezing and dyspnea What is atelectasis? - collapsed, shrunken, deflated section of alveoli "atel-": imperfect, incomplete "-ectop-" :located away from usual place What is bronchitis? - inflammation of the bronchi with partial obstruction of bronchi due to excessive mucus secretion What is bronchophony - -when you hear the patient say "99" more clearly or louder than normal -the spoken voice heard thru auscultation -normal should be muffled and indistinct over normal lung tissue What is consolidation of lungs? - the solidification of portions of lung tissues as it fulls up with infectious exudate, as in pneumonia what is crepitus? - course, crackling sensation palpable over the skin when air abnormally escapes from the lungs and enters the subq tissue What is fremitus? - a palpable vibration from the spoken voice felt over the chest wall What is hypercapnia? - increased levels of carbon dioxide in blood aka hypercarbia What is hypoxemia? - low oxygen in the blood What are Kussmaul respirations? - -an effort to rid the body of increased CO2 levels -type of hyperventilation -deep/labored breathing pattern -occurs with diabetic ketoacidosis What is pleural effusion? - fluid in the pleural space Select the correct description of the left lung: A) narrower than the right lung with three lobes B) narrower than the right lung with two lobes C) wider than the right lung with two lobes D) shorter than the right lung with three lobes - B) narrower than the right lung with two lobes You assess a patient who reports a cough. The characteristic timing of the cough of chronic bronchitis is described as: A) continuous throughout the day B) productive cough for at least 3 months of the year for 2 consecutive years C) occurring in the afternoon or evening bc of exposure to irritants at work D) occurring in the early morning - B) productive cough for at least 3 months of the year for 2 consecutive years Which of the following assessments best confirms symmetric chest expansion? A) placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch a small fold of skin between the thumbs B) inspection of the shape and configuration of the chest wall C) placing the palmar surface of the fingers of one hand against the chest and have the person repeat the word 99 D) percussion of the posterior chest - A) placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch a small fold of skin between the thumbs Absence of diaphragmatic excursion occurs with: a. asthma b. an unusually thick chest wall c. pleural effusion or atelectasis of the lower lobes. d. age-related changes in the chest wall - c. pleural effusion or atelectasis of the lower lobes. You are auscultating breath sounds on a patient. Which of the following best describes how to proceed? A) hold the bell of the stethoscope against the chest wall; listen to the entire right side and then the entire left side B) hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side to side comparisons C) listen from the apices to the bases of each lung field using the bell of the stethoscope D) select the bell or diaphragm depending on the quality of sounds heard; listen from one respiration in each location, moving from side to side - B) hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side to side comparisons Select the best description of bronchovesicular breath sounds: A) high pitched, of longer duration on inspiration than expiration B) moderate pitches, inspiration equal to expiration C) low pitched, inspiration greater than expiration D) rustling sound, like the wind in the trees - B) moderate pitches, inspiration equal to expiration