NSG 6020 Midterm Questions and Answers (Verified Solutions)

NSG 6020 Midterm Questions and Answers (Verified Solutions) What age does bronchiolitis occur? most common at age 6 months- does not occur after age 2 main symptom of bronchiolitis wheezing-lasts about 7 days most common cause of bronchiolitis RSV Treatment for bronchiolitis No specific treatment Order of lung exam inspect, palpate, percuss, auscultate Pectus Excavatum congenital posterior displacement of lower aspect of sternum -hollowed-out appearance -concave appearance of lower sternum Pectus carinatum at birth -post CABG mid childhood and 11-14 year old pubertal males undergoing a growth spurt -convex deformity -97% have MVP Barrel Chest associated with emphysema and lung hyperinflation -accompanying x-ray demonstrates increased ant-post diameter as well as diaphragmatic flattening Tactile fremitus palpable vibrations of the bronchiopulmonary tree as the patient is speaking (99 or 1-2-3) -impeded in COPD, pulm effusion or pneumothorax -increased in consolidation and PNA percussion: flatness (thigh) Large Pleural effusion Percussion- dullness (liver) Lobar PNA Percussion: resonance (Lung) simple chronic bronchitis Percussion: hyperresonance None -emphysema, pneumothorax Percussion: tympany (gastric bubble) -large pneumothorax Auscultation: vesicular soft and low pitched; usually heard over most of both lungs Auscultation: bronchial louder and higher in pitch; usually heard over the manubrium Auscultation: bronchovesicular intermediate intensity and pitch; usually heard over the 1st and 2nd interspaces Auscultation: tracheal over the trachea and neck, very loud Rhonchi low-pitched snore-like sounds, often characterized by secretions w/in the large airways -sometimes cleared with a cough Wheezes continuous, high-pitched, musical, sounds that are produced by air flowing through narrowed bronchi -predominately expiratory stridor loud, rough, continuous, high-pitched sound that is pronounced during inspiration -indicates proximal airway obstruction absent/attenuated sounds NO airflow to the region being auscultated -can occur in a pneumothorax, hemothorax, pleural effusion, or parenchymal consolidation Crackles intermittent, nonmusical, very brief, more pronounced during inspiration -fine or course fine (softer, higher in pitch) course (louder, lower in pitch) Bronchophony ask pt to say "99" -should be muffled and indistinct -CLEAR sounds are called bronchophony Egophony ask pt to say "ee" -you should hear a muffled long ee sound -"ee" sounds like "ay" it is positive and called egophony -present over consolidation whispered pectoriloquy ask pt to say "99 or 1-2-3" -whispered voice is normally faint and indistinct -louder, clearer sounds are called whispered pectriloquy- heard over consolidation Pleural effusion -fremitus, percussion, whispered pectoriloquy, breath sounds frem= decreased perc=dull whis pect= decreased breath sounds= decreased Consolidation or PNA -frem, perc, whisp pect, breath sounds frem=increased prec= dull whispered pect= increased breath sounds=decreased emphysema -frem, perc, whisp pect, breath sounds frem=decreased perc=hyperresonant whisp pect= decreased breath sounds= crackles pneumothorax -frem, perc, whisp pect, breath sounds frem= decreased perc= hyper-resonant whisp pect= decreased breath sounds= decreased PNA: breath sounds, bronchophony, egophany, whisp pect breath sounds bronchial or bronchovesicular over involved area positive bronchophony: spoken words louder, clearer -pos egophony: Ee heard as ay -pos whisp pectroiloquy: whisp words louder and clearer -increased tactile fremitus CAP Cxray often lags behind clinical presentation Tobacco cessation- 5 A's -ASK about smoking at each visit -ADVISE patients regularly to stop smoking using a clear, personalized message -ASSESS patient readiness to quit -ASSIST patients to set stop dates and provide educational materials for self-help -ARRANGE for follow-up visits to monitor and support patient progress preload volume of blood returning to the heart contractility ability of ventricles to contract during systole afterload vascular resistance against contraction cardiac output SV x HR BP CO x SVR Ventricular systole ventricles contract -mitral and tricuspid valves close producing S1 -right ventricle pumps blood into PA (pulmonic valve is OPEN) -left vent pumps blood into aorta (aortic valve is OPEN) V systole=S1 V diastole = S2 Ventricular diastole ventricles relax -aortic and pulmonic valves close producing s2 -Tricuspid valve OPEN- blood flows from RA to RV -Mitral valve OPEN- blood flows from LA to LV Left coronary arteries -LEFT MAIN *LAD- left anterior descending -supplies walls of BOTH VENTRICLES AND SEPTUM *CIRCUMFLEX- -supplies walls of the LA and lateral wall of LV -also may supply SA and AV node (if not supplied by RCA) Right Coronary arteries RCA -branch to SA node -branch to AV node -branches to LV posterior descending artery -supplies RA, RV, SA node and some of AV node How is the metabolic syndrome diagnosed? *waist circ- female 35, male 40 *triglycerides- >150 *HDL male <40, female <50 *BP 130/85 *fasting glucose 100 2-3 confirms diagnosis: 3/5 definite metabolic syndrome palpation- finger pads palpates for heaves or lifts from abnormal ventricular movements palpation- ball of hand palpate for thrills- turbulence transmitted by a damaged heart valve PMI point of maximal impulse -palpate at apex for PMI -tapping- normal -sustained- suggests LV hypertrophy from HTN or aortic stenosis -diffuse- suggests a dilated ventricle from CHF or CMO` Cardiac palpation and auscultation sites aortic- 2nd ICS, right sternal border pulmonic- 2nd ICS, left sternal border tricuspid- lower left sternal border 4th ICS mitral- mid clavicular line and 5th ICS (apex) diaphragm of stethoscope listens to high pitched noises -heart sounds, murmurs, lung sounds, bowel sounds -some bruits -picks up S1 and S2, aortic and mitral regurg -press firmly for pericardial friction rubs Bell of stethoscope -hears low pitched noises -recommended for extra heart sounds (S3 and S4) -rumble of mitral stenosis -to identify some bruits S1 heart sounds BEGINNING OF SYSTOLE -occurs with closure of AV valves (tricuspid and mitral) S2 heart sounds END OF SYSTOLE/BEG OF DIASTOLE -occurs with closure of semi-lunar valves (aortic and pulmonic) split s2 ventricular pressure is higher in left than right -closure of aortic valve a2 occurring followed by closure of pulmonic valve p2 S3 heart sounds DIASTOLE -heard just after S2 -turbulent blood flow (may be normal in pregnancy and kids) S4 heart sounds END DIASTOLE -just before S1 -ventricles resistant to filling, r/t weak ventricles -ALWAYS PATHOLOGIC M S A R D M R P A S S M V P -DIASTOLIC MURMURS- indicate valvular heart disease -SYSTOLIC MURMURS- occur when heart is not diseased -MVP- most common valvular abnormality --affects approx 2-6% of USA population --many asymptomatic MS.ARD Mitral Stenosis Aortic Regurg DIASTOLIC MR.PASSMVP Mitral Regurg Pulmonic -and- Aortic stenosis SYSTOLIC M V P Heart murmur grade Grade 1- Barely audible Grade 2- quiet but audible grade 3- moderate grade 4- loud grade 5- loud with palpable thrill grade 6- very loud, heard with stethoscope almost off the chest wall and has a palpable and visible thrill Acute MI -inferior MI II, III, and aVF Lateral MI I, aVL, V5, V6 Septal MI V1, V2 Anterior MI V3, V4 MVP -presenting symptoms -anxiety, panic attacks, arrhythmias, exercise intolerance, palpitations, atypical chest pain, fatigue, orthostasis, syncope MVP -testing and assessment mid-systolic click and/or mid-to-late systolic murmur Assessing JVP reflects right atrial pressure -horizontal line from top of JVP to ruler, making right angle -measure distance above sternal angle in centimeters -3 to 4 CENTIMETER ELEVATION IS NORMAL Carotid pulse palpation -upstroke brisk-normal delayed-suggests aortic stenosis bounding- suggests aortic insufficiency PAD- peripheral arterial disease Intermittent claudication -pale or blue; ischemia to muscle Venous peripheral vascular disease swelling of feet and legs -ulcers on lower legs red/purple areas ABI ratio of BP in lower legs vs the arms -used to diagnose PAD -detects stenosis of >50% in major vessels of legs CEAP classification Clinical manifestation Etiologic factors Anatomic distribution of disease Pathophysiology underlying the condition Trendelenburg Test/Torniquet test to assess varicose veins and the competence of the saphenofemoral junction -same test, except finger pressure is used to occlude the SFJ instead of a tourniquet