Podcast
Questions and Answers
What term describes deep, rumbling, continuing breath sounds that are more pronounced on expiration?
What term describes deep, rumbling, continuing breath sounds that are more pronounced on expiration?
- Coarse crackles
- Expiratory wheezing
- Vesicular sounds
- Rhonchi (correct)
What condition does hyperresonant percussion notes indicate in the context provided?
What condition does hyperresonant percussion notes indicate in the context provided?
- Air trapping (correct)
- Pleural effusion
- Pulmonary edema
- Consolidation
What is the term for the decrease in pulse strength during inspiration observed in acute asthma exacerbation?
What is the term for the decrease in pulse strength during inspiration observed in acute asthma exacerbation?
- Tachycardia
- Orthostatic hypotension
- Pulsus paradoxus (correct)
- Bradycardia
What is required from the patient to ensure understanding of their care options?
What is required from the patient to ensure understanding of their care options?
What does pursed lip breathing often indicate?
What does pursed lip breathing often indicate?
What is the normal range for Peak Expiratory Flow Rate (PEFR) in a healthy adult?
What is the normal range for Peak Expiratory Flow Rate (PEFR) in a healthy adult?
What is a common characteristic of cough associated with a respiratory infection?
What is a common characteristic of cough associated with a respiratory infection?
Learning occurs in which of the following domains?
Learning occurs in which of the following domains?
What heart sound is produced by the closure of the mitral and tricuspid valves?
What heart sound is produced by the closure of the mitral and tricuspid valves?
Which factors may cause an increase in intensity of S1?
Which factors may cause an increase in intensity of S1?
Which of the following may cause an increase in intensity of S2?
Which of the following may cause an increase in intensity of S2?
In which area on the precordium can the aortic valve best be auscultated?
In which area on the precordium can the aortic valve best be auscultated?
Where is the Point of Maximal Impulse (PMI) typically located?
Where is the Point of Maximal Impulse (PMI) typically located?
What is the second heart sound also known as?
What is the second heart sound also known as?
Which condition is NOT commonly associated with an increase in the drive to breathe?
Which condition is NOT commonly associated with an increase in the drive to breathe?
Which of the following is of right ventricular origin?
Which of the following is of right ventricular origin?
What heart sound occurs late in diastole just before S1?
What heart sound occurs late in diastole just before S1?
What term describes the chest pain associated with blockage of the coronary arteries?
What term describes the chest pain associated with blockage of the coronary arteries?
Which heart sounds may show decreased intensity due to cardiac reasons?
Which heart sounds may show decreased intensity due to cardiac reasons?
What causes the S1 sound during cardiac auscultation?
What causes the S1 sound during cardiac auscultation?
Where is the apical pulse palpated most strongly?
Where is the apical pulse palpated most strongly?
What is the most common cause of pedal edema?
What is the most common cause of pedal edema?
What causes an increase in intensity of S1?
What causes an increase in intensity of S1?
How is auscultation to determine the rate and rhythm of the heart performed?
How is auscultation to determine the rate and rhythm of the heart performed?
What learning domain is demonstrated when a patient adjusts the flow meter on an oxygen concentrator?
What learning domain is demonstrated when a patient adjusts the flow meter on an oxygen concentrator?
Which approach is most effective in encouraging patients to take responsibility for their health?
Which approach is most effective in encouraging patients to take responsibility for their health?
Which learning domain has been addressed if a patient understands that oxygen therapy is for those with breathing difficulties?
Which learning domain has been addressed if a patient understands that oxygen therapy is for those with breathing difficulties?
What symptoms indicate Mr. Carney may be experiencing respiratory distress?
What symptoms indicate Mr. Carney may be experiencing respiratory distress?
If a patient's total respiratory time remains the same but expiratory time is increased, what happens to inspiratory time?
If a patient's total respiratory time remains the same but expiratory time is increased, what happens to inspiratory time?
Which of the following would be associated with left ventricular origin diseases?
Which of the following would be associated with left ventricular origin diseases?
What auscultation finding might indicate a problem in the lungs?
What auscultation finding might indicate a problem in the lungs?
What does a respiratory rate of 25 breaths per minute indicate?
What does a respiratory rate of 25 breaths per minute indicate?
Flashcards
Breath sounds: deep, rumbling, continuing sounds, more pronounced on expiration
Breath sounds: deep, rumbling, continuing sounds, more pronounced on expiration
These are described as coarse crackles, indicating fluid or mucus in the airways.
Hyperresonant percussion notes (left side)
Hyperresonant percussion notes (left side)
A sign of trapped air, like in the case of a spontaneous pneumothorax. It indicates air-filled pockets in the lungs.
Pulmonary Paradoxical Pulse
Pulmonary Paradoxical Pulse
A decreased pulse strength during inspiration and increased strength during exhalation, observed in some respiratory diseases.
Informed Consent
Informed Consent
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Pursed-lip breathing
Pursed-lip breathing
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Consolidation in RLL
Consolidation in RLL
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COPD
COPD
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Learning Domains
Learning Domains
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Patient Psychomotor Learning
Patient Psychomotor Learning
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Patient Cognitive Learning
Patient Cognitive Learning
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Patient Education for Health Management
Patient Education for Health Management
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Increased Expiratory Time effect on Inspiratory Time
Increased Expiratory Time effect on Inspiratory Time
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Respiratory Rate and Total Respiratory Time Relationship
Respiratory Rate and Total Respiratory Time Relationship
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Left Ventricular Disease
Left Ventricular Disease
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Fine Crackles in Lungs
Fine Crackles in Lungs
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Decreased Thoracic Expansion
Decreased Thoracic Expansion
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Aortic Stenosis
Aortic Stenosis
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S1 Heart Sound
S1 Heart Sound
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S2 Heart Sound
S2 Heart Sound
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PMI (Point of Maximal Impulse)
PMI (Point of Maximal Impulse)
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Increased S1 Intensity
Increased S1 Intensity
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Increased S2 Intensity
Increased S2 Intensity
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Dyspnea
Dyspnea
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Right Ventricular Origin
Right Ventricular Origin
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Gallop Rhythm
Gallop Rhythm
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Angina
Angina
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Apical Pulse
Apical Pulse
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Pedal Edema
Pedal Edema
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Ventricular Failure
Ventricular Failure
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Causes of Increased S1 Intensity
Causes of Increased S1 Intensity
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Study Notes
Breath Sounds and Respiratory Distress
- Rhonchi (coarse crackles): Deep, rumbling, continuous sounds, more pronounced during expiration.
- 66-year-old patient: Presented with respiratory distress, fixed arms, accessory muscle use, pursed lip breathing, and chest tightness.
- Symptoms/Observations: Heart rate 123 bpm, Blood Pressure 157/110, Respiratory Rate 30 shallow breaths per minute. Hyperresonant notes on left percussion, dull on right lower lung field (RLL). Expiratory wheezing and coarse crackles bilaterally, more diminished in RLL. Large amount of thick yellow secretions. ABG: 7.27, PaCO2 64, HCO3 25, PaO2 48 on room air.
- Chest X-ray Findings: Severely depressed diaphragm and consolidation in RLL. Peak expiratory flow 165 L/min.
- Diagnosis/Possible Concerns: Air trapping, possibly COPD. Pulsus paradoxus (marked decrease in pulse strength during inspiration).
- Informed Consent: Essential for patients to understand their care plan.
Identifying Learning Domains
- Psychomotor: Adjusting oxygen concentrator flow, using oxygen cannula.
- Cognitive: Understanding oxygen therapy's purpose in treating breathing difficulties.
- Important Patient Responsibility: Patient education essential to assuming responsibility for health.
Case Study: Mr. Carney - Post-Surgical Respiratory Issues
- Patient Presentation: 35-year-old male, one day post abdominal surgery. Reported difficulty breathing ("just so hard to breathe"). Temp 37.3°C, BP 145/95 mmHg, HR 120 bpm, RR 25, SpO2 92% on 1 LPM nasal cannula. Painful cough, no sputum production.
- Physical Exam Findings: Fine crackles bilaterally in lower lung areas, decreased thoracic expansion, lateral spinal curvature, indented sternum, increased vibrations with palpation in lower lung bases, neck and shoulder muscle use with breathing, ap diameter 1:2, capillary refill 2 seconds, cool extremities with blue tint on nail beds, midline trachea.
- Lab Values: pH 7.53, PaCO2 28, PaO2 62, HCO3 20.
- Possible Diagnoses (considerations): Possible reasons for respiratory distress, likely related to surgery. Note hypocarbia (low carbon dioxide). Possible issues include pulmonary edema, aspiration, or other complications from surgery.
Heart Sounds and Underlying Causes
- S1: Closure of atrioventricular valves (mitral and tricuspid).
- S2: Closure of semilunar valves (aortic and pulmonary).
- Increased S1 Intensity: Fever, tachycardia, anemia, exercise.
- Increased S2 Intensity: Possible causes include pulmonary embolism, chronic left ventricular dysfunction, primary pulmonary hypertension.
- PMI (Point of Maximal Impulse): Located in the 5th intercostal space at the mid-clavicular line. May shift laterally with left ventricular hypertrophy.
- Common Causes for Increased Breathing Effort (Dyspnea): Hypocarbia.
Other Medical Findings
- Pulsus paradoxus: Drop in pulse strength during inspiration. Important diagnostic finding needing immediate evaluation.
- Pedal Edema: Right ventricular failure suggested as possible cause.
General Medical Considerations
- Informed Consent: Patient must be given adequate information about their condition to make decisions for care.
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