Nur220 Exam 2 Study Guide PDF

Nura2O Exam 2 Study Guide (Exam Date : 9/27/202) Frida  NUR220: HA- EXAM 2 Study Guide Thorax &...

Nura2O Exam 2 Study Guide (Exam Date : 9/27/202) Frida  NUR220: HA- EXAM 2 Study Guide Thorax & Long (CH 19). I Healthy Lung Sounds Anterior Palpation and Percussion of the Chest 1. Bronchial (Tracheal) Sounds: - Pitch: High Symmetric Chest Expansion: - Amplitude: Loud - Place hands on the anterolateral wall, thumbs along costal margins, - Duration: Inspiration < Expiration pointing to the xiphoid process. - Quality: Harsh, hollow, tubular - Ask the patient to take a deep breath and observe thumbs moving apart - Location: Trachea and larynx symmetrically for smooth expansion. - Limitations in thoracic expansion are easier to detect in the anterior chest. 2. Bronchovesicular Sounds: - Pitch: Moderate Tactile (Vocal) Fremitus: - Amplitude: Moderate - Begin palpation over lung apices in su praclavicular areas. - Duration: Inspiration = Expiration - Have the patient say "ninety-nine" and compare vibrations on both sides. - Quality: Mixed - Avoid palpating over female breast tissue to prevent damping of sound. - Location: Over major bronchi, posterior (between scapulae, especially right), anterior (u pper sternum, 1st and 2nd intercostal spaces) Percussion of the Anterior Chest: - Start at the apices in su praclavicular areas and percuss down through 3. Vesicular Sounds: interspaces, comparing sides. - Pitch: Low - Shift breast tissue when necessary and avoid direct percussion over it. - Amplitude: Soft - Note cardiac dullness borders and recognize normal liver dullness at the - Duration: Inspiration > Expiration 5th intercostal space in the right midclavicular line, with tympany over the - Quality: Rustling (like wind in trees) gastric space on the left. - Location: Over peripheral lung fields (smaller bronchioles and alveoli) Posterior Chest Assessment Adventitious Lung Sounds Inspection: Definition: - Observe the thoracic cage's shape and configuration. Adventitious lung sounds are abnormal sounds not normally heard in the lungs, - Ensure spinous processes are aligned and the thorax is symmetric, elliptical, typically su perimposed on normal breath sounds. They occur due to moving air with ribs sloping down about 45 degrees. colliding with secretions in the tracheobronchial passageways or the popping open of - Anteroposterior (AP) diameter should be less than the transverse diameter previously deflated airways. (AP:transverse ratio 0.70-0.75). - Note the development of neck and trapezius muscles. Common Types: - Assess the person's breathing position for comfort. - Examine skin color and condition for consistency with genetic background, 1. Wheezes (High-pitched, musical sounds that occur primarily during expiration due checking for cyanosis or lesions. to narrowing of the airways) 2. Crackles (Rales) (are discontinuous popping sounds heard over inspiration) Palpation: 3. Rhonchi (Low-pitched, rumbling sounds resembling snoring, typically heard during - Symmetric Expansion: Place hands on the posterolateral chest wall at T9 or expiration and caused by air moving through thick secretions in the larger T10, noting symmetric expansion during deep breaths. airways.) - Tactile Fremitus: Use palmar base or ulnar edge of fingers, palpating while the patient says “ninety-nine” to assess vibrations. - Fremitus is strongest between the scapulae and decreases downwards. - Note any areas of abnormal fremitus, which can indicate conditions like Assessment: pneumonia or COPD. Describe adventitious sounds as: Percussion: ◦ Inspiratory or Expiratory - Percuss starting at the apices, moving downwards in interspaces to assess lung ◦ Loud ness fields. ◦ Pitch - Resonance indicates healthy lung tissue; dullness suggests abnormal density (e.g., pneumonia); hyperresonance indicates excess air (e.g., emphysema). ◦ Location on the Chest Wall Atelectatic Crackles: Auscultation: - Listen for normal breath sounds while the patient breathes deeply through the Characteristics: mouth. ◦ Short, popping, crackling sounds lasting only a few breaths. - Compare sounds bilaterally and ensure to differentiate lung sounds from Cause: background noise. ◦ Occur when sections of alveoli are not fully aerated, deflating slightly - Familiarize yourself with potential extraneous noises, like examiner breathing or tubing contact. and accumulating secretions. Location: ◦ Heard in the periphery of the lungs, especially in dependent areas. Additional Fremitus Info. Disappearance: - Rhonchal fremitus: Palpable with thick bronchial secretions. ◦ These sounds disappear after a few deep breaths or a cough. - Pleural friction fremitus: Felt with pleural inflammation. - Crepitus: Coarse, crackling sensation felt over the skin; occurs when air escapes into subcutaneous tissue, such as in pneumothorax or after thoracic injury/surgery. Fremitus Assessment in COPD MECHANICS OF RESPIRATION Definition: Fremitus refers to the vibrations The respiratory system has four major felt on the chest wall when a functions: patient speaks. 1. Su pplying oxygen for energy Assessment: production. - Increased Fremitus: 2. Removing carbon dioxide as a waste - Indicates denser lung tissue, product. often due to conditions like 3. Maintaining homeostasis (acid-base pneumonia or consolidation. balance) of arterial blood. 4. Maintaining heat exchange (less - Decreased Fremitus: significant in humans). - Commonly seen in conditions such as chronic obstructive Respiration regulates blood pH by pulmonary disease (COPD), pleural adjusting carbon dioxide levels. effusion, or pneumothorax, where Hypoventilation leads to carbon dioxide air or fluid interferes with normal buildu p, while hyperventilation causes vibration transmission. excessive carbon dioxide elimination. Implications for Patients with Control of respiration is involuntary and COPD: managed by the respiratory center in - **Decreased fremitus** is typically the brainstem (pons and medulla). The noted due to air trapping and primary stimulus for breathing is an hyperinflation of the lungs. increase in carbon dioxide (hypercapnia), - This assessment helps evaluate while decreased oxygen levels the severity of COPD and can guide (hypoxemia) can also trigger breathing further diagnostic testing or but are less effective. management strategies.  NUR220: HA- EXAM 2 Study Guide Thorax + Lung (CH 19). 2 Changes in Lung Structure and Function with Aging Cough Characteristics and Timing: Normal Lung Assessment in Healthy Adults 1. Costal Cartilage and Mobility - Costal cartilages become calcified, reducing thoracic mobility. 1. Continuous throughout the day – Acute Respiratory Rate - Respiratory muscle strength declines after age 50, continuing into the 70s. illness (e.g., respiratory infection). - 10 to 20 breaths per minute. 2. Afternoon/evening – Possible exposure to 2. Elastic Properties of Lungs work irritants. Tidal Volume (Depth) - Decrease in elastic properties makes lungs less distensible. 3. Night – Postnasal drip, sinusitis. - 500 to 800 mL of air per breath. - Results in decreased compliance, making lungs stiffer and harder to inflate. 4. Early morning – Chronic bronchial inflammation, common in smokers. Breathing Pattern 3. Airway Closure and Lung Capacity - Even and regular. - Increased small airway closure leads to decreased vital capacity. Chronic bronchitis involves a productive - Increased residual volume (air remaining in lungs after forceful expiration). cough for at least 3 months in 2 consecutive Pulse to Respiratory Ratio years. - Approximately 4:1; both increase with exercise, fear, 4. Histologic Changes or fever. - Gradual loss of intra-alveolar septa and decreased number of alveoli reduce gas Hemoptysis (coughing u p blood) may be a exchange surface area. sign of serious conditions such as TB, lung Air Movement - Lung bases become less ventilated, increasing risk for dyspnea with exertion. cancer, or pulmonary embolism. - Smooth inhalation and exhalation with each breath. 5. Postoperative Risks Sputum characteristics: - Greater risk for postoperative atelectasis and infection due to decreased ability to 1. White/clear – Colds, bronchitis, viral Sighs cough and increased secretions. infections. - Occasional sighs are normal to expand alveoli. 2. Yellow/green – Bacterial infections. - Frequent sighs may indicate emotional issues and 6. Respiratory Efficiency 3. Rust-colored – TB, pneumococcal can lead to hyperventilation and dizziness. - Less efficient respiratory system results in decreased vital capacity and less pneumonia. tolerance for activity. 4. Pink/frothy – Pulmonary edema, some Lung volume & Capacities medications. - Sedentary or bedridden individuals are at higher risk for respiratory dysfunction. Tidal Volume (TV): Air inhaled or exhaled in one normal breath; about 500 mL in adults. Provides Cough types: 7. Chest Configuration Changes baseline for lung volume. - Increased anteroposterior (AP) diameter leading to a barrel-shaped chest and - Hacking – Mycoplasma pneumonia. kyphosis. - Dry – Early heart failure. Inspiratory Reserve Volume (IRV): Maximum air inhaled - Barking – Crou p. - Compensation by extending and tilting the head back; palpation may reveal bony beyond TV; average is 3000 mL. Indicates lung reserve prominences due to decreased subcutaneous fat. - Congested – Colds, bronchitis, pneumonia. capacity during exertion. 8. Chest Expansion Expiratory Reserve Volume (ERV): Maximum air exhaled - Chest expansion may be decreased but should remain symmetric. after a normal breath; typical range is 1200 to 1500 - Older adults may tire easily, especially during deep breathing; allow rest periods. mL. Assesses lung's ability to expel air, often reduced in COPD. 9. Coping Strategies - Activities may decrease due to shortness of breath or pain; some older adults may Residual Volume: Air remaining in lungs after forceful feel pleuritic pain less intensely. exhalation; typically 1000-1200 mL. Prevents lung collapse and su pports gas exchange; changes 10. Auscultation Considerations indicate lung disease. - Be cautious of hyperventilation leading to dizziness; brief rest periods may be needed. Abnormal Breath Sounds: Decreased or absent breath sounds occur when: 1. The bronchial tree is obstructed by secretions, a mucus plug, or a foreign body. 2. Emphysema results in loss of lung elasticity and decreased air movement. 3. Transmission of sound is obstructed by conditions like pleurisy, pneumothorax, or pleural effusion. A silent chest indicates no air movement, which is an ominous sign. Increased breath sounds are louder than normal, typically heard with consolidation (e.g., pneumonia) or compression (e.g., pleural effusion). They have a high-pitched, tubular quality with a distinct pause between inspiration and expiration. Stridor is a high-pitched inspiratory crowing sound heard without a stethoscope, often associated with u pper airway obstruction (e.g., crou p, foreign body, or epiglottitis). Pleural Rub: A coarse, grating sound heard when pleural surfaces become inflamed and rub together, as seen in pleuritis. Thorax Configurations: Normal Adult Thorax: The thorax has an elliptical shape with a 1:2 anteroposterior-to-transverse diameter. Respiratory Patterns This is the expected chest shape in healthy adults. Tachypnea: Rapid, shallow breathing (>24 breaths per minute). Pectus Excavatum (Funnel Chest): A sunken sternum and adjacent cartilages. The depression starts at the 2nd Seen in fever, fear, or exercise, and also occurs in conditions like intercostal space, deepest at the xiphoid junction. Usually congenital and asymptomatic but can cause body respiratory insufficiency, pneumonia, pleurisy, and alkalosis. image issues. Surgery may be needed in severe cases. Indicates a need for increased oxygen or the removal of excess CO2. Barrel Chest: The AP-to-transverse diameter is equal with ribs in a horizontal position (instead of the normal Bradypnea: Slow breathing (45 degrees) may reduce lung volume and impair It is also normal during sleep in infants and older adults. cardiopulmonary function, but mild cases are typically asymptomatic. Hyperventilation: Increased rate and depth of breathing. Occurs in Kyphosis: An exaggerated posterior curvature of the thoracic spine (humpback). Associated with back pain and extreme exertion, anxiety, or fear, and compensates for metabolic limited mobility, it can impair cardiopulmonary function if severe. Often seen in older adults and acidosis (e.g., **Kussmaul respirations in diabetic ketoacidosis). postmenopausal women with osteoporosis, though exercise may help prevent it. It can also occur with midbrain lesions, hepatic coma, or salicylate overdose. Kussmaul respirations are deep, labored breaths often seen in diabetic ketoacidosis as the body attempts to correct metabolic acidosis by eliminating CO2. Hypoventilation: Irregular, shallow breathing, typically caused by narcotic or anesthetic overdose. Can occur with prolonged bed rest or chest splinting due to pain. Leads to CO2 retention and respiratory acidosis. Biot's Respiration: Irregular pattern of normal respirations followed by apnea. Seen in head trauma, brain abscesses, heat stroke, meningitis, and encephalitis. It indicates significant brainstem injury or dysfunction. Chronic Obstructive Breathing: Normal inspiration with prolonged expiration due to increased airway resistance. Seen in chronic obstructive pulmonary disease (COPD). Any exertion can cause air trapping, leading to dyspnea because the person cannot fully exhale before the next breath.  Thorax Lungs (CH 19) 3 NUR220: HA- EXAM 2 Study Guide. Inspiration Vs Expiration Common Lung Conditions: Ventilation = the act of breathing. Lung Cancer the leading cause of cancer death in the U.S. About 80% of deaths are due to smoking, which causes DNA Inspiration: Air enters the lungs as the chest expands. mutations. This is driven by the diaphragm contracting and moving downward, Screening with CT is recommended for those aged 50-80 with a 20-pack-year smoking history. which lengthens the vertical diameter of the thoracic cavity. E-cigarettes and vaping are not safe and can cause lung damage (e.g., EVALI outbreak in 2019-2020). The intercostal muscles also lift the ribs, increasing the anteroposterior (AP) diameter. Tuberculosis (TB) Expiration: TB is an airborne disease that spreads easily, especially in crowded conditions (e.g., shelters, prisons). Air is expelled as the chest recoils. High-risk grou ps include those with HIV and people born outside the U.S. TB incidence has decreased, but This process is passive, with the diaphragm relaxing and moving efforts to treat active and latent TB remain critical for control. u pward, aided by elastic forces of the lungs and chest. Pressure increases, pushing air out. Asthma the most common chronic disease in children, Forced breathing (during exercise or respiratory distress) involves accessory muscles like the sternomastoids, scaleni, and trapezii for with higher rates in racial minorities and low-income populations. inspiration and abdominal muscles for forced expiration. Environmental factors like air pollution can trigger asthma attacks, and persistent asthma can lead to reduced lung function. Dyspnea (Shortness of Breath) Pneumonia Chronic dyspnea an infection that inflames the air sacs in the lungs, causing symptoms like cough, fever, and difficulty lasts >1 month breathing. can be caused by neurogenic, respiratory, or cardiac issues, as well as Vaccination is key to prevention in vulnerable populations. anemia, anxiety, or deconditioning. Ask how much activity (e.g., number of blocks or stairs) triggers SOB. Patient Education: Strategies for Promoting Cultural Considerations: Orthopnea Lung Health is difficulty breathing when lying flat. Respiratory Health Ask how many pillows are needed for comfort. Language barriers - may Smoking cessation: Strongly encourage affect communication during Paroxysmal nocturnal dyspnea quitting smoking to prevent lung cancer, assessments. Use interpreters is waking u p suddenly with SOB and needing to sit u pright for relief. COPD, and other respiratory conditions. when needed. Su pport includes counseling, nicotine Certain cultural practices Diaphoresis (excessive sweating) may accompany dyspnea. replacement, or medications. (e.g., herbal treatments, Cyanosis, signals hypoxia (lack of oxygen). smoking habits) may influence Vaccination: Recommend annual influenza patient beliefs about health. and pneumococcal vaccines, especially for Access to healthcare - varies, high-risk grou ps (elderly, affecting preventive measures immunocompromised, chronic respiratory like vaccinations and diseases). screenings. Respiratory diseases like Environmental exposure: Advise minimizing asthma and TB are more exposure to irritants (e.g., pollution, prevalent in some ethnic/ secondhand smoke, occu pational hazards). racial grou ps due to socioeconomic factors, Respiratory health maintenance: Encourage environmental exposure, and regular physical activity to strengthen access to care. lungs and improve respiratory function.  NUR220: HA- EXAM 2 Study Guide 9) + Neck Vessels (CH 20). 4 Heart Anatomy and Function: Valve Locations and Heart Sounds (APE to MAN) Valves: Pericardium: Protective outer sac of the heart. Aortic Valve: Atrioventricular (AV) Valves: 2nd intercostal space, right sternal border Tricuspid (right side) and Mitral (left side). Best heard at the base of the heart Myocardium: Muscular layer responsible for pumping. Open during diastole (filling), close during systole (pumping). Pulmonic Valve: Semilunar (SL) Valves: Endocardium: Inner lining of heart chambers and 2nd intercostal space, left sternal border Pulmonic (right) and Aortic (left). Also heard at the base valves. Prevent backflow from arteries into ventricles during diastole. Erb's Point: Right heart: Pumps blood to the lungs. 3rd intercostal space, left sternal border Good for hearing S1 and S2 equally Tricuspid Valve: Left heart: Pumps blood to the body. 4th intercostal space, left sternal border Located at the lower left sternal border Mitral Valve: Atria: Thin-walled reservoirs for blood (RA, LA). 5th intercostal space, midclavicular line Best heard at the apex of the heart (S1 is louder here) Ventricles: Thick-walled muscular chambers for pumping (RV, LV). Normal Heart Sounds Cardiovascular System Overview First Heart Sound (S1): Components: Occurs with closure of the atrioventricular (AV) - Heart: Muscular pump. valves, marking the beginning of systole. - Blood Vessels: Major arteries and veins. Mitral component (M1) slightly precedes tricuspid component (T1), but typically heard as one sound. Precordium: Loudest at the apex of the heart. - Area on the anterior chest overlying the heart and great vessels. Second Heart Sound (S2): Occurs with closure of the semilunar valves, Location: signaling the end of systole. - Heart and great vessels are located between the lungs in Aortic component (A2) slightly precedes the mediastinum. pulmonic component (P2). - Heart extends from the 2nd to the 5th intercostal space, Loudest at the base of the heart. from the right sternum border to the left midclavicular line. Effect of Respiration: During inspiration, decreased intrathoracic pressure Heart Anatomy increases venous return to the right heart, enhancing right ventricular stroke volume and Orientation: prolonging systole. - Right side is anterior; left side is mostly posterior. This causes a delay in pulmonic valve closure. - Right ventricle: Behind sternum, largest anterior surface Conversely, more blood is retained in the lungs, area. reducing return to the left heart, decreasing left - Left ventricle: Behind right ventricle, forms apex and left ventricular stroke volume, and leading to earlier border. aortic valve closure. - Right atrium: Above right ventricle, forms right border. A significant early closure of the aortic valve - Left atrium: Mostly posterior; left atrial appendage can result in a split S2, where the two components are visible anteriorly. heard separately. Blood Circulation Loops: Extra Heart Sounds and Murmurs - Pulmonary Circulation: Carries deoxygenated blood to lungs. Third Heart Sound (S3): - Systemic Circulation: Delivers oxygenated blood to the Normally, diastole is silent, but in certain body. conditions, vibrations from ventricular filling can be heard as S3. Heart Shape and Impulse Occurs when ventricles are resistant to filling during the early rapid filling phase Shape: (protodiastole) right after S2 when the AV valves - Upside-down triangle. open. - Base at the top, apex points down and to the left. Fourth Heart Sound (S4): Apical Impulse: Occurs at the end of diastole (presystole) when - Felt at the 5th intercostal space, 7 to 9 cm from the the ventricle is resistant to filling. midsternal line during contraction. Atria contract and push blood into a noncompliant ventricle, creating vibrations heard Great Vessels as S4, which occurs just before S1. - Su perior and Inferior Vena Cava: Return unoxygenated Murmurs: blood to the right heart. Normally, blood flow through cardiac Cardiovascular Changes in the Aging Adult - Pulmonary Artery: Exits the right ventricle, bifurcates to chambers and valves is silent, but turbulent blood carry blood to lungs. flow creates murmurs. Overview: - Pulmonary Veins: Return oxygenated blood to the left Murmurs are gentle, blowing, swooshing sounds - Aging affects the cardiovascular (CV) system and is influenced by lifestyle heart. heard on the chest wall. factors such as smoking, diet, exercise, and stress. - Aorta: Ascends from the left ventricle, arches at the Conditions leading to murmurs include: sternal angle, descends behind the heart. 1. Increased blood velocity (e.g., during exercise, Hemodynamic Changes: thyrotoxicosis). - Isolated Systolic Hypertension: Increased systolic blood pressure due to 2. Decreased blood viscosity (e.g., anemia). stiffening of large arteries (arteriosclerosis). 3. Structural defects in valves (e.g., stenotic or - Heart Size: Overall size stable, but left ventricular wall thickness regurgitant valves) or unusual openings in increases to manage increased workload. chambers (e.g., dilated chamber, septal defect). - Diastolic Pressure: May decrease after age 50, leading to increased pulse pressure. - Heart Rate and Cardiac Output: Resting heart rate and cardiac output remain stable, but exercise capacity decreases due to a lower maximum Characteristics of Heart Sounds heart rate. All heart sounds are described by: Dysrhythmias: - Higher incidence of su praventricular and ventricular dysrhythmias, including common ectopic beats. Frequency, or pitch: high or low - Older adults may not tolerate tachydysrhythmias well due to thicker myocardium and impaired diastolic filling. Intensity, or loud ness: loud or soft Duration: very short for heart Electrocardiogram (ECG) Changes: sounds; silent periods are longer - Prolonged P-R and Q-T intervals, with left axis deviation and increased bundle branch block incidence. Timing: systole or diastole Clinical Implications: A heart murmur is a gentle, blowing, - Increased cardiovascular disease (CVD) risk with age, making CVD a leading cause of death in those 65 and older. swooshing sound that can be heard on the - Lifestyle habits significantly influence heart disease risk; moderate chest wall. physical activity reduces CVD and respiratory illness mortality. - Health education is crucial to encourage physical activity and healthier lifestyle choices.  NUR220: HA- EXAM 2 Study Guide 97 : Neck Vessels (CH 20). a Cardiovascular Disease Risk Factors Neck Vessel Assessment Carotid Bruit Non-Modifiable Risk Factors Jugular Venous Distention (JVD) - Age: Risk increases with age. Definition: An abnormal sound or murmur heard - Position the patient su pine at a 30 to 45-degree angle - Family History: Genetic predisposition to cardiovascular disease (CVD). during blood flow through narrowed or turbulent to observe pulsations. - Sex: Men generally have a higher risk; women’s risk increases post- carotid arteries in the neck. - Inspect for distention of the jugular vein. menopause. Carotid Artery Palpation Assessment: Detected using a stethoscope during a Modifiable Risk Factors physical examination. - Palpate carotid arteries one side at a time to - Hypertension: Increases workload on the heart and accelerates prevent compromised blood flow to the brain. atherosclerosis. Causes: - Assess the contour and amplitude of the pulse; - Smoking: Raises heart oxygen demand while decreasing su pply; increases - Atherosclerosis (plaque buildu p in arteries) expected strength is 2+. blood pressure and heart rate. - Other conditions that cause arterial narrowing - Findings should be symmetrical bilaterally. - Elevated Cholesterol: High low-density lipoprotein (LDL) levels contribute and disru pted blood flow to plaque formation. Carotid Bruit Auscultation - Type 2 Diabetes: Requires management through diet, exercise, and - Use the bell of the stethoscope to assess for carotid medication to lower CVD risk. bruit. - Poor Nutrition: Diets high in processed foods and low in fruits and The Aging Adult - Avoid compressing the artery to prevent an vegetables increase risk. artificial bruit. - Physical Inactivity: At least 150 minutes of moderate-intensity aerobic 1. Blood Pressure Changes: - Keep the neck in a neutral position and place the activity weekly reduces risk. - Gradual rise in systolic blood pressure (SBP) stethoscope at: - Overweight/Obesity: BMI ≥ 25 increases CVD risk; weight management is with aging; diastolic blood pressure (DBP) remains - Angle of the jaw crucial. constant, resulting in a widened pulse pressure. - Midcervical area - Sex and Gender Differences: Women face unique risks, especially related - Some older adults may experience orthostatic - Base of the neck to pregnancy complications and societal perceptions of risk. hypotension, leading to sudden drops in BP when standing or sitting. Edema 2. Carotid Artery Caution: - Use caution when palpating and auscultating Definition: Swelling caused by excess fluid in tissues, often associated the carotid artery. with heart failure. - Avoid pressure in the carotid sinus area to prevent reflex slowing of the heart rate and Key Points: potential compromise of circulation in narrowed - Dependent edema is common in heart failure. arteries. - Cardiac edema worsens in the evening and improves in the morning after elevating the legs. 3. Chest Changes: - Cardiac edema is typically bilateral; unilateral swelling indicates - Increased anteroposterior diameter of the a local vein issue. chest with aging complicates palpation of the apical impulse and auscultation of S2 splitting. - S4 heart sounds are common in older adults without known cardiac disease. Mechanisms: - Systolic murmurs occur in over 50% of older adults. Increased hydrostatic pressure in capillaries due to heart failure leads to fluid leakage into surrounding tissues. 4. Ectopic Beats: Decreased oncotic pressure from low albumin levels can - Occasional premature ectopic beats are also contribute to edema. common and usually do not indicate heart Assessment: disease; consider obtaining an ECG for confirmation. Pitting Edema: Apply pressure to the swollen area; if a - ECGs represent only a brief moment; 24-hour depression remains, it's pitting edema. ambulatory monitoring may be necessary for a Non-Pitting Edema: No indentation remains after pressure is comprehensive assessment. applied; often associated with conditions like lymphedema. Management: 5. S3 Heart Sound: - The presence of S3 in individuals over 35 years is associated with heart failure and is considered Elevation of limbs to reduce swelling. abnormal. Diuretics may be prescribed to help remove excess fluid. Monitor weight daily; significant weight gain may indicate fluid retention. Health Promotion & Patient Teaching ABCs of Heart Health Heart disease is increasing, especially among adults aged 35 to 64. Here are key steps to maintain heart health: 1. Aspirin Therapy: - Evaluate 10-year ASCVD risk. - Daily low-dose aspirin may be recommended for ages 40-59 with higher risk. - Routine aspirin use is not advised due to bleeding risk. 2. Blood Pressure (BP) Control: - Regular BP checks every 6 months are advised. - Lifestyle changes can help maintain healthy BP levels. - Medication options available if necessary. 3. Cholesterol Control: - Annual cholesterol screening: men from age 35, women from age 45. - Focus on managing LDL cholesterol levels with diet or statin medications if elevated. 4. Smoking Cessation: - Quitting smoking significantly protects heart health. - Provide resources and su pport for quitting, including medication if needed. 5. Lifestyle Modifications: - Adopt a heart-healthy diet: increase fruits/vegetables, avoid trans fats and excess salt. - Aim for 30 minutes of physical activity most days. - Maintain a healthy weight through diet and exercise..  NUR220: HA- EXAM 2 Study Guide Peripheral Vascular System (CH 2). 6 Vascular System Overview Artery Conditions: Ischemia: Lack of oxygenated Deep Vein Thrombosis (DVT) The vascular system transports blood and lymph. Diseases in this system hinder blood due to an arterial blockage. oxygen and nutrient delivery, and slow the removal of waste products, impacting ◦ Complete blockage: Tissue What it is: A blood clot that forms in a deep vein, cell function. death. typically in the legs. ◦ Partial blockage: Ischemia Risk factors: Prolonged immobility, recent surgery, clotting disorders, smoking, obesity, pregnancy, and use of oral Arteries evident during increased oxygen contraceptives. demand (e.g., exercise). Dorsiflexion test (Homans sign): When the foot is Function: Arteries carry oxygenated blood from the heart to body tissues Peripheral Artery Disease (PAD): dorsiflexed (pulled toward the shin), expect no pain in a healthy under high pressure. Their walls contain elastic fibers and vascular smooth Affects arteries in the limbs, person. Pain may indicate DVT, but this test is not fully reliable on muscle (VSM), allowing them to stretch with each heartbeat and control blood commonly caused by atherosclerosis, its own (may need to use an ultrasound Doppler) flow. embolism, or arterial dissection. Peripheral Pulses Pulse: Arterial pulses can be felt where arteries are near the skin and bone. Veins Overview Varicose Veins Veins run parallel to arteries but carry What they are: Causes: carbon dioxide and waste products from Pulses found in the Incompetent valves lead to dilated, Key Arteries: the body back to the heart. Veins are more arms and legs, such as twisted veins, often from increased numerous and lie closer to the skin’s radial, brachial, venous pressure due to prolonged surface. femoral, popliteal, Temporal artery: Palpated in front of the ear. standing, sitting, or bed rest. dorsalis pedis, and Symptoms: Key Veins posterior tibial.. Swollen, twisted veins (legs), Carotid artery: Found in the groove between the sternomastoid muscle and - Jugular veins: These veins are assessed in If they can’t be discomfort, heaviness, and aching. trachea. the neck, covered in Chapter 20. felt: Use a doppler to Risk Factors: - Arm veins: Each arm has two sets of veins: assess blood flow. - Prolonged immobility su perficial and deep. The su perficial veins, Grading radial Arm arteries: - Hypercoagulable states located in the subcutaneous tissue, are pulses (0-3+): - Vein trauma responsible for most of the venous return. ◦ 0 = Absent - Genetics Brachial artery: Main artery of the arm; bifurcates into the radial and ulnar - Obesity ◦ 1+ = Weak arteries at the elbow. Veins in the Leg - Multiple pregnancies ◦ 2+ = Normal Deep veins: These run alongside the deep arteries and conduct most venous return ◦ 3+ = Bounding Radial pulse: Felt at the wrist near the radius. Pretibial Edema Assessment: from the legs. The key deep veins are the femoral and popliteal veins. Su perficial Ulnar artery: Located deeper, often hard to palpate. veins can be removed without affecting Check for pretibial edema: Press Dependent Rubor and circulation as long as these remain intact. skin over the tibia or medial Arterial Insufficiency: malleolus for 5 seconds and Leg arteries: release. Dependent rubor: A deep Su perficial veins: Femoral artery: Major artery in the leg; becomes the popliteal artery behind Normally, no indentation is blue-red color caused by - Great saphenous vein: Starts on the the knee. seen, but a pit may form after severe arterial medial side of the foot and ascends the leg, Dorsalis pedis: Continuation of the anterior tibial artery on the foot. standing all day or in insufficiency, resulting crossing the tibia and continuing u p the Posterior tibial artery: Travels behind the medial malleolus. pregnancy. from chronic hypoxia. medial side of the thigh. - Small saphenous vein: Begins on the - Pitting Edema Grading: This leads to loss of lateral side of the foot, ascends behind the - 1+: Mild pitting, slight vasomotor tone and Embolism: What It Is and How It Is Identified indentation, no leg swelling blood pooling in veins. lateral malleolus, and joins the popliteal vein at the back of the leg. - 2+: Moderate pitting, indentation Delayed venous filling: - What is it? disappears quickly Occurs due to arterial - Blood flows from su perficial veins into An embolism is the sudden blockage of a blood vessel by material such as a - 3+: Deep pitting, indentation insufficiency. deep veins. blood clot (thrombus), fat globule, air bubble, or other debris that travels remains briefly, leg looks swollen through the bloodstream and lodges in a smaller vessel, obstructing blood - 4+: Very deep pitting, indentation The American Heart Association Perforators: These are connecting veins flow. lasts long, leg is grossly swollen (AHA) indicates that PAD risk that route blood from the su perficial veins factors are highest among the into the deep veins. They have one-way Black population. How is it identified? Conditions: valves that prevent blood from flowing back Signs and symptoms depend on the location but may include: Bilateral pitting edema: into the su perficial veins. Pulmonary embolism (lungs): Chest pain, dyspnea, tachypnea, cough, Associated with heart failure, Environmental factors hemoptysis, cyanosis, anxiety. diabetic neuropathy, and contributing to PAD include Other areas: Pain, swelling (if limb-related), and reduced pulse strength. Epitrochlear Lymph Node Check (palpation cirrhosis. smoking, poor access to healthy Imaging studies like ultrasound, CT scan, or ventilation-perfusion (V/Q) scan of u pper extremities) food, limited physical activity, Unilateral edema: Suggests and high-stress living conditions. help confirm diagnosis. deep vein occlusion. Ensuring access to care requires To check the epitrochlear lymph nodes, Brawny edema: Nonpitting, firm increasing preventive services, palpate 2-3 cm above and behind the improving healthcare education, edema, seen with lymphatic Modified Allen Test. (Performed during palpation of u pper extremity assessment) medial condyle of the humerus by shaking and addressing socioeconomic obstruction. barriers in underserved hands with the patient and reaching under communities. The modified Allen test assesses collateral circulation before cannulating the radial artery. the elbow into the groove between the biceps and triceps. Peripheral Artery Disease (PAD) and African Americans ↳ Procedure: Occlude both ulnar and radial arteries while the patient - Normally, these nodes are not palpable. makes a fist. This causes the hand to blanch. Have the patient open their hand, - Enlarged epitrochlear nodes can indicate Prevalence: African Americans have about twice the prevalence of PAD then release the ulnar artery while keeping the radial artery occluded. infection of the hand or forearm, or compared to non-Hispanic Whites, even after adjusting for traditional ;**Normal result**: Palmar blush (hand returns to normal color) within 7 generalized lymphadenopathy seen in risk factors (smoking, diabetes, hypertension, and obesity). seconds, indicating adequate circulation. conditions like lymphoma, chronic leukemia, - Note: The test is simple but may be inaccurate if pressure on the arteries is not infectious mononucleosis, or HIV. Healthcare Disparities: applied uniformly. - African Americans are less likely to receive: - Preventive care Peripheral artery disease (PAD) is a - Timely diagnosis The Aging Adult: condition where the arteries, - Proper treatment particularly those su pplying blood to - These disparities lead to worse outcomes such as: the limbs, become narrowed or blocked - Severe disease progression Arteriosclerosis: Peripheral arteries grow more rigid with age, causing a due to atherosclerosis (fatty plaque - Higher rates of amputation rise in systolic blood pressure. buildu p). - Increased cardiovascular morbidity and mortality Atherosclerosis: Fatty plaque deposits on arterial walls, common with This limits blood flow, leading to aging, especially in peripheral artery disease (PAD). symptoms like leg pain during walking Contributing Factors: Differences in outcomes are primarily due to PAD (Peripheral Artery Disease): Often underdiagnosed, PAD is a major (intermittent claudication), disparities in healthcare access and treatment intensity, not racial or cause of morbidity (e.g., painful walking, poor wound healing) and mortality. poor wound healing, or, in severe genetic differences. Prevalence increases with age, affecting about 20% of those 80 and older. cases, tissue damage. Symptoms include intermittent claudication (IC), but many older adults may PAD is more common in older adults Screening and Management: be asymptomatic or avoid walking due to leg pain. and is a major cause of morbidity -Comprehensive screening is essential, particularly for: DVT Risk: Increased with aging, prolonged bed rest, immobilization, and reduced mobility. Risk factors - African Americans chronic diseases, and COVID-19 infection. Anticoagulants reduce venous include smoking, diabetes, high - Women thromboembolism risk. cholesterol, and high blood pressure. - Aging adults Lymphatic Changes: Older adults have fewer and smaller lymph nodes. - The **Ankle-Brachial Index (ABI)** is the first-line, non-invasive test used for PAD diagnosis. The Allen Test  NUR220: HA- EXAM 2 Study Guide Abdomen (CH 22). 7 Right Upper Quadrant (RUQ) Midline Structures Left Upper Quadrant (LUQ) Liver: Should be non-tender, with no palpable masses. Aorta: Palpable; should be Stomach: Soft, non-tender; no masses. Gallbladder: Non-tender, with no signs of inflammation. midline and non-tender. Spleen: Generally not palpable; assess for tenderness. Duodenum: Generally not palpable. Uterus: Palpable if enlarged. Left Lobe of Liver: Non-tender, typically not palpable. Head of Pancreas: Not normally palpable, assess for tenderness. Bladder: Palpable if distended. Body of Pancreas: Not normally palpable. Right Kid ney and Adrenal Gland: Typically not palpable in a healthy Left Kid ney and Adrenal Gland: Typically not palpable in a healthy adult. adult. Splenic Flexure of Colon: Should be non-tender. Hepatic Flexure of Colon: May feel soft; no tenderness. Abdominal Division Part of Transverse and Descending Colon: Non-tender, soft. Part of Ascending and Transverse Colon: Should be non-tender. The abdomen is divided into four quadrants by a vertical and a Left Lower Quadrant (LLQ) Right Lower Quadrant (RLQ) horizontal line bisecting the umbilicus. Part of Descending Colon: Should feel soft, non-tender. Cecum: Non-tender; may feel soft. Quadrants: Sigmoid Colon: Non-tender. Appendix: Should not be palpable; assess for tenderness. Left Ovary and Tube: Palpable if enlarged; non-tender. Right Upper Quadrant (RUQ) Right Lower Quadrant (RLQ) Left Ureter: Not palpable. Left Upper Quadrant (LUQ) Left Spermatic Cord: Not palpable. Expected Findings in Healthy Adults Left Lower Quadrant (LLQ) Regional Terms: Soft, non-tender abdomen Epigastric: Area between the costal margins. Percussion of the Abdomen Umbilical: Area around the umbilicus. No palpable masses Hypogastric/Su prapubic: Area above the pubic bone. Symmetrical contours Purpose: Percussion is used to assess the density Bowel sounds present in all four quadrants, described as of abdominal contents and to screen for normal active sounds abnormal fluid or masses. No signs of inflammation or tenderness when palpating Auscultation of Vascular Sounds organs Procedure Procedure: While auscultating the abdomen, use - Lightly percuss in all four quadrants, moving firmer pressure over the aorta, renal arteries, clockwise. Auscultation of Bowel Sounds iliac arteries, and femoral arteries, especially - Tympany: should predominate due to air in in hypertensive patients. the intestines when the patient is su pine. Sequence: Depart from the usual examination order and auscultate - Dullness: indicates the presence of a the abdomen right after inspection. This prevents percussion and Normal Findings: distended bladder, adipose tissue, fluid, or a palpation from increasing peristalsis, which can falsely alter bowel - Typically, no vascular sounds are present. mass. sound interpretation. - Normal systolic bruits may occur in 4%-20% of - Hyperresonance: suggests gaseous distention. healthy individuals (usually under 40 years) Technique from the celiac artery, characterized as medium Use the diaphragm end piece of the stethoscope for high-pitched to low in pitch between the xiphoid process and Abdominal Palpation bowel sounds. umbilicus. Hold the stethoscope lightly against the skin to avoid stimulating Purpose: Palpation assesses organ size, location, consistency, and checks for abnormal additional bowel sounds. Key Considerations: masses or tenderness. Start auscultation in the right lower quadrant (RLQ) at the Do not rely on auscultation to confirm ileocecal valve, where bowel sounds are typically present. Comfort Measures nasogastric tube placement, as it can lead to 1. Bend the patient’s knees. serious complications. 2. Keep your palpating hand low and parallel to the abdomen. Types of Bowel Sounds Confirm placement with chest x-ray, measure 3. Instruct the patient to breathe slowly (in through the nose, out through the mouth). Hyperactive Sounds: Loud, high-pitched, rushing sounds indicating the external tube length, and test gastric 4. Use a low, soothing voice; conversation may help relax the patient. increased motility. aspirate pH (acceptable if