nursing 210 test 2 objectives-study guide

8/3/2019 Nursing 210 Test 2 Objectives-Study Guide

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Nursing 210 Test 2 Objectives 10/27/2011 10:02:00 PM

Cardiovascular System:

Relate anatomic structures to the correct landmark or anatomic location.

List the significant anatomic features of the heart.

Relate the name of the heart sound to the physiologic cause.Describe the characteristics of heart sounds

Describe the assessment of the carotid artery pulse.

Discuss significance of jugular vein assessment.

Cite the risk factors for CVD and stroke.

Describe the pathway of blood through the fetal heart.

List the hemodynamic changes that occur with pregnancy and aging.

Describe the steps of physical assessment of the heart.

Chart findings of a carotid and cardiac assessment.


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Peripheral Vascular and Lymphatic Systems

*List the pulses accessible to examination.

*Describe the mechanisms that keep blood moving toward the heart in the

venous system

*Explain the termcapacitance vessels.*List the risk factors for venous stasis.

*Describe the function of the lymph nodes.

*Identify accessible lymph nodes and name the related organs and functions

of the lymphatic system.

*List subjective and objectives components of an assessment of the

peripheral vascular and lymphatic systems


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Identify the organs located within each of the four abdominal

quadrants.

Identify pertinent topics that must be reviewed during the

abdominal portion of the interview.

Identify the correct sequence of examining techniques.Interpret findings obtained during inspection, auscultation,

percussion and palpation of the abdomen.


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10/27/2011 10:02:00 PM

Examine patient and family educations potential impact on mortality across

the lifespan

Differentiate between patient education and health promotion and discuss

opportunities for both

Discuss patients and healthcare providers motivations and perspectives inhealth care


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N210 Fall 2011: Exam 2 Study Guide

Thorax and Lungs

Landmarks:(Anterior)

Suprasternal notch: hollow U-shaped depression just above the sternum, in

between the clavicles.

Sternum: 3 parts: manubrium, the body, and the xiphoid process. (bony

ridge on the sternum is the sternal angle)

Sternal Angle: Angle of Louis articulation of the manubrium and the body

of the sternum and is continuous with the second rib. Marks the site of

tracheal bifurcation.

(Posterior):

Vertebra Prominens: Most prominent bony spur protruding at the base of the

neck. This is the spinous process C7.

Spinous Processes: The spinous processes align with their same numbered

ribs only down to T4. After T4 the spinous processes angle downward from

the vertebral body.

Inferior border of the scapula: The lower tip is usually at the 7th or 8th rib.

Twelfth Rib: palpate midway between the spine and the persons side to

identify its free tip.

Reference lines:

(Anterior):

Midsternal line

Midclavicular: bisects the center of each clavicle at a point halfway between

the palpated sternoclavicular and acromioclavicular joints.

(Posterior):

Vertebral line: Midspinal line

Scapular line: extends through the inferior angle of the scapula when the

arms are at the sides of the body.

(Side or Lateral Chest)

Anterior axillary line: extends down from the anterior axillary fold where the

pectoralis major muscle inserts.


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Posterior axillary: continues down from the posterior axillary fold where the

latissimus dorsi muscle inserts

Midaxillary line: runs down from the apex of the axilla and lies between and

parallel to the other two.

Lobes of the lungs:

Right lung is shorter than the left lung because of the Liver. Left lung is narrower because the heart bulges to the left. Right lung has 3 lobes, the left has 2. The lungs stack in diagonal sloping segments and are separated by

fissures that run obliquely through the chest.

The Left lung has no middle lobe. The anterior chest contains mostly upper and middle lobe with very little

lower lobe.

The posterior chest contains all lower lobe. Right middle lobe does not project onto the posterior chest at all. Fissures: p.414:Oblique: (right lung) crosses the 5th rib in the midaxillary line and terminates

at the 6th rib in the midclavicular line.

(Right lung) horizontal fissure: divides the right upper and middle lobes.

Extends from the 5th rib in the right midaxillary line to the 3rd intercostal

space or 4th rib at the right sternal border.

AP-to-transverse diameter

Normal adult: the thorax has an elliptical shape with an anteroposterior-to-

transverse diameter of 1:2 or 5:7.

Barrel Chest: ribs are horizontal instead of the normal downward slope.

Associated with normal aging/chronic emphysema and asthma as a result of

hyperinflation of the lungs.

Slides 9, 10, 11, 12:


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I will ask you where you would put your stethoscope to listen to a

particular lobe.

RUL:


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RML:

RLL:

LUL:

LLL:

LUL:RUL:

LLL:

RLL:

Right Lateral view:

RUL : extends from apex of the axilla down to the horizontal fissure at the

5th rib.

RML: extends from the horizontal fissure down and forward to the 6th rib at

the midclavicular line.

RLL: continues from the 5th rib to the 8th rib in the midaxillary line.

Left Lateral View:

LUL: extends from apex of the axilla down to the 5th rib at the midaxillary

line.

Left oblique fissure:

LLL: continues down to the 8th rib in the midaxillary line.

Slide 38:


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Definitions, sounds produced slide 40: p.444

Adventitious sounds: added sounds that are not normally heard in the

lungs. Caused by moving air colliding with secretions in the tracheobronchial

passageways or by the popping open of previously deflated airways.

Crackles, fine (rales): discontinuous, high pitched short popping during

inspiration. Sounds like rolling a strand of hair.

Coarse crackles or rales: Loud, low pitched bubbling and gurgling sounds

start in early inspiration and may be present during expiration. Sounds like a

Velcro fastener.

Wheezing: (rhonchi): high pitched: musical squeaking that have multiple

notes. Predominate in expiration but may occur in both.

Stridor: high-pitched, monophonic, inspiratory, crowing sound, louder in

neck than over chest wall. During inspiration.

Slide 41: respiratory distress, pending respiratory arrest

TachypneaInfants >60, children >30-40, adults >22

Bradypnea

Infants


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Anatomy of the heart:

Neck Vessels:

-Carotid Artery: Central artery; timing closely coincides with ventricular

systole

-Jugular Veins: Internal & External: Empty unoxygenated blood directly intosuperior -vena cava (Vein) Jugular veins give info about activity on the right

side of the heart. They reflect filling pressure and volume changes. Because

volume & pressure increase when the right side of the heart fails to pump

efficiently, the jugular veins expose this.

-Jugular pulse results from a backwash, waveform moving backward.

Structure and Function:

Position and surface landmarks

Precordium: area on anterior chest overlying heart and great vessels

During contraction, the apex beats against the chest wall, producing an

apical impulse

Four Chambers: Atria and ventricles

Great vessels lie bunched above the base of the heart

Pulmonary veins return freshly oxygenated blood to left side of heart, and

aorta carries it out to body

Conduction:Heart has unique ability: automaticity

Can contract by itself, independent of any signals or stimulation from body

Contracts in response to an electrical current conveyed by a conduction

system

Specialized cells in sinoatrial (SA) node initiate an electrical impulse, it is

called the pacemaker

Current flows in orderly sequence, first across atria to AV node low in atrial

septum

There, it is delayed slightly so that atria have time to contract before

ventricles are stimulated

Then, impulse travels to bundle of HIS, right and left bundle branches, and

then through ventricles

Electrical impulse stimulates heart to do its work, which is to contract


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Pathway of blood through the heart:

Unoxygenated (red) blood drains into vena cava, follows route of venous

blood

From liver to right atrium through inferior vena cava\

Superior vena cava drains venous blood from the head and upperextremities. From RA, venous blood travels through tricuspid valve to RV.

From RV, venous blood flows through pulmonic valve to pulmonary artery

to lungs. Pulmonary artery delivers unoxygenated blood to lungs.

Lungs oxygenate blood

From LA, arterial blood travels through Mitral valve to Left ventricle.

Aorta delivers oxygenated blood to body

Circulation is continuous loop; blood is kept moving by continually shifting

pressure gradients

Blood flows from area of higher pressure to area of lower pressure

Cardiac cycle: Rhythmic flow of blood through heart is cardiac cycle

Has two phases, diastole and systole

Diastole: ventricles relax and fill with blood; this takes up two thirds of

cardiac cycle

Systole: hearts contraction, blood pumped from ventricles fills pulmonary

and systemic arteries; this is one third of cardiac cycle

What are you hearing with S1, S2?S1 occurs with closure of the AV valves (tricuspid and mitral) and thus

signals the beginning of systole.

S2 occurs with closure of the semilunar valves (pulmonic and aortic)

and signals the end of systole.

Definition and causes of a murmur:

Conditions resulting in murmur:

Changes in velocity (flow murmur)

From hyperdynamic state (exercise, pregnancy, thyrotoxicosis)

Changes in viscosity

Anemia decreases H&H, decreases viscosity so produces hyperdynamic

state

Structural defects

Narrowed or incompetent valves, wall defects (patent ductus arteriosis,

patent foramen ovale)


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Turbulent blood flow and collision currents. A murmur is a gently, blowing

and swooshing sound. Can be heard over the precordium or radiate to the

carotid arteries.

Grading and recording of a murmur:Grade i barely audible in quiet room

Grade ii clearly audible, but faint (most common)

Grade iii moderately loud, easy to hear

Grade iv loud, asso. w/ palpable thrill

Grade v very loud, heard w/ one edge of stethoscope lifted off chest

Grade vi loudest, heard w/ entire stethoscope lifted just off chest

No such thing as a S1 or S2 murmur!!!

Definition and symptoms of angina:

Angina is chest pain or discomfort you get when your heart muscle does not

get enough blood. It may feel like pressure or a squeezing pain in your

chest. It may feel like indigestion. You may also feel pain in your shoulders,

arms, neck, jaw or back.

Symptoms:

Chest/back/jaw/L shoulder pain/pressure

DyspneaPallor

Diaphoresis

Fatigue

Palpitations/tachycardia

Nausea/vomiting

Dizziness

Exertional pattern

Silent MIs

If blockage on the inferior or back side you get nausea and vomiting

because of the vagus nerve. If blockage on right side of heart pain up into

the jaw.

Left atrium pain, pain in area up into the left shoulder

Women are different however. Women have different symptoms. More

back pain and nausea and indigestion. Less pain in general and not as


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severe. You have a group of symptoms that come after exertion and go

away with rest.

Landmarks for auscultation of the heart:

Landmarks in an adult with a normal heartRSB, 2nd ICS Aortic valve-

Rate, rhythm

S1 S2 (tricuspid, mitral) (LUB is louder?)

- Check for mitral murmur

Check for extra heart sounds

S3 and S4

Switch to bell and go back through all areas with patient supine, then in left

lateral position

Heard best LSB, 3rd or 5th ICS or over apex

PV and Lymphatic System

Know all arterial pulse sites on the body:

On arms: Radial, Ulnar, Brachial

On legs: Dorsalis Pedis, Posterior Tibialis, Popliteal, Femoral, Carotid


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Apical (aorta).

Pathway of lymph through body:

*2 Main trunks: Right lymphatic duct & thoracic duct

*Right: Drains R side of head and thorax and R arm and empties intosubclavian vein

*Thoracic: Drains rest of the body and empties into L subclavian vein

*Lymph nodes: Clumps of lymphatic tissue located along the vessels that

filter fluid before it is returned to blood stream, filtering out microorganisms.

Both superficial & deep.

Cervical nodes drain the head and neck

Axillary nodes drain the breast and upper arm

Epitrochlear node drain the hand and lower arm

Inguinal node drains most of the lymph of the lower extremity, the external

genitalia, and the anterior abdominal wall.

Definition and grading of edema:

Bilateral, dependent, pitting edema occurs with heart failure, diabetic

neuropathy, and hepatic cirrhosis. Unilateral edema occurs with

occlusion of a deep vein. Unilateral or bilateral edema occurs with lymphatic

obstruction.

Scale:1+ = Mild pitting, slight indentation, no perceptible swelling of the leg

2+ = Moderate pitting, indentation subsides rapidly

3+ = Deep pitting, indentation remains for short period of time, leg looks

swollen

4+ = Very deep pitting, indentation last a long time, leg is very swollen

Definition of lymphadenopathy:

Enlargement of the lymph nodes (>1 cm) from infection, allergy, or

neoplasm.

Definition of bruit:

A bruit occurs with accelerated or turbulent blood flow, indication

hyperplasia of the thyroid or atherosclerotic narrowing.

A soft, pulsatile, whooshing, blowing sound heard best with the bell.


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How to assess circulation:

assess capillary refill, look at color (pallor, cyanosis, deep blue/purple,

erythemea, brown-all signal abnormal circulation for a variety of different

reasons), warm vs cold, look for hair growth, edema (can occur with chronicvenous insufficiency), check the pulses, do Allen's test, etc

Abdomen

GI system:

Anus, Rectum

Anatomy what is in each quadrant, which organs are solid, hollow

Solid Viscera Organs

Solid viscera are those that maintain a characteristic shape: liver,

pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus

Liver fills most of RUQ and extends to midline

Pancreas: Posterior surface of liver just lateral to MCL

Spleen: soft mass of lymphatic tissue on posterolateral wall of abdominal

cavity, immediately under diaphragm

Kidneys & Adrenal glands: Lower pole of R kidney palpable

Ovaries & Uterus: Found midline on pelvic bimanual exam

Hollow Viscera Organs

Includes: stomach, gallbladder, small intestine, colon, and bladder

Stomach just below diaphragm, between liver and spleen

Gallbladder rests under posterior surface of liver, just lateral to right MCL

Small Intestines throughout (all 4 quadrants)

Stomach just below diaphragm, between liver & spleen

Gallbladder rests under posterior surface of liver, just lateral to right

midclavicular line

Aorta: Midline

RUQ

Liver solid

Gallbladder hollow

Duodenum hollow


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Head of pancreas * solid

Right kidney and adrenal gland solid

Hepatic flexure of colon * hollow

Part of ascending and transverse colon hollow

LUQ

Stomach hollow

Spleen solid

Left lobe of liver solid

Body of pancreas * solid

Left kidney and adrenal gland solid

Splenic flexure of colon * hollow

Part of transverse and descending colon hollow

RLQ

Cecum

Appendix

Right ovary and tube

Right ureter

Right spermatic cord

LLQPart of descending colon

Sigmoid colon

Left ovary and tube

Left ureter

Left spermatic cord

Midline

Aorta

Uterus, if enlarged

Bladder, if distended

Definition of constipation:Less than 3 bowel movements per week.

Or:


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Straining

Lumpy or hard stool

Feeling of incomplete evacuation

Feeling of anorectal blockage

Use of manual maneuvers

Types of ABD pain:

Nociceptive dull, cramping, crushing, throbbing Neuropathic shooting, stabbing, burning, tingling

o (Both can be described as sharp, intense)Visceral (nociceptive):dull, cramping, crushing, throbbing.

Hollow organ:

Stomach, bladder

Solid organ:

Pancreas, kidney

Referred (neuropathic)

Hollow organ

Stomach, bladder

Solid organ

Pancreas, kidney

Sequence of steps in abd assessment

Inspection, Auscultation, Percussion, Palpation.

Percussion:

Percussion

General tympany

Hollow organ/air RESONANT

Lungs, distended bowels (gas)

Solid organ/liquid DULL

Liver, ascites

Liver span

Normal adult (6cm -12cm)

Scratch test

Splenic dullness not usually done unless enlarged below costal

margin


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Costovertebral angle tenderness

Musculoskeletal System

Slides 4, 30, 50-65

Slide 4:1. Bone is living tissue that is constantly changing.

2. Ligaments: attach bone to bone, tendons: attach muscle to bone

3. Cartilage does not regenerate.

4. Dehydration decreases joint fluid.

5. Pregnant pelvis: increased levels of circulating hormones cause increased

mobility of the joints. Progressive Lordosis occurs and balance shifts

forward. This puts strain on the lower back muscles and may cause slumping

of the shoulders and anterior flexion of the neck. These upper back changes

may put pressure on the ulnar and median nerves during the third trimester.

MSK movements (flexion, extension, etc.)

Neurological system

Basis A&P (slide 2)

(You do not need to learn the cranial nerves for this exam)

Components of a standard neuro exam (slide 9)

Mental status

Cranial nerves

Motor system, including gait, coordination

Sensory system

Reflexes

Slides 61-70

Health Promotion

DHHS is an umbrella organization for what agencies?

USPSTF Recommendations, meaning of grades

Office of Minority Health National Partnership for Action

Secondary gain


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The leading cause of death in the US (all ages) in 2007

nursing 210 test 2 objectives-study guide

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