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Cardiology and Respiratory Health Assessment
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- Denver School Of Nursing
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HA Exam 3 Study GuideHalf will be Respiratory-focused and the other half Cardiovascular.
Use your lecture notes and pull in textbook as needed. Practice the physical assessment multiple times and think about what you are doing and why. Complete the Sherpath quizzes, including the case studies.
Remember your Nursing Process. Assess then Analyze then you can Intervene. We apply supplemental oxygen only if they need it.
The order of the assessment doesn’t matter that much for Resp and CV. Use your clinical judgment. What is the acuity of the situation? Are they in respiratory distress? What would be the most important assessments for that client? Respiratory (Ch 19)
Anatomy: incorporated into multiple exam questions
olung lobes
RUL: supraclavicular down to 4th rib
LUL: supraclavicular down to 5th rib
RML: 4-5 ICS anteriorly/laterally
RLL/LLL: scapular area (T3) down to T10
oSternal angle: continuous with 2nd rib; trachea bifurcates here
ocostal angle should be 90 degrees
oSuprasternal notch is in between clavicles, above sternal angle
oLung borders (ICS) anteriorly and posteriorly
anteriorly: supraclavicular (apices) down to 5th ICS posteriorly: C7 (apices) down to T10
Breathing Patterns : what do they look like and what can cause them?
oTachypnea
oBradypnea
oHypoventilation
oHyperventilation S/S of acute vs chronic respiratory disease
oAcute: labored breathing (retractions, accessory muscle use, tripod)
Acute hypoxemia – changes in LOC (restlessness, anxiety), cyanosis
oChronic: AP = or > T (barrel chest)
costal angle widened
nail clubbing (angle of nail base >180°)
hypertrophy of accessory muscles
Sputum analysis oFrothy = pulmonary edema (HF, ARDS)
oClear/white = viral or chronic bronchitis
oPurulent = acute infection
Palpation: normal vs abnormal findings
oCrepitus: how would you describe this and what does this mean?
oTactile fremitus
What can cause increased fremitus?
Where on thorax is it normally stronger?
Percussion: oResonance = Normal finding over lungs oDullness = abnormal density (fluid, mass)
oHyperresonance = abnormal air (pneumothorax, COPD)
Auscultation: oAppropriate technique: diaphragm, side-to-side, mouth breathing (not nose), listen from apices to bases, can moisten chest hair
oBronchial vs bronchovesicular vs. vesicular lung sounds: what do they sound like and where do you normally hear them?
oAdventitious breath sounds (what do they sound like and what does it mean?): Crackles (rales)
Rhonchi
Wheeze Friction rub Stridor oVoice sounds: perform if you suspect consolidation; know normal vs abnormal findings for these tests
Bronchophony
Whispered Pectoriloquy Egophony Respiratory Disorders: oAsthma: common triggers and S/S
oS/S of ARDS
oAtelectasis: causes, risk factors, S/S
oPneumothorax: S/S
oPleural effusion: causes, S/S
oPleuritis: S/S
oCOPD: head-to-toe S/S
oPneumonia: risk factors and S/S
oCroup: S/S
Cardiovascular (Ch 20-21)
Assessments to include in a CV exam: oPrecordium: inspect & palpate PMI, rate, rhythm, heart sounds
oPeripheral arteries : bruits (carotids, aorta, renal, iliac, femoral)
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