NR-302 PHYSICAL ASSESSMENT: – EXAM 3 STUDY GUIDE
50 Questions – Multiple Choice, Select All That Apply, HOTSPOT, Multiple Sequences
Respiratory
4 major functions
Supplying oxygen for energy
Removing carbon dioxide
Acid-base balance (homeostasis)
Maintaining heat exchange
Control of respirations – normal stimulus, alternative stimulus and what condition
Pons and medulla
Normal stimulus (Hypercapnia)
Decrease in O2 in blood (Hypoxemia)
Inspiration (Active) expiration (passive)
Lower – bronchi, pleural membranes, muscles of respiration (normal, accessory)
Bronchi- right main bronchus
Pleural membranes- the parietal lines diaphragm and thoracic wall, the visceral lines outer surface
of lung, and pleural fluid acts as lubricant
Muscles of inspiration- normal( intercostal muscles, diaphragm), accessory ( neck, abdomen,
chest)
Anterior Landmarks – sternum (Angle of Louis, sternal angle, 2ICS), clavicle, costal angle (normal)
Costal angle < 90 degrees
Posterior Landmarks – vertebra prominens, spinous processes (T1 to T4), CVA tenderness
Vertebra prominens- C7 (if 2 bumps equally prominent C7, T1)
Spinous processes- aligned w/ same numbered rib to T4
CVA tenderness- kidney problems
References Lines – anterior, posterior, and lateral thorax
Anterior- sternal, midclavicular, anterior axillary
Posterior- vertebral, scapular, posterior axillary
Lateral- anterior axillary, midaxillary, posterior axillary
Lobes (3 on right, 2 on left), apex versus base
Right- upper, middle, lower lobes
Left- upper, lower lobes
Apex (highest point) anterior and 3-4 cm above clavicle
Base (lower border)
Pediatric (AP:Transverse diameter, abdominal breathing, role of surfactant)
AP: transverse 1:1 ratio
Abdominal breathing until 5-7 yrs
Pregnant (Diaphragmatic breathing, SOB, costal angle changes, lordosis)
Muscles and cartilage of the ribs relaxes
o Diaphragm rises into chest to accommodate fetus
o Diaphragmatic breathing
o Shortness of breath (SOB), dyspnea, increase awareness of breathing in last trimester
Total oxygen demand can increase 20%
, Costal angle widens
Deeper breathing, respiratory rate unchanged
Lordosis or swayback, “waddling” gait
Geriatric (overall aging changes to respiratory rate and depth, vital capacity, alveoli); cough ability, kyphosis
Aging lung is more rigid, harder to inflate
o Decrease vital capacity, increased residual volume
o Decreased number of alveoli
o Decreased in respiratory depth
o Slight increase in respiratory rate
Decrease in cough ability
o Weakening of the chest muscles, decrease cilia
o Compromises airway clearance
Kyphosis “hunchback”
Subjective
Cough – differences between acute versus chronic; time of day; productive versus non-productive;
color of phlegm or sputum; descriptions and meaning; associated symptoms; possible treatments
Acute (lasts 2 or 3 weeks), chronic (over 2 months)
Often? Time of day?
o Continuous – acute illness, respiratory infection
o Afternoon/evening – may irritants at work
o Night – postnasal drip
o Early morning – chronic bronchial inflammation, smokers
Productive or non-productive? Phlegm or sputum?
o Hemoptysis (blood), frank blood versus streaks of blood
o White or clear – colds, bronchitis, viral infections
o Yellow or green – bacterial infections
o Rust colored – TB, pneumonia
o Pink, frothy – pulmonary edema, medications
Describe your cough?
o Hacking – pneumonia
o Dry – early congestive heart failure (CHF)
o Barking – croup
o Congested – colds, bronchitis, pneumonia
Associated?
o Activity? Position (lying)? Fever? Congestion? Talking? Anxiety?
Treatment?
o OTC medications? Vaporizer? Rest? Position change?
Brings on anything?
o Chest pain? Ear pain? Tiring? Concern?
SOB – with exertion or at rest; position – orthopnea, PND; associated symptoms
Exertion or at rest? Amount of activity brings it on?
o Number of blocks walked, number of stairs, talking, rest
50 Questions – Multiple Choice, Select All That Apply, HOTSPOT, Multiple Sequences
Respiratory
4 major functions
Supplying oxygen for energy
Removing carbon dioxide
Acid-base balance (homeostasis)
Maintaining heat exchange
Control of respirations – normal stimulus, alternative stimulus and what condition
Pons and medulla
Normal stimulus (Hypercapnia)
Decrease in O2 in blood (Hypoxemia)
Inspiration (Active) expiration (passive)
Lower – bronchi, pleural membranes, muscles of respiration (normal, accessory)
Bronchi- right main bronchus
Pleural membranes- the parietal lines diaphragm and thoracic wall, the visceral lines outer surface
of lung, and pleural fluid acts as lubricant
Muscles of inspiration- normal( intercostal muscles, diaphragm), accessory ( neck, abdomen,
chest)
Anterior Landmarks – sternum (Angle of Louis, sternal angle, 2ICS), clavicle, costal angle (normal)
Costal angle < 90 degrees
Posterior Landmarks – vertebra prominens, spinous processes (T1 to T4), CVA tenderness
Vertebra prominens- C7 (if 2 bumps equally prominent C7, T1)
Spinous processes- aligned w/ same numbered rib to T4
CVA tenderness- kidney problems
References Lines – anterior, posterior, and lateral thorax
Anterior- sternal, midclavicular, anterior axillary
Posterior- vertebral, scapular, posterior axillary
Lateral- anterior axillary, midaxillary, posterior axillary
Lobes (3 on right, 2 on left), apex versus base
Right- upper, middle, lower lobes
Left- upper, lower lobes
Apex (highest point) anterior and 3-4 cm above clavicle
Base (lower border)
Pediatric (AP:Transverse diameter, abdominal breathing, role of surfactant)
AP: transverse 1:1 ratio
Abdominal breathing until 5-7 yrs
Pregnant (Diaphragmatic breathing, SOB, costal angle changes, lordosis)
Muscles and cartilage of the ribs relaxes
o Diaphragm rises into chest to accommodate fetus
o Diaphragmatic breathing
o Shortness of breath (SOB), dyspnea, increase awareness of breathing in last trimester
Total oxygen demand can increase 20%
, Costal angle widens
Deeper breathing, respiratory rate unchanged
Lordosis or swayback, “waddling” gait
Geriatric (overall aging changes to respiratory rate and depth, vital capacity, alveoli); cough ability, kyphosis
Aging lung is more rigid, harder to inflate
o Decrease vital capacity, increased residual volume
o Decreased number of alveoli
o Decreased in respiratory depth
o Slight increase in respiratory rate
Decrease in cough ability
o Weakening of the chest muscles, decrease cilia
o Compromises airway clearance
Kyphosis “hunchback”
Subjective
Cough – differences between acute versus chronic; time of day; productive versus non-productive;
color of phlegm or sputum; descriptions and meaning; associated symptoms; possible treatments
Acute (lasts 2 or 3 weeks), chronic (over 2 months)
Often? Time of day?
o Continuous – acute illness, respiratory infection
o Afternoon/evening – may irritants at work
o Night – postnasal drip
o Early morning – chronic bronchial inflammation, smokers
Productive or non-productive? Phlegm or sputum?
o Hemoptysis (blood), frank blood versus streaks of blood
o White or clear – colds, bronchitis, viral infections
o Yellow or green – bacterial infections
o Rust colored – TB, pneumonia
o Pink, frothy – pulmonary edema, medications
Describe your cough?
o Hacking – pneumonia
o Dry – early congestive heart failure (CHF)
o Barking – croup
o Congested – colds, bronchitis, pneumonia
Associated?
o Activity? Position (lying)? Fever? Congestion? Talking? Anxiety?
Treatment?
o OTC medications? Vaporizer? Rest? Position change?
Brings on anything?
o Chest pain? Ear pain? Tiring? Concern?
SOB – with exertion or at rest; position – orthopnea, PND; associated symptoms
Exertion or at rest? Amount of activity brings it on?
o Number of blocks walked, number of stairs, talking, rest
