NURS 6225 Advanced Health Assessment Exam 2 (2022)

NURS 6225 Advanced Health Assessment Exam 2 (2022) When examining a patient for the apical impulse (PMI), which of the following is LEAST important to assess? A. Location B. Amplitude C. Rhythm D. Diameter - Answer- C. Rhythm Assess location, amplitude, duration, and diameter 5 A's of tobacco cessation - AnswerWhat is tactile fremitus? - Answer- palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking "99" NORMAL= buzzing on hands when patient say "99" SOLIDS CONDUCT SOUND/VIBRATIONS BETTER THAN AIR Conditions where tactile fremitus is absent or decreased - Answer- Fremitus is decreased or absent when the transmission of vibrations is impeded. Feeling little or no buzzing at all compared to similar lung areas; LARGE POCKETS OF AIR IN THE LUNGS thick chest wall obstructed bronchus COPD pleural effusion fibrosis pneumo (Air) infiltrating tumor fibrosis emphysema consolidation Asthma Causes of asymmetrical fremitus - Answer- Decreased fremitus Unilateral pleural effusion Pneumo neoplasm Increased fremitus Unilateral pneumonia Causes of increased fremitus - Answer- feeling of a strong vibration compared to similar lung areas Consolidation of lung tissue pneumonia atelectasis bronchitis Apical Impulse (PMI) - Answer- Point of Maximal Impulse (Apex of the heart): between 4th to 5th intercostal space, midclavicular Apex beat is palpable in only 25-40% of healthy adults in supine position and 50% in left lateral decubitus position—especially those who are thin Some hide behind rib cage, despite positioning diaphragmatic excursion - Answer- *assesses degree and symmetry of diaphragm movement; percuss from areas of resonance to dullness * not percussing the diaphragm itself you are identifying the resonant lung tissue and the duller structures below. * you can infer the probable location of the diaphragm from the level of dullness during diaphragmatic excursion an "absent decent" means what? - Answer- An abnormally high level suggests a pleural effusion or an elevated hemidiaphragm from atelectasis or phrenic nerve paralysis fine crackles/rales - Answer- occurrence- on end inspiration; dont clear with cough. Quality- High pitched short crackling Causes- collapses or fluid-filled alveoli open Course crackles/rales - Answer- Occurrence- End inspiration, doesn't clear with cough Quality- Loud, moist, low-pitched, bubbling Causes- Collapsed or fluid-filled alveoli open Wheezes - Answer- Occurrence- Expiration and inspiration when severe Quality- High-pitched, continuous Causes- blocked airflow as in asthma, infection, foreign body obstruction Ronchi - Answer- Occurrence- Expiration/inspiration; change/disappeat with cough Quality- Low-pitched, continuous, snoring, rattling Cause- Fluid blocked airways Stridor - Answer- Occurrence- Inspiration Quality- loud, hi-pitched crowing heard without stethoscope Cause- obstructed upper airway........