NURS 612 Key Points to Review for Exam 2

NURS 612 Key Points to Review for Exam 2 Key Point to Review – Chest / Lungs STUDENT NOTES What are examples of appropriate history of present illness questions you may ask a patient with a chief complaint of a respiratory issue? Pg. 264—267 Targeted topics of HPI: --Cough 1. cough- onset(gradual, sudden, duration) e of cough ( dry, wet, barking, nonproductive, productive) 3. Sputum production and characteristics 4.Pattern—occasional, productive, positional 5. Severity- tires? Disrupts sleep/ conversations? 6. associated symptoms- sob, chest pain, fever, nasal congestion 7. efforts to treat --Past medical history 1. thoracic, nasal or pharyngotracheal trauma or surgery. Hospitalizations for pulmonary disorders 2. oxygen use 3. chronic pulmonary diseases 4. cardiac, ca, blood clotting disorders. 5. testing, allergies, tb tests, 6. immunizations against streptococcus pneunomiae , influenza Family history— Tb? Cystic fibrosis, allergy, asthma, clotting disorders, bronchitis, bronchiectasis Personal history— Employment/home environment- allergens/tobacco use/exposure to respiratory illnesses/nutritional status/travel exposures/alternative therapies/ etoh/ illict drugs. Infants and children:low birth weight? Aspiration of toy? Ingestion of chemicals? Swallowing dysfunction? Apneic episodes Key Point to Review – Chest / Lungs STUDENT NOTES Pregnant women: gestation to delivery, exercise and energy expenditure, Exposure to respiratory illness/flu vaccine? Any condition that would displace the diaphragm upwards Older adults— Sedentary habits? Difficulty swallowing? Need for 02? Flu and pna vaccine? ---*chronic respiratory diseases Emphasize:--smoking history, cough, dyspnea on exertion, blood tinged, yellowish/greenish sputum fatigue weight change fever, night sweats Describe how you would inspect the chest. How do you describe the size shape (A/P diameter) and symmetry of the chest? What are the thoracic landmarks? Pg. 267. Inspect the chest with the patient upright, if possible without support, unclothed to the waist. Position the patient so that the light source comes from at different angels to accentuate findings that are more subtle and otherwise difficult to detect—retractions or the presence of a deformity. NOTE: the shape and symmetry of the chest from both the back and the front, the costal angle, the angel of the ribs and the intercostal spaces. The bony framework is obvious, the clavicles prominent superiorly, the sternum usually rather flat and free over overlying abdunance of tissue. A/P Diameter:: pg. 267 AP diameter is normally less than the lateral diameter. The ratio is expected to be about 0.70 to Key Point to Review – Chest / Lungs STUDENT NOTES 0.75. It does increase with age. ** If a/p diameter approaches or is equal to about 1 then a chronic condition is present.--- *Barrel chest—from chronic asthma, emphysema, or cystic fibrosis IN BARREL CHEST- ribs are more horizontal, spine is kyphotic and the sternal angle is more prominent. The trachea may posteriorly be displaced. Pigeon chest—structural deformity. Pectus carinatum. Prominent sternal protrusion. Funnel chest—pectus excavatum. An indentation of the lower sternum above the xiphoid process. Spine deviated posteriorly- kyphosis Spine deviated laterally—scoliosis Thoracic landmarks—pg. 269 Midsternal line: vertically down the midline of the sternum. Right and left midclavicular lines: parallel to the midsternal line, beginning at the midclavicular, the inferior borders of the lungs, generally cross the sixth rib at the midclavicular line. Right and left anterior axillary lines: parallel to the midsternal lines. Beginning at the anterior axillary lines. Right and left mid axillary lines: parallel to the midsternal line, beginning at the midaxilla. Right and left posterior axillary lines: parallel to the midsternal line, beginning at Key Point to Review – Chest / Lungs STUDENT NOTES the posterior axillary folds. Vertebral lines: vertically down the spinal process. Right and left scapular lines: parallel to the vertebral lines, through the inferior angle of the scapula when the patient is erect --the spinous process is the 7th cervical vertebra is readily palpated. The thoracic vertebrae can be counted from there. Describe how you assess the rate and quality of respirations? What is normal and abnormal? Pg. 269-270 Should be between 12 and 20. Do not tell the patient you are going to count to prevent them from varying the rate. *ratio of respirations to heartbeats should be 1:4. Count the respirations after palpating the pulse -depends on the age of the patient and the degree of exertion. Normal: expect the patient to breathe easily, regularly, without apparent distress. Abnormalities: Air trapping: increasing difficulty in getting breath out. Occurs if the pulmonary tree is obstructed. The rate of respirations increases to compensate. . the effort becomes more shallow, the amount of trapped air increases and the lungs inflate ( p. 268) Bradypnea—slower than 12 breaths per