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Characteristics of normal breath sounds:
Bronchial
- Intensity and Pitch: Loud and high
- Quality: Course or tubular
- Duration: Insp < Exp
- Locations: Larynx and trachea
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Characteristics of normal breath sounds:
Bronchovesicular
- Intensity and Pitch: Intermediate & Int
- Quality: Intermediate
- Duration: Insp = expiration
- Locations: Anterior-between 1st and 2nd interspaces; between scapula
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Characteristics of normal breath sounds:
Vesicular
- Intensity and Pitch: Soft and low
- Quality: Whispering undertones
- Duration: Insp>exp
- Locations: Over most of lung fields
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Bronchophony
- During auscultation, ask patient to say "99"
- Normal: sounds are muffled or difficult to distinguish
- Abnormal (e.g., consolidation): easily understood or louder
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Egophony
- During auscultation, have patient say ee
- Normal: muffled, difficult to hear
- Abnormal: ee sounds like A
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Whispered pectoriloquy
- During auscultation, ask patient to whipser "one, two, three"
- Normal: faint, muffled, difficult to hear
- Abnormal: Louder and clearer than whispered sounds
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Techniques for breath sounds
- bronchophony, egophony, whispered pectoriloquy
- Abnormal results found with consolidation, or compression (e.g., lobar pneumonia, atelectasis (collapsed lung), or a tumor)
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Wheeze
- Sounds musical, high pitched
- Futtering of narrowed airway walls (think of a vibrating reed)
- Take note of if it occurs during inspiration or expiration or both
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stridor
- Stridor is an abnormal, high-pitched, musical breathing sound caused by a blockage in the throat or voice box (larynx). It is usually heard when taking in a breath.
- Emergency situation!
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Eupnea
- Normal respiration rate
- 12-20 breaths/minute
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dyspnea
difficulty breathing
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apnea
periods without respirations
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hyperpnea
- rapid + deep breathing
- hyperventilation
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Cheyne-Stokes
periods of deep breathing followed by periods w/o respirations
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crepitus
- air under skin
- discovered during palpation
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Chest expansion test
- Place thumbs at T10 with fingers around rib cage
- push loose skin into a fold
- assess for symmetric side to side expansion while patient breathes
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Tactile fremitus
- Do when concerned about consolidation or obstruction
- Palmar base or ulnar surface of hand above scapula
- patient says, "99"
- Vibration results are reduced with obstruction, fluid, or tumors
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Crackle
- Result from fluid in ariway or alveoli
- Sounds like velcro
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Rhonchi
- AKA course wheezing or gurgling
- Caused by secretions moving during respiration
- commonly accompanies pneumonia
- Lower pitch, but louder volume
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Assessment of patient with atelectasis
- Shortness of breath
- Decreased breath sounds
- Decreased O2 saturation
- Increased tactile fremitus
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Preload
- Streching of muscle fibers in ventricles
- Stretching results from blood volume in ventricles at end of distole
- Poor venous return=poor preload
- Right heart problems cause left heart problems
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Contractility
- Inherent ability of myocardium to contract normally
- Influenced by preload
- Greater the stretch (i.e., preload), the more forceful the contraction
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Afterload
- amount of pressure the ventricle muscles must generate to overcome higher pressure in the aorta to get blood out
- Reflects changes in radius of arterioles
- Afterlooad increased in hypertension and vasoconstriction
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Stroke volume
Amount of blood ejected from heart with each heart beat
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Cardiac output
Stroke volume x beats/min
CO = SV x R
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Ejection fraction (EF)
- Fraction of blood pumped out of heart with each beat
- Normal EF = 55% or higher
- Echocardiogram is test used to determine EF
- Congested heart failure: low EF, causes shortness of breath
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First heart sound (S1)
- LUB
- Closure of tricuspid and mitral valves
- Beginning of systole
- Loudest at apex
- Coincides with carotid artery pulse
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Second heart sound (S2)
- DUB
- closure of pulmonic and aortic valves
- end of systole
- loudest at base
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Third heart sound (S3)
(SLOSH-ing-in ) (S1, S2, S3)
- Normally can't hear diastole
- Heart failure: when the ventricles fill, a vibration is created (ventricles resistance to fill)
- Ventricular gallop
- Low pitched, use bell of stethoscope
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Fourth heart sound (S4)
(a-STIFF-wall) (S4, S1, S2)
- Ventricle filling sound
- Heard at end of diastole
- Related to ventricular filling resistance
- Atria contract and push blood into noncompliant ventricle
- heard right before S1
- Best heard at apex
- Conditions: hypertension
- Use bell
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Conditions leading to cardiac murmurs
- Increase in velocity of blood flow
- Decrease in viscosity of blood (e.g., anemia)
- Structural defects in the valves or unusual openings in the chambers
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Mumurs
- Timing: systolic or diastolic
- Quality: crescendo, decrescendo, crescendo-decrescendo (blowing, harsh, or rumbling or musical)
- Location: 5 places to auscultate on the anterior chest
- Radiation: where the murmur sound radiates; radiates in direction of blood flow
- Intensity: loudness graded 0-6
- Pitch: low, medium, high
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