has thorax

• Auscultation of the heart


  1. Place the diaphragm of the stethoscope at the apex and listen closely to the rate and rhythm of the apical impulse

  2. Auscultate to identify S1 and S2

  3. Auscultate for extra heart sounds
• Normal heart rate and rhythm


  • Rate should be 60-100 bpm, with regular rhythm
• S1 (lub)


  Corresponds with each carotid pulsation and is loudest at the apex of the heart
• S2 (dub)


  Immediately follows after S1, and is loudest at the base of the heart
• Extra heart sounds


  • Normally no sounds are heard
  • Ejection sounds or clicks (e.g. a mid-systolic click associated with mitral valve prolapse)
• Rubric: Assessment of the Heart

  
• Abdominal pain

  Occurs when specific digestive organs or structures are affected by chemical or mechanical factors such as inflammation, infection, distention, stretching pressure, obstruction, or trauma
• Indigestion (pyrosis)


  Often described as heartburn, may be an indication of acute or chronic gastric disorders including hyperacidity, Gastroesophageal reflux disease (GERD), peptic ulcer disease, and stomach cancer
• Nausea


  May reflect gastric dysfunction and is also associated with many digestive disorders and diseases of the accessory organs, such as the liver and pancreas, as well as with renal failure and drug intolerance
• Appetite


  Loss of appetite (anorexia) is a general complaint often associated with digestive disorders, chronic syndromes, cancers, and psychological disorders
• Bowel elimination


  Changes in bowel patterns must be compared with usual patterns for the client
• Constipation


  Usually defined as a decrease in frequency of bowel movements or the passage of hard and possibly painful stools
• Diarrhea


  Defined as frequency of bowel movements producing unformed or liquid stools

  
• Personal health history

  • Ulcers
  • GERD
  • Inflammatory or obstructive bowel disease
  • Pancreatitis
  • Gallbladder or liver disease
  • Diverticulosis
  • Appendicitis
  • Urinary tract disease
  • Abdominal surgery or trauma
• Medications


  May produce side effects that adversely affect the GI tract
• Family history

  Increases the client's risk for certain GI disorders
• Alcohol intake


  Can affect the GI tract through immediate and long-term effects on such organs as the stomach, pancreas, and liver
• Dietary and fluid intake

  Helps to determine nutritional and fluid adequacy and risk factors for altered nutrition, constipation, diarrhea, and diseases such as cancer
• Exercise


  Promotes peristalsis and thus regular bowel movements, and may help reduce risk factors for various diseases
• Stress


  Can affect GI function through effects on secretion, tone, and motility
• The sternum is the breastbone.
• upper airway structures

  Nasopharynx

  Oropharynx

  Larynx
• Nasopharynx


  warms, filter and humidify
• Oropharynx


  helps to make sound
• Larynx


  sends air to lower airways
• lower airway structures

  • Trachea
  • Bronchioles
  • Alveoli
• Trachea


  divides into the right and left mainstem bronchi and continues to divide into smallerpassages
• Bronchioleso

  terminate into the alveolar ducts and alveoli
• Alveolio

  Is the gas exchanging units in the lungs
• THORAX

  2 clavicles

  2 scapula

  1 Sternum (breast bone)

  12 pair of ribs – allow chest to contract and expand during each breath 12 thoracic vertebrae
• RESPIRATORY MUSCLES

  • Diaphragm

  • Intercostal Muscles

  • Trapezius

  • Sternocleidomastoid
• Anatomical Landmarks


  • the right lung has three lobes, and the left has two these lobes are divided by fissures
• Auscultate / Palpate Cardiovascular (normal)

  ▪ Heart, regular rate and rhythm (HRRR)

  ▪ no extra sounds
• Auscultate / Palpate Cardiovascular (Deviations from normal)


  ▪ Right – sided S3 and S4

  ▪ Absent / diminished pedal pulses and ankle

  ▪ Pedal edema
• RESPIRATION PATTERNS (Normal / Eupnea)


  normal breathing pattern

  16–20 breaths/min and regular
• RESPIRATION PATTERNS (Tachypnea)

  may be a normal response to fever, anxiety, or exercise

  more than 24 breaths / min and shallow
• Bradypnea


  less than 10 breaths / min and regular

  may be normal in well – conditioned athletes
• Hyperventilation


  usually occurs with extreme exercise, fear, or anxiety

  causes of hyperventilation include disorders of the central

  nervous system

  overdose of the drug salicylate
• Kussmaul


  a type of hyperventilation associated with diabetic ketoacidosis

  rapid, deep, labored
• Hypoventilation 


  Usually associated with overdose of narcotics or anesthetics

  Decreased rate, decreased depth, irregular pattern