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Lecture 2

NSE13 - Winter Semester - Week 2

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Department
Nursing
Course
NSE 13A/B
Professor
Mary Santilli
Semester
Winter

Description
Yasmin Groisman Winter Semester Week 2 Outline subjective questions 1. Cough Questions to ask:  Do you have a cough? When did it start? Gradual or sudden?  How long have you had it?  How often do you cough? At any special time of day or just on arising? Cough wake you up at night?  Do you cough up any phlegm or sputum? How much? What color is it?  Cough up any blood? Does this look like streaks or frank blood? Does the sputum have a foul odor?  How would you describe your cough: hacking, dry, barking, hoarse, congested, bubbling?  Cough seem to come with anything: activity, position (lying), fever, congestion, talking, anxiety?  Activity make it better or worse?  What treatment have you tried? Prescription or over-the-counter medications, vaporizer, rest, position change?  Does the cough bring on anything: chest pain, ear pain? Is it tiring? Are you concerned about it? 2. Shortness of breath Questions to ask:  Ever had any shortness of breath (SOB) or hard breathing spells? What brings it on? How severe is it? How long does it last?  Is it affected by position, such as lying down?  Occur at any specific time of day or night?  Shortness of breath episodes associated with night sweats?  Or cough, chest pain, or bluish color around lips or nails? Wheezing sound?  Episodes seem to be related to food, pollen, dust, animals, season or emotion?  What do you do in a hard-breathing attack? Take a special position, or use pursed-lip breathing? Use any oxygen, inhalers, or medications?  How does the SOB affect your work or home activities? Getting better or worse or staying about the same? Yasmin Groisman 3. Chest pain with breathing Questions to ask:  Any chest pain with breathing? Please point to the exact location.  When did it start? Constant, or does it come and go?  Describe the pain: burning, stabbing?  Brought on by respiratory infection, coughing, or trauma? Is it associated with fever, deep breathing, unequal chest inflation?  What have you done to treat it? Medication or heat application? 4. History of respiratory infections Questions to ask:  Any past history of breathing trouble or lung diseases such as bronchitis, emphysema, asthma, pneumonia?  Any unusually frequent or unusually severe colds?  Any family history of allergies, tuberculosis, or asthma? 5. Smoking history Questions to ask:  Do you smoke cigarettes or cigars? At what age did you start? How many packs per day do you smoke now? For how long?  Have you ever tried to quit? What helped? Why do you think it did not work? What activities do you associate with smoking?  Live with someone who smokes? 6. Environmental exposure Questions to ask:  Are there any environmental conditions that may affect your breathing? Where do you work? At a factory, chemical plant, coal mine, farm, outdoors in a heavy traffic area?  Do anything to protect your lungs, such as wear a mask or have the ventilatory system checked at work? Do anything to monitor your exposure? Have periodic examinations, pulmonary function tests, radiographic examination?  Do you know what specific symptoms to note that may signal breathing problems? 7. Self-care behaviors Questions to ask:  Last tuberculosis skin test, chest radiographic study, pneumonia or influenza immunization? Yasmin Groisman Identify the location of the following landmarks: suprasternal notch, sternal angle, vertebral prominences of C and 7 , midc1avicular line, midsternal and midaxillary lines, inferior angle of scapula, costal angle Yasmin Groisman Identify the location of the apex and base of the lung anteriorly and posteriorly and locate landmarks for each lobe Yasmin Groisman Anteriorly: apex – highest point, lung tissue is 3 or 4 cm above the inner third of the clavicles base – lowest boarder, rest on the diaphragm at about the sixth rib in the midclavicular line Posteriorly: apex – C7 base – T10 Identify anterior and posterior landmarks where the trachea bifurcates The trachea lies anterior to the esophagus and is 10 to 11 cm long in the adult. It begins at the level of the cricoid cartilage in the neck and bifurcates just below the sternal angle into the right and left bronchi. Posteriorly, tracheal bifurcation is at the level of T4 or T5. Yasmin Groisman Identify the respiratory muscles and state their function Inspiration:  Sternomastoid – elevate sternum  Scalenus muscles – elevate upper ribs  External intercostals – elevate ribs  Diaphragm – descends as it contracts Expiration:  Internal intercostals – depress ribs  External oblique and abdominal rectus – depress lower ribs and compress viscera Differentiate the following percussion notes in terms of intensity, pitch, and location: dullness, resonance, hyperresonance, tympany  Dullness amplitude: soft pitch: high quality: muffled thud duration: short location: relatively dense organ, as liver or spleen  Resonance amplitude: medium-loud pitch: low quality: clear, hollow duration: moderate location: over normal lung tissue  Hyperresonance amplitude: louder pitch: lower quality: booming duration: longer location: normal over child’s lung, abnormal in the adult, over
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