Health Assessment Exam 3-Chapters 17 & 18

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Montgomery glands:

Small, elevated sebaceous glands located within the areola.

Glandular Tissue:

Tissue composed of lobes, lobules and alveoli
Lactiferous ducts and sinuses

3 tissues of breast:

Glandular, Fibrous and Adipose

Cooper's Ligaments:

aka: suspensory ligaments
fibrous bands extending vertically from the
surface to attach on chest wall muscles

Upper outer quadrant:

This is the site of most breast tumors.

Four groups of axillary nodes in breast:

Central axillary nodes, pectoral (anterior) nodes,
subscapular (posterior) nodes & lateral nodes.

Tanners maturity rating scale:

Preadolescent-small elevated nipple
Breastbud stag-small mound breast/nipple; areola widens breast//areola enlarge-nipple flush w/surface
Areola & Nipple form secondary mound over breast
Mature Breast--Only nipple protrudes; areola flush w/breast

Menarche:

The beginning of menstruation, which usually begins in breast development stage 3 or 4

2nd month:

Breast changes during pregnancy first noticed

Colostrum:

Thick, yellow fluid that is a precursor for milk, that contains same amount of protein & lactose, but no fat.

After menopause:

Ovarian secretion of estrogen & progesterone decreases causing breast glandular tissue to atrophy.

Gynecomastia:

Excessive breast development in men

Mastalgia:

Pain in the breast

Galactorrhea:

Spontaneous flow of milk from the nipple

Paget's Disease:

A malignant condition that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast.

Left breast:

This breast is sometimes larger because of heart.

Between days 4-7:

Time when breasts are at smallest density due to decreased levels of estrogen & progesterone.

Benign breast disease:

50% of women have it
Breasts sore & tender
Can have bumpy consistency

Premature thelarche:

Early breast development w/no other hormone-dependent signs.

Mammary Duct ectasia:

A condition in which there is dilation of the lactiferous duct, caused by stagnation of cellular debris. Occurs in women who have lactated. Signs of duct ectasia can include nipple retraction, inversion, pain, and sometimes a bloody discharge.

Carcinoma:

Bloody, unilateral nipple discharge from a single duct.

Intraductal Papilloma:

A small, noncancerous (benign) tumor that grows in a milk duct of the breast; may have serous or serosanguineous discharge.

Mastitis:

Inflammatory mass before abscess formation usually occuring in one quadrant; area is red, swollen, tender, hard and very hot. Most common in women who are lactating.

Spinous Processes:

a part of the vertebrae projecting backward from the arches, giving attachment to the back muscles

7th or 8th rib:

Location of the inferior border of the scapula.

Mediastinum:

Middle section of thoracic cavity containing the esophagus, trachea, heart and great vessels.

Pleural cavities:

Found on either side of the mediastinum, these cavities contain the lungs.

Right lung:

Has 3 lobes & is shorter than other lung because of underlying liver

Pleurae:

A serous membrane which folds back onto itself to form a two-layered, membrane structure

Pleural cavity:

The body cavity that surrounds the lungs.

Pleural Cavity:

The thin space between the two pleural layers; it normally contains a small amount of pleural fluid.

Visceral pleura:

The inner pleura that covers the lungs and adjoing structures.

Parietal pleura:

The outer pleura that is attached to the chest wall and is highly sensitive to pain.

Trachea:

Lies anterior to the esophagus & is 10-11 cm long

Parenchyma of lung:

Although often used to refer solely to alveolar tissue, term describes any form of lung tissue including bronchioles, bronchi, blood vessels, interstitium, and alveoli.

Acinus:

A functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs and alveoli.

Gaseous exchange:

Occurs across the respiratory membrane in the alveolar duct and in the alveoli.

4 major functions of respiration:

1. Oxygen to body for energy production
2. Removing CO2 as waste product of energy reactions
3. Maintaining acid-base balance of arterial blood
4. Maintaining heat exchange

Pons & Medulla:

The respiratory center in the brainstem that controls involuntary respirations.

Hypercapnia:

Too much CO2 in the blood, which stimulates us to breathe.

Hypoxemia:

A decrease of oxygen in the blood.

Inspiration:

Contraction of the bell-shaped diaphragm causes an increase in size of the thoracic container.

Alveoli:

Gas exchange happens here.

Crackles or Rails:

Fluid colliding with air.

Immediately after birth:

The foramen ovale in the heart closes.

A few hours after birth:

the ductus arteriosus (linking the pulmonary artery and the aorta) contracts and closes.

Respiratory Changes in older adults:

Costal cartilage becomes calcified; respiratory muscles strength declines; lung is more rigid and harder to inflate.

Vital Capacity:

The maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum.

Residual Volume:

The amount of air remaining in the lungs even after the most forceful expiration.

Hemoptysis:

The expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g. in tuberculosis or other respiratory infections or cardiovascular pathologies).

Chronic bronchitis:

History of productive cought for 3 months of the year, for 2 years in a row.

Orthopnea:

Difficulty breathing when supine.

Paroxysmal nocturnal dyspnea:

Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing. It is most closely associated with congestive heart failure

Childhood respiratory infections:

4 to 6 uncomplicated upper respiratory infections per year is expected in early childhood.

Barrel Chest:

Occurs from hyperinflation of the lungs.

Normal Chest ratio:

1:2. Width of chest should be wider than depth of chest.

Unequal chest expansion:

Occurs with marked atelectasis or pneumonia, fractured ribs or pneumothorax.

Atelectasis:

Defined as the lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation. It may affect part or all of one lung.

Fremitus:

A palpable vibration on the human body.

Decreased fremitus:

Occurs when anything obstructs transmission of vibrations, such as obstructed bronchi, Pleural thickening, pneumothorax or emphysema.

Crepitus:

Coarse crackling sensation palpable over the skin surface.

Diaphragmatic Excursion:

The movement of the thoracic diaphragm during breathing.

Hyperresonance:

Lower-pitched, booming sound found when to much air is present, as in emphysema or pneumothorax.

Resonance:

Low-pitched, clear, hollow sound in healthy lung tissue.

Dull:

Soft, muffled thud, as with pneumonia, pleural effusion, atelectasis, or tumor.

Wheezes/Ronchi:

Obstruction of airflow.

Abnormal breath sounds:

Absent or diminished

Advintitious Breath Sounds:

Extra or additional sounds that are heard over normal breath sounds

Bronchial / Tracheal breath sounds:

High pitched; loud amplitude; Harsh, hollow tubular

Bronchovesicular breath sounds:

Moderate pitch; moderate amplitude; mixed quality

Vesicular breath sounds:

Low pitch; soft amplitude; Rustling, like wind through trees.

Reasons for decreased/absent breath sounds:

Bronchial tree obstructed-secretions, mucus plug, foreign body
Emphysema-Loss elasticity in lung fibers; decreased force of inspired air-lungs already hyperinflated, so inhaled air doesn't make much noise.

Reasons for increased breath sounds:

Louder than they should be, w/high pitched tubular w/prolonged expiratory phase & distinct pause bet in & ex
Occur when consolidation (pneumonia) or compression (fluid in intrapleural space) yields dense lung area enhancing sounds

Atelectatic crackles:

Short, popping, crackling sounds that do not last beyond a few breaths; not pathologic.

Tactile Fremitus:

Palpating over the lung apices while patient says "99"; compare vibrations.

Forced expiratory time:

Number of seconds it takes for a person to exhale from total lung capacity to residual volume; measures air flow obstruction.

Pulse oximeter:

Assesses arterial oxygen saturation.

6 minute distance walk:

Measures pulmonary rehabilitation abilities.

Apgar scoring system:

0-2 indicates severely depressed newborn-full resuscitation
3-6 indicates moderately depressed newborn
7-10 indicates newborn in good condition

5 categories of Apgar:

Heart rate Respiratory effort muscle tone
Reflex irritability Color

Normal infant respirations:

30-40 breaths per minute; may spike to 60

Pectus Excavatum:

Chest wall sunken in; most noticeable on inspiration.

Pectus Carinatum:

Forward protrusion of sternum.

Scoliosis:

S shaped curvature of thoracic and lumbar spine.

Kyphosis:

Exaggerated posterior curvature of thoracic spine (humpback)

Tachypnea:

Rapid, shallow breathing w/a rate of >22 BPM; normal response to fever, fear, or exercise.

Bradypnea:

Slow breathing, with decreased rate of <12 BPM.

Hyperventilation:

Blows off too much CO2, causing need to breath again; increase in both rate and depth and occurs w/extreme exertion, fear or anxiety.

Hypoventilation:

Irregular shallow respirations; not getting enough oxygen.

Cheyne-Stokes respirations:

Usually occurs near death; Long periods of apnea; cycle of wax and wane.

Chronic obstructive breathing:

Normal inspirations-prolonged expirations (empysema); feels like they are suffocating.

Stridor:

Very high pitched sound; inflammation of epiglotis; common in croup.

Pleural friction rub:

Inflammation of pleural membrane; course grating sound when rubbed together during breathing.

Bronchitis:

Inflammation of the bronchi w/partial obstruction of bronchi by secretions or constrictions; acute or chronic.

Lobar Pneumonia:

Infection in lung parenchyma; alveoli become consolidated w/bacteria resulting in decreased surface area of respiratory membrane, causing hypoxemia.

Atelectasis:

Collapsed shrunken section of alveoli or entire lung as a result of airway obstruction, compression of lung or lack of surfactant.

Asthma:

Allergic hypersensitivity that produces responses of bronchospasm, inflammation, and highly viscous mucus into airways. Increases airway resistance.

Emphysema:

Destruction of pulmonary connective tissue; permanent enlargement of air sacs; increased airway resistance, especially on expiration-produces hyperinflated lung.

Pleural effusion (thickening):

Collection of excess fluid in the intrapleural space.

Heart failure:

Pump failure causing pulmonary congestion or increased blood in pulmonary capillaries; dependent air saces are deflated; pulmonary capillaries engorged.

Pneumothorax:

Free air in pleural space, neutralizes negative pressure, causing partial or complete lung collapse; no symetrical expansion.

Pulmonary Embolism:

Undissolved material originating in legs or pelvis detach and travel through venous system and lodge in pulmonary vessels.

Tuberculosis:

Crackles w/productive cough and dark colored sputum.

ARDS:

Acute respiratory distress syndrome: Acute pulmonary insult damages alveolar capillary membrane leading to plumonary edema.

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