A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe in this situation?
Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema
Rasping cough, thick mucoid sputum, wheezing, and bronchitis
Productive cough, dyspnea, weight loss, anorexia, and tuberculosis
Fever, dry nonproductive cough, and diminished breath sounds
ANS: Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, ankle edema
Heart failure often presents with increased respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema, and pallor in light-skinned individuals. A patient with rasping cough, thick mucoid sputum, and wheezing may have bronchitis. Productive cough, dyspnea, weight loss, and dyspnea are seen with tuberculosis; fever, dry nonproductive cough, and diminished breath sounds may indicate Pneumocystis jiroveci (P. carinii) pneumonia. See Table 18-8.
ANS: Chest pain that is worse on deep inspiration, dyspnea
Findings for pulmonary embolism include chest pain that is worse on deep inspiration, dyspnea, apprehension, anxiety, restlessness, PaO2 less than 80, diaphoresis, hypotension, crackles, and wheezes.
ANS: A. Voice sounds are faint, muffled, and almost inaudible when the patient whispers "one, two, three" in a very soft voice.
C. When the patient speaks in a normal voice, the examiner can hear a sound but cannot distinguish exactly what is being said.
D. As the patient says a long "ee-ee-ee" sound, the examiner also hears a long "ee-ee-ee" sound.
As a patient says "ninety-nine" repeatedly, normally, the examiner hears sound but cannot distinguish what is being said. If a clear "ninety-nine" is auscultated, then it could indicate increased lung density, which enhances transmission of voice sounds. This is a measure of bronchophony. When a patient says a long "ee-ee-ee" sound, normally the examiner also hears a long "ee-ee-ee" sound through auscultation. This is a measure of egophony. If the examiner hears a long "aaaaaa" sound instead, this could indicate areas of consolidation or compression. With whispered pectoriloquy, as when a patient whispers a phrase such as "one-two-three," the normal response when auscultating voice sounds is to hear sounds that are faint, muffled, and almost inaudible. If the examiners hears the whispered voice clearly, as if the patient is speaking through the stethoscope, then consolidation of the lung fields may exist.