Question

Discuss the elements of inspection of an anterior and posterior chest wall.

What are three factors that affect tactile fremitus?

Discuss the five (5) factors that can affect auscultation.

Part 2

What are normal heart sounds? Where are they best heard? What do these heart sounds indicate?

What are abnormal heart sounds? What do these heart sounds indicate?

What is a pulse deficit? How is it calculated?

Part 3

Identify the peripheral arterial pulses. Discuss the grading scale for arterial pulses.

Discuss the grading scale for edema. What does the presence of edema indicate?

Answer 1

1. Inspection is a active process done with observation . Initial process begins with watching the patient breathing pattern .

Posterior chest Inspection.

1. Shape of chest wall
2. Position of person
3. Color and skin condition

• Barrel chest - Bulging of chest wall normally in children
• Pectus Excavatum - sternum shunkun into chest
• Pectus Carinatum - sternum protruding outside the chest

2. Tactile fremitus

It is vibration produced by the lungs

Factors:

A. High pitched voice

B. It feels more in the thin patient than in obese patient as the ches is close to skin

C. Its felt more near the sternum and it decrease as you moves done because of increase in tissues

3 .

• Poor lighting
• Week sound generation
• Nosing environment
• Position of patient
• Size of the patient ( thin or obese)

Part 2

Heart sound are the noise generated by the beating heart and the resulting blood flowing through it .

1.Normal Heart sound 2. Location where they heard 3. sound indication

• S1

- Sound like ' lubb '

- it is sound of mitral and tricuspid vavle closing simultaneously.

- It starts of systole

- Heard loudest at apex of the heart ( approximately at 5^th intercostal space , midclavicular line on left )

• S2

- Sound like ' Dubb '

- Sound of simultaneous closing of pulmonic and aortic vavles

- its end systole

- Heard loudest at base of heart ( best over 2^nd intercoastal space on right )

Abnormal heart sounds are and their indication

• Heart murmurs are of two types

1. innocent - found in children caused by blood flow moving in heart

2. abnormal - due to congenital heart malformations

• Galloping rhythms - it's normal sound when your heart is pumping at very fast rate

Pulse Deficit means the difference in the number of beats of the heart and of the pulse .

It is calculated by finding the difference between the apical and radial pulse

Part 3

1. The palpation of the high of blood moving away from the heart though vessel in the extremities .E.g. Radial, Brachial, femoral, Popliteal, Posterior tibial, dorsal pedis.

The intensity of the pulse is graded on a scale of 0 to 4

0 - refers to the nonpalpable pulse

1+ - refers to the barely detectable pulse

2+ - refers to diminished but greater than 1+

3+ - normal pusle easily palpable

4+ - stronger than normal

2.Edeam means accumulation of excessive amount of fluid in the extravascular space of the body.

Grading:

1+ : less than 2mm disappears early

2+ : 2-4 mm disappears in10-15 sec

3+ : 4-6 mm last more than 1min

4+ : 6-8 min last more than 2 min

It indicates problems associated with kidney , heart and liver function etc