Page 300 - Cardiac Nursing

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276 P A R T III / Assessment of Heart Disease
■ Figure 12-20 Acute respiratory distress syndrome, as evidenced
by diffuse bilateral opacities in patient postoperatively after bilateral
lung transplantation. ■ Figure 12-21 Right lower lobe pneumonia. Signs of consolida-
tion (bronchial breathing, crackles, and dullness to percussion) are
heard over the right lower chest. In pneumonia, egophony is heard
over areas of consolidated lung. The patient is instructed to say the
letter “e,” and the lung is auscultated to demonstrate this finding.
Normally the “e” sound is heard, but consolidated lung changes the
“e” to an “a” that sounds like the “bleating of a goat.” This sign is also
known as “an e-to-a change.” (Film courtesy of Julie Takasugi, MD)
REFERENCES Braunwald’s heart disease (8th ed., pp. 327–343). Philadelphia: Saunders
Elsevier.
1. McAdams, H. P., Samei, E., Dobbins, J., et al. (2006). Recent advances in 4. Connolly, M. A. (2001). Black, white, and shades of gray: Common ab-
chest radiology. Radiology, 241(3), 663–683. normalities in chest radiographs. AACN Clinical Issues, 12(2),
2. Erkonen, W. E. (2005). Radiography, computerized tomography, magnetic 259–269.
resonance imaging, and ultrasonography: Principles and indications. In W. E. 5. Stanford, W. (2007). Radiologic evaluation of acute chest pain-suspected
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Erkonen & W. L. Smith (Eds.), Radiology 101. The basics and fundamentals myocardial ischemia. American Family Physician, 76(4), 533–537.
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of imaging (pp. 3–15). Philadelphia: Lippincott Williams & Wilkins. 6. Hendrikse, K. A., Gratama, J. W., Hove, W., et al. (2007). Low value of
3. Bettman, M. A. (2008). The chest radiograph in cardiovascular disease. In routine chest radiographs in a mixed medical-surgical ICU. Chest, 132(3),
P. Libby, R. O. Bonow, D. L. Mann, D. P. Zipes, & E. Braunwald (Eds.), 823–828.