Ch 16: Thorax And King Assessment Flashcards
What is the function of the upper respiratory portion
What is the function of the lower respiratory portion
Upper: warm, moisturize, transport air to lower
Lower: oxygenize, ventilation occurs
Give a few structures of the mid thoracic cavity
Mediastinum heart and great vessels lungs - R: 3lobes -L: 2 lobes thoracic nerves -T1-T12 -phrengic -intercoastal nerves Thoracic muscles Arterial blood supply Pulmonary arteries (2) -deoxy Pulmonary veins (2) -oxy
Give the thoracic nerves and whaT they innervate

Phrenic nerve: innervate diaphragm
Intercostal nerve: innervate coastal muscles
Name the thoracic muscles all 5
1. Intercostal
- Transverse thoracic
- Subcostal
- The Levator posterium
- Serratus posterior
What landmarks do we use to document accurately in relation to the anterior chest
(Give the 2 types)
Vertical: ribs (with isc)
Horizontal: UP AND DOWN horizontal lines provide a reference land mark for documentation (midclavicular)
What are other names for the sternal angle
Where is the sternal angle brief description
Angle of Louis, and sternal manubrial angle
The origin for the second rib (bump)
How do you get posterior thoracic landmarks
Ribs plus vertical spinal processes
Give the true ribs, false ribs, how many ribs are in the anterior and posterior structure
Give the location of the coastal angle and what it should be
True: 1-7
False: 8-12
There are a total of 12 ribs anterior and posterior
Coastal angle is at the. bottom of sternum at the xiphoid process. Should be 90°
What is the exact purpose of the reference lines and ribs
The reference lines and ribs used to document findings accurately when assessing
How do you find the sternal angle
Start at trachea you go down to the sternal notch walk 4-5 cm to the bony manubrium, the little hill is known as your sternal angle (angle of Louis) 
What are the anterior reference lines parallel to
Give the anterior reference lines
How far do the lines run
What is the most important reference line to establish
Anterior reference lines parallel to sternum

Reference lines:
1. Midsternal: center of sternum
*2. Mid clavicular: from clavicle to 12th rib
3. Anterior axillary: extends from anterior axillary fold when arms are at side 
The lines from all the way down the 12th rib
The most important reference line to establish is the mid clavicular
What are the posterior reference lines parallel to
Give the posterior reference lines
How do you determine the vertebral line beginning
Posterior reference lines parallel to vertebra line
Posterior reference lines 1. Vertebral line 2. Mid scapular line 3. Posterior auxiliary line 4 mid auxiliary line
Determine vertebral line beginning by having patient flex neck to expand process C7 and T1
What is each lung divided by and how many lobes do each lung have
(R and L)
Give reference line landmarks in auscultating of right middle lobe
What is The anterior reference line you want to use to discover the right middle lobe
Each long is divided by oblique fissure
R: three lubes
L-two lobes
How to find right middle lobe:
-Right mid lobe extends from 4th rib at sternal boarder to 5th rib at mid axillary line ANTERIORLY
Use right mid clavicular to assess right middle lobe
What is a variation you have to implement for women to be able to hear the right middle lobe and how do you do it
In women you may have to move the breast (displays tissue) by asking patient to move breast or lifting it with your forearms
What is the only lung divided into thirds
Where is the base of the lung
where is the Apex along
What is a key difference in relation to the apex of both lungs and how do we acknowledge this difference when auscultating
Only the right lung is divided into thirds
Base= big =bottom
Apex =top
In relation to both Apex:
-right apex of right lung displaced higher than left Apex about (2 to 4 cm) Above of clavicle which is why we auscultate supraclavicular

What side do we hear the right middle lobe on anterior or posterior and why
Right middle lobe heard anteriorly because it is blocked in the posterior section
Where does your lower respiratory tract begin
Lower respiratory tract begins at the trachea is bifurcation to right and left at the Carina
Give characteristics of the right main bronchus
what is most likely to happen to the right main bronchus
How do we ensure this mistake does not happen
Right mean bronchus: shorter, wider more vertical
Right Main Bronchus more likely to be intubated because
-people go too far in
Which ends up blocking the left lung
We ensure this does not happen by always auscultating after insertion and comparing lung sounds
Give the structural progression of the branches of the lower respiratory tract along with the progression of sounds
From bronchi, to bronchioles, to aveoli
Loud larger airway sounds to softer, finer, more difficult to auscultate airways sounds
1 INDICATOR
How do you know if someone’s airway is narrowing/worsening asthma
You will hear wheezes
Where is the pleura and what does it contain in relation to the visceral and parietal layers
What does this substance cause
Pleura located within the thorax
Plural contains plural fluid in plural space that lubricates visceral ( outer lung) and parietal (lines thoracic wall)
The plural fluid causes smooth sliding movements of lungs during respiration
What is the main trigger for breathing
An increase in CO2
What are things that can alter breathing patterns
(Give medication‘s and others)
Give specific example and how bidy responds 
Medications
-opiates, sedatives, overdose, hypoventilation
• OPIATES : decrease respiratory rate so not enough oxygen is reaching brain and a decrease in body acidity (pH)
Anxiety
Brain injury
Hyperventilation
What can fear and anxiety lead a patient to in relation to breathing
What do you want to do with a patient was having an anxiety attack

Fear and anxiety can lead to patient to progressively stop breathing and an MI
Aka HYPERVENTILATION
NEVER LEAVE OATIENT HAVING ANXIETY ATTACK you want to stay with the patient who’s having an anxiety attack and try to calm them down THEN get help
What are two things you’re gonna notice in a patient with a heroin overdose
What do you use to combat the overdose
With a heroin overdose patient will have
- pinpoint pupils
- CNS depression
Use Narcan (naloxone) to combat overdose
What is our ultimate goal during inhalation
What is the typical amount of air entering lung during inhalation and what is it known as
Our ultimate goal during inhalation is to increase thoracic diameter and pressure
Typical amount of air entering lung during inhalation is 500 to 800 mL
- AKA: title volume
What is the normal SP O2 of someone with COPD/emphysema
What is their main breathing trigger
If COPD/emphysema SPO2: 88%
COPD/emphysema main breathing sugar equals low O2 concentration that causes a decrease in acidity triggering decrease in SPO2
Normal SPO2 of healthy person
Normal: 94–95%
During inhalation what does the diaphragm do to the lungs, what do thorax and lungs increase, and what increases in the external intercostals
What is inhalation pressure greater than
During inhalation:
- diaphragm pulls lungs down
- thorax and lungs increase vertical diameter/pressure
- external intercostals increase diameter
Tidal volume greater v atmospheric pressure
What kind of process is respiration
What kind of process is expiration
Respiration(inhalation) : automatic
Expiration: passive process
What does expiration Involve in relation to internal structures
Expiration involves diaphragm, internal intercostal, abdominals relax
Air ispushed out of the lungs and chest, while the abdomen relaxes
Name conditions at altar respirations
Obesity pregnancy muscular dystrophy fractures anxiety pneumonia asthma COPD/emphysema * tension/ pneumo * Hemothorax *head injury *spinal injury *pulmonary embolism
How specifically does a tension pneumothorax/pneumothorax affect respirations
Attention/pneumothorax causes an accumulation of air in the pleural cavity compressing the lung
Breath sounds ABSENT (are not auscultatable )on affected side
How does a brain stem injury Alter respirations
Where is injury most likely to be located
With a brainstem injury you lose involuntary respiratory control
Location of injury C3 – C5
