Ch 18 Throax & Lungs Flashcards
Pleural cavities
On either side of the mediastinum contain the lungs
Mediastinum
Middle section of the thoracic cavity containing the esophagus trachea heart and great vessels
Lobes of the lungs of
Right lung has 3 lobes and left lung has 2
lobes
Pleurae
Thin slippery, forms an envelope between the lungs and the chest wall
Visceral pleura
Lines the outside of the lungs dipping down into the tissues it is continuous with the parietal pleura lining the inside of the chest wall and diaphragm
Costodiaphragmatic recess
The pleural extend about 3cm below the level of the lungs forming . This is the potential space; when it abnormally fills with air or fluid it compromises lung expansion
Acinus
Functional respiratory unit consist of bronchioles, alveolar ducts, alveolar sacs, and the alveoli. Gas exchange occurs across the respiratory membrane in alveoli ducts.
Mechanics of Respirations
(1) supply oxygen to the body for energy production (2) removing carbon dioxide as a waste product for energy reaction (3) maintain homeostasis (acid-base balance) of Arterial blood (4) maintain heat exchange
Hypercapnia
Increase of carbon dioxide in the blood
The normal stimulus for us to breathe
Hypoxemia
A decrease of oxygen in the blood
Also increases Respirations but is less effective
Surfactant
The complex lipid substance needed for sustained inflation of the air sacs
Characteristics timing of a cough
Continuous throughout the day– acute illness (ex respiratory infection)
Afternoon/evening– may reflect exposure to irritants at work
Night– postnatal drip, sinusitis
Early morning – chronic bronchial inflammation of smokers
Hemoptysis
The act of coughing up blood
Chronic bronchitis characterized
History of productive cough for 3 months out of a year for 2years in a row
Characteristic sputum production :
White or clear mucoid
Colds , bronchitis, viral infections,
Characteristic sputum production :
Yellow or green mucoid
Bacterial infection
Characteristic sputum production :
Rust colored mucoid
Tuberculosis pneumococcal pneumonia
Characteristic sputum production :
Pink frothy mucoid
Pulmonary edema some sympathomimetic medication have side effect pink tinged mucus
Conditions of Characteristics cough sound
Mycoplasma pneumonia = hacking
Early heart failure= dry
Croup= Barking
colds, bronchitis, pneumonia = congested
Orthopnea
Difficulty breathing when supine need pillows to fine a comfort zone to breath
Paroxysmal nocturnal dyspnea
Awakening from sleep with a shortness of breath (SOB) and needing to be upright to achieve comfort
Emphysema
A type of COPD damaging the air sac alveoli in the lungs
Histoplasmosis
A fungus that can effect the lungs once inhaled typical seen with farmers the fungus is found in soil
Coccidioidomycosis
A fungus Found in the soil of south western United States and Mexico
Pneumoconiosis
Lung disease cause by inhaling dust and coal mines
Atelectasis
collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung.
Symmetric chest expansion
You place your hand on the back of pt. as they inhale your thumbs slide apart evenly
Unequal chest expansion occur with atelectasis or pneumonia
Tactile (vocal) Fremitus
Fremitus is a palpable vibration sound is generated from larynx are transmitted through patent bronchi and lung parenchyma to the chest wall where you feel the vibration
Have pt. repeat 99 or blue moon they generate strong vibrations
Tactile Fremitus can be heard:
More prominent between the scapulae and around the sternum,
Affects the normal intensity: Thick chest wall , obese or muscular chest , pitch and intensity: a loud, low-pitch voice generates more than soft, high-pitched sound.
Decreased Fremitus (vibration)
Occurs when anything obstructs transmission of vibrations (ex. Obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema
Increased Fremitus
Occurs with compression or consolidation of lung tissue (ex. Lobar pneumonia)
Rhonchal Fremitus
Is palpable with thick bronchial secretions. vibration felt when inhaled air passes through thick secretion in the larger bronchi
Pleural friction Fremitus
Is palpable with inflammation of the pleura produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid
Crepitus
Is a coarse crackling sensation palpable over the skin surface. Occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue.
Resonance
Is the low-pitched , clear, hollow sound that predominates in healthy lung tissue in the adult. However it has not constant standard
Hyperresonance
Is a low-pitched booming sound found when too much air is present as in emphysema or pneumothorax
Dull
Soft muffled thud signals abnormals density in the lungs as with pneumonia , pleural effusion atelectasis or tumor
Diaphragmatic excursion
“Exhale and hold it” briefly while you press down the scapular line until sound changes from resonant to dull (on ea. side) this estimates the level of diaphragm separating the lungs from the abdominal viscera mark that spot “take a deep breath and hold it” continue précis sing down from 1st mark and mark the level where the sound changes to dull. Measure the difference this is the diaphragmatic excursion Should be equal bilaterally and measure about 3 to 5 cm in adults
Pleural effusion
is excess fluid that accumulates in the pleural cavity. This excess can impair breathing by limiting the expansion of the lungs.
Types of Normal breath sounds
Bronchial (tracheal) , bronchovesicular , vesicular
Bronchial (tracheal)
High pitched loud amplitude sound quality is harsh, hollow tubular in the trachea and larynx
Bronchovesicular
Moderate pitch and amplitude sound quality is mixed heard over the bronchi where fewer alveoli are located around the sternum
Vesicular
Low pitch soft amplitude sound rustling like the sound of wind in trees heard over the peripheral lungs fields where air flows through
Adventitious sounds
The added sounds that are not normally heard in the lungs. Crackles/rales, wheeze/rhonchi, or stridor
Crackles (fine)
Sounds like rolling hair between the fingers occurs with obstructive disease (emphysema, chronic bronchitis) or restrictive diseases (pneumonia, heart failure)
Crackles (coarse)
Loud low pitch bubbling gurgling sound sounds like opening Velcro occurs with pulmonary edema , pneumonia, pulmonary fibrosis
Wheeze (sibilant) high pitched
High pitched musical squeaking sounds that sound polyphonic occurs diffuse airway obstruction from acute asthma or chronic emphysema
Wheeze low pitched (sonorous rhonchi)
Low pitched monophonic single note musical snoring moaning sounds they are heard throughout the cycle occurs Bronchitis, single bronchus obstruction , Tumor
Voice sounds
Ask a person to repeat a phrase such as 99 while you listen normal voice transmission is soft muffled and indistinct. Usually not done in the routine examination. Performed if suspected lung pathology on the basis of earlier data
Testing for bronchophony, egophony, or whispered pectoriloquy
Bronchophony
Person repeats 99 listen with stethoscope Normally: is soft muffled and indistinct Abnormal : you auscultate a clear 99 pathology that increases lung density will enhance transmission of voice sounds
Egophony
Listen while person says long “ee-ee-eee-ee” Normally: you hear eeeeeee
Abnormal: you hear a bleating long aaaaa sound
Whispered Pectoriloquy
Auscultate ask pt. whispers one-two-three
Normally: faint muffled almost inaudible
Abnormal: with only small consolidation the whisper is very clearly
Apgar scoring system
Scores the baby on its ability to extrauterine life it scores heart rate respiratory effort, muscle tone, reflex irritability and color
Barrel chest
Equal anteroposterior-to-transverse Ribs are horizontal instead of normal downward slope An increased anteroposterior chest diameter.
Scoliosis
A lateral S-shaped curvature of the thoracic and lumbar spine usually involved vertebrae rotation unequal shoulder and scapular height and unequal hip levels
Kyphosis
An exaggerated posterior curvature of thoracic spine (humpback) that causes significant back pain and limited mobility
Phrenic Nerve
When breathing is initiated messages are sent from the medulla’s respiratory center by way of this nerve to the primary respiratory muscles.
