Ch 19. Lungs

Question 1

Anterior thoracic landmarks

Answer 1

Suprasternal notch
Sternum
Sternal angle
Costal angle: when the R/L costal margins from an angle of the xiphoid process

Question 2

Posterior thoracic landmarks

Answer 2

Vertebra prominens
Spinous processes
Inferior border of scapula
Twelfth rib

Question 3

Dif between R/L Lungs

Answer 3

Right is shorter due to the liver
Right has 3 lobes

Left is narrower due to the heart
Left has 2 lobes

Question 4

Functions of respiratory system

Answer 4

• Control of respiration
• Changing chest size during respiration
• Inspiration/Expiration
• suppying oxygen to the body
• Removing CO2 from the body
• Maintain homesosistis for the acid/base balance in arterial blood
• Maintain heat exchange

Question 5

Expiration is a …

Answer 5

passive act

Question 6

Developmental Considerations: Pregnant women

Answer 6

• Enlarging uterus elevates diaphragm; decreases vertical diameter of thoracic cage, compensated by increase in horizontal diameter
• Enlarging uterus decreases lung expansion
• Fetus increases o2 demands

Question 7

Developmental Considerations: Older adults

Answer 7

• Lungs more rigid and harder to inflate
• Decrease in vital capacity
• Increase in residual volume
• Decrease in number of alveoli
• Increased shortness of breath on exertion
• Increased risk for postoperative complications
• Round, barrel-shaped thoracic cage and kyphosis
• Chest expansion somewhat decreased
• Less mobile thorax

Question 8

Cultural and Social Considerations

Answer 8

• New and re-emergent cases of TB in Canada (2010) at unprecedented national low
• Variation in rates by jurisdiction; disproportionately high in Nunavut
• Asthma rates down, but contributing factor in 10% of hospital admissions of children under 5 years
• Preventable risk factors for respiratory disease: tobacco smoke, poor air quality
• Lung cancer is leading cause of cancer death in Canada
• Women incur greater lung damage from exposure to environmental tobacco than men

Question 9

Subjective Data: Health History

Answer 9

Cough
Shortness of breath
Chest pain with breathing
History of respiratory infections
Smoking history
Environmental exposure
Self-care behaviours

For older adults 
Activity intolerance
Level of activity
Lung disease
Pain

Question 10

Inspection

Answer 10

Thoracic cage

• Shape and configuration of chest wall
• Anteroposterior/transverse diameter
• Position patient takes to breathe
• Skin colour and condition

Anterior chest

• Shape and configuration of chest wall
• Facial expression
• Level of consciousness
• Skin colour and condition
• Quality of respirations
• Rib interspaces
• Accessory muscles

Question 11

Palpation

Answer 11

• Symmetrical expansion:
- thumbs at T9-T10 take a big breath, hands should be going up/down symmetrically. Uneven expansiton could be due to Atelectisis or phnemonia

• Tactile (or vocal) fremitus:

• palpable vibration. Use palm/base of fingers. Repeat “99” or “blue moon” start at apex of lung and palpate from one end to other. Each area should feel the same symmetrically.
• location of bronchi can effect this
• Increased fremitis over increased solidation of lung tissue. Would need to be pretty big changes to increase fremitis.

• Palpate the entire chest wall

Question 12

Percussion

Answer 12

Predominant note over lung fields
Resonance
Don’t palpate over female breast tissue as it’ll dampen sound
Note boarders of cardiac dullness in percussing, dullness in liver boarder, tympany over gastric space

Question 13

Auscultate

Answer 13

Breath sounds

• Listen to a full respiration in each area, use diagram
• Bronchial breath sounds— IE
• Vesicular breath sounds are soft and low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over the most of the lung surface. They have an inspiration/expiratory ratio of 3 to 1
• Bronchial breath sounds are hollow, tubular sounds that are lower pitched. They can be auscultated over the trachea where they are considered normal.There is a distinct pause in the sound between inspiration and expiration. I:E ratio is 1:3

Adventitious sounds – abnormal lung sound, caused by secretions or air moving with secretions

• Crackles
• Wheeze
• Atelectatic crackles

Do not place stethoscope directly over female breast
Don’t forget lateral chest
-Extension of the vesicular lung field
-Right middle lobe

Question 14

Measurement of pulmonary function status

Answer 14

Pulse oximeter

• Values evaluated in context of patient’s hemoglobin level, acid–base balance, and ventilatory status
• normal is 95-100%
• COPD normal could be 88-92%

6-minute distance walk

• clip on pulse ox and get patient to walk at their own pace as far as they can in 6 min
• patient that walks more than 300m in 6min more likely to engage in ADLs