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NUR 3066 Health Assessment > CH 19 Respiratory (Thorax and Lungs) > Flashcards

CH 19 Respiratory (Thorax and Lungs) Flashcards

1
Q

Structure and Function (thoracic cage)

A

sternum
12 pairs of ribs
31 thoracic vertebrae
diaphragm - floor of thoracic cage (separates the thoracic cavity from abdomen)

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2
Q

Thoracic Landmarks (anterior)

A

surface landmarks are important for assessing underlying respiratory structures

landmarks include:

  • suprasternal notch (jugular notch)
  • sternal angle (angle of louis)
    - useful location to start counting ribs
  • costal angle (90 degrees or less)
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3
Q

Thoracic Landmarks (posterior)

A

more difficult to count ribs because of muscle mass and soft tissue

landmarks include:

  • vertebra prominens (beginning point/ help start to palpate spine)
  • spinous processes (correlated with rib number)
  • inferior border of scapula
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4
Q

Reference Lines

A

Anterior chest - midsternal line and midclavicular line

Lateral Chest - anterior axillary, posterior axillary, and midaxillary

Posterior Chest - vertebral line (midspinal) and scapular line

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5
Q

Thoracic Cavity (sturctures)

A

mediastinum (middle section containing esophagus, trachea, heart, and great vessels)

Pleural Cavities (contain left and right lungs)

Apex of Lung (highest point - 3-4cm above clavicle)

Base of Lung (lower border - rests on diaphragm)

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6
Q

Lobes of the Lungs

A

Paired but not symmetric

Right Lung
- 3 lobes

Left Lung

  • 2 lobes
  • more narrow because of cardiac notch
  • LUL better to auscultate anteriorly and LLL better to auscultate posteriorly
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7
Q

Pleurae

A

serous membranes that envelop between lungs and chest wall

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8
Q

Visceral vs parietal pleurae

A

visceral - lines outside of lungs

parietal - lines inside of chest wall and diaphragm

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9
Q

Pleural Cavity

A
  • space filled with lubricating fluid which enable lung
    movement during inspiration and expiration
  • negative pressure holds lungs tightly against chest all
  • costodiaphramatic recess (pleural space beneath the
    lungs)
    - potential space to abnormally fill with fluid or air
    (compromises lung expansion)
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10
Q

Trachea and Bronchial Tree

A

Acinus - where gas exchange occurs

- bronchioles -> alveolar ducts -> alveolar sacs -> alveoli

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11
Q

Respiration (4 major functions)

A

Supply oxygen to the body for energy production

Removing CO2 as a waste product of energy reactions

Maintaining homeostasis (acid/base balance)

Maintaining heat exchange

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12
Q

Respirations

A

major negative feedback loop (reaction that causes a decrease in function to stabilize the system)

increase of CO2 in blood (hypercapnea) is normal stimulus to breathe

respiratory control center in brainstem = involuntary control of respirations

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13
Q

Inspiration vs expiration

A

inspiration - air rushing into lungs
(diaphragm contracts, flattens, descends)

Expiration - air is expelled/ chest recoil
(diaphragm relaxes)

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14
Q

Developmental Considerations: Infant/children

A

susceptible to adverse effects of second-hand smoke

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15
Q

Developmental Considerations: Pregnant Women

A

increased oxygen demand for fetus

enlarges uterus, displaces diaphragm

increased estrogen allows widening of costal angle

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16
Q

Developmental Considerations: The Aging Adult

A
  • costal cartilage becomes calcified/thorax less mobile - respiratory muscle strength declines
  • lung is more rigid and hard to inflate
  • decreased number of alveoli
17
Q

Inspection

Collecting Objective Data: Inspection

A

observe for retractions and use of accessory muscles

observe the rate, rhythm, depth, and effort of breathing

18
Q

Observations to make

Collecting Objective Data: Inspection

A 
Lips: observe color, pursed lip breathing? 
Nares: nasal flaring? 
Skin: cyanosis? 
Nails: Clubbing?
Chest symmetry or deformity?
Costal angle – >90 degrees?
19
Q

Breathing Position

Collecting Objective Data: Inspection

A

NORMAL - upright and relaxed
ABNORMAL - tripod (leaning forward on stationary object/with elbows on their knees)
- respiratory distress (pursed lip breathing)

20
Q 
Thorax Configurations (normal, abnormal, congenital abnormalities)
(Collecting Objective Data: Inspection)
A

normal - transverse diameter is approx 2x the AP diameter (AP:T 1:2)

abnormal (barrel chest) - transverse diameter is the same as AP diameter (AP:T 1:1)

Pectus Excavatum (sunken sternum/funnel chest) - sternum grows inward, chest wall skins

Pectus Carnatum (forward protrusion of the sternum) - creates more room in chest wall

21
Q

Collecting Objective Data: Palpation (anterior and posterior)

A

Anterior
- identify areas of tenderness/deformity by palpating ribs and sternum (examine thoracic expansion for symmetry)

Posterior
- identify areas of tenderness, crepitus (air in tissue), or deformity
- palpate for chest excursion (deviation) (normal = chest expansion symmetrical)
- Tactile Fremitus (feeling for vibration on chest wall when patient speaks)
- should be diminished and difficult to feel once you
start moving down from trachea

22
Q

Stethoscope (what to listen for, where, and how)

Collecting Objective Data: Auscultation

A
  • listen for one full breath cycle

- start at apices; side to side comparison with Greek key pattern

23
Q

Normal Breath Sounds

Collecting Objective Data: Auscultation

A

Vesicular - heard over most lung fields
Bronchovesicular - heard over main bronchus area
Bronchial/Tracheal - heard only over trachea

24
Q

Decreased Breath Sounds (occurs if…)

Collecting Objective Data: Auscultation

A
  • fluid/puss accumulation in pleural space
  • secretions/foreign body obstructs bronchi
  • lungs are hyper-inflated
  • shallow breathing
25
Q

Adventitious Breath Sounds

Collecting Objective Data: Auscultation

A

Extra sounds
-Crackles (rales) - fine, medium, or coarse /// fluid in lower airways // heard during inspiration/// usually not cleared with cough

  • Rhonchi - loud, low coarse ///thick secretion in airway /// heard during inspiration and expiration /// may be cleared with cough (productive)
  • Wheeze - high-pitched/// narrow airway /// heard on inspiration and expiration, but louder on expiration///can hear in the rest of lung field
  • Stridor - inspiratory only wheeze associated with upper airway obstruction
26
Q

Assessment of Respiratory System (respiratory patterns: normal and abnormal)

A

Normal – rate 12-20; even volume and rhythm; comfortable
Bradypnea – rate < 12
Tachypnea – rate > 20
Hyperventilation – rate and depth increase
Sighing – frequently interspersed deeper breath
Apnea – cessation of breathing

27
Q

Assessment of Respiratory System (respiratory conditions)

A

Atelectasis - partial/complete collapse of a lung or lobe of a lung

Bronchitis - acute (infection of trachea and larger bronchi) /// chronic - prolonged inflammation of trachea and larger bronchi

Emphysema - hyperinflated lungs//destruction of pulmonary connective tissues

Pleurisy - pulmonary infection when lining of lung becomes inflamed

Pleural effusion - excessive fluid in the pleural space

Pneumonia - inflammatory response to infection

Pneumothorax - air in pleural cavity resulting in collapsed lung

Asthma - allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress or exercise
- raised concern if patient has absent breath sounds
when wheezes were previously heard

28
Q

Incentive Spirometer (purpose, who is it useful for, how to use)

A
  • prevents lung consolidation (filled with liquid) (Ex. pneumonia)
  • useful for surgical patients or bedbound patients
  • instruct patient to slowly take deep breath in (expanding lungs as much as possible)
29
Q

Peak Flow Meter (what is PEFR and how it is performed)

A

Peak Expiratory Flow Rate (PEFR) is used to monitor pulmonary function in asthma patients
- Ask patient to inhale deeply and then exhale into
meter as fast as possible, expelling as much air

30
Q

Signs and Symptoms of Hypoxia

A 
Restlessness – The #1 Sign/Symptom
Apprehension, anxiety
Disorientation
Decreased Level Of Consciousness
Increased fatigue Increased pulse, B/P, RR
Dyspnea
Arrhythmias
Pallor
Cyanosis (late)
Clubbing (chronic)
Behavioral changes

NUR 3066 Health Assessment (20 decks)

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