CH: 19 Thorax and Lungs Flashcards
suprasternal notch location?
top of sternum between clavicles
*hollow U shaped depression
what is the manubriosternal angle known as?
angle of Louis
manubriosternal angle lines up with?
2nd rib
location of 1st rib?
below clavicle
are intercostal spaces above or below ribs?
below
ex. 7th intercostal space below 7th rib
what is the costal angle?
right and left costal margins form angle where they meet at the Xiphoid process
*usually 90 degrees or less
how many ribs on the front?
11
how many ribs on the back?
12
which ribs attach directly to the sternum via costal cartilage?
1-7
which ribs attach to the costal cartilage above?
8, 9, 10
*7’s cartilage attaches to sternum, 8’s cartilage attaches to 7’s cartilage
which ribs are floating?
11 and 12
what is the bony prominence at the top of the neck?
spinous process of C7
where is the midsternal line?
down middle of sternum anteriorly
where is the midclavicular line?
the middle of the clavicle anteriorly
where is the midspinal/vertebral line?
down middle of back/spine posteriorly
where is the scapular line?
middle of scapula posteriorly
where is the anterior axillary line?
between anterior arm and chest
where is the midaxillary line?
middle of axillary laterally
posterior axillary line?
between posterior deltoid and back
what is contained in the mediastinum?
esophagus
trachea
heart
great vessels
what is contained in the right and left pleural cavities?
the lungs
apex of lung location?
above the clavical
base of lung location?
rests on diaphragm at about the 6th rib at midclavicular
how many lobes does the right lung have?
three (middle lobe)
how many lobes does the left lung have?
two
which lobe dominates the posterior region?
LOWER lobe
which lobe is SHORTER?
right
*because of underlying liver
which lobe is NARROWER?
left
*because heart bulges to the left
use of accessory muscles usually indicates?
trouble breathing, possible respiratory distress
why is surface area important?
so alveoli have space for gas exchange
what is atelectasis?
alveolar collapse
what is decubitus positioning?
lay flat and lift head
*to see fluid movement
what do loop diuretics help with?
ventilation and gas exchange
*they get rid of fluid
respiratory system mechanic functions?
chest size change during respiration
inspiration
expiration
control of respiration (breathing rate controlled by baroreceptors controlled by brain stem)
coughing up blood is called?
hemoptysis
*could indicate lung cancer
pulmonary edema cough produces?
thick, pink, frothy sputum
*could lead to respiratory arrest, emergent
what color sputum with TB?
rust
bacterial/viral production?
green/yellow color
*ex. bronchitis
SOB is a concern _____?
at rest
takes deep breath and chest pain stays the same, possible cause?
heart/MI
takes deep breath and chest pain worsens, possible cause?
lungs
orthopnea?
difficulty breathing in supine position
what is anteroposterior diameter?
distance from front to back when looking from the side
what is transverse diameter?
true width of patient when looking straight at anterior
normal AP diameter?
1:2 ratio
barrel chest AP diameter?
1:1 ratio - hyperinflation
*usually in COPD
assessment order for thorax and lungs?
inspect
palpate
percuss
auscultate
organs sound ___?
dull
bones sound ___?
flat
in percussion, normal healthy lung sounds?
resonance
-low pitched, clear, hollow
in what diseases might you see accessory muscle use?
COPD
ARDS
asthma
respiratory infection
chronic bronchitis
pneumonia
emphysema
pulmonary edema
pulmonary embolism
positioning for respiratory distress?
tripod
thumb placement during symmetric expansion?
9th rib
*normal should be bilaterally symmetric
who might not have bilaterally symmetric expansion?
atelectasis (collapsed lung/alveoli)
pneumonia
pneumothorax
lobotomy
what does tactile fremitus assess?
vibration of larynx through bronchi
who might not have equally bilateral tactile fremitus?
lung disease
pneumonia
who might have decreased tactile fremitus?
asthma
pleural effusion
atelectasis
*with hyperinflation
what are the three breath sounds?
bronchial
bronchovesicular
vesicular
which breath sound is the loudest with high pitch, hollow quality, expiration>inspiration?
bronchial
which breath sound is moderate pitch and amplitude, mixed quality, expiration=inspiration?
bronchovesicular
which breath sound is quieter with low pitch, rustling quality, inspiration>expiration?
vesicular
main airway sounds?
vesicular
peripheral field sounds?
vesicular
is the diaphragm better for high or low pitched?
high pitched
*bell for low pitched
crackles sound and cause?
discontinuous popping, like rice crispies
high pitched
*caused by inhaled air colliding with deflated airway
*inspiration, expiration, or both
wheezes sound and cause?
continuous high pitched whistling
*caused by airway constriction
*inspiration, expiration, or both
rhonchi sound and cause?
continuous low pitched snoring quality
*caused by secretions in large airway
*inspiration, expiration, or both
stridor sound and cause?
continuous high pitched wheeze in upper airway
*caused by obstruction or narrowing, associated with anaphylaxis late response
*usually heard on inspiration, listen over trachea
bronchophony sound?
have patient say 99
*muffled is normal
*clear indicates fluid or mucus in lungs
egophony sound?
whisper 99
*clear sound is abnormal
whispered pectoriloquy?
have patient say “e”- if sounds like “a” indicates fluid accumulation
are breath/lung sounds louder through vesicular or bronchial tubes?
bronchial
*vesicular is quieter
cyanosis occurs with?
tissue hypoxia
what is rhonchal fremitus?
palpable with thick bronchial secretions
what is pleural friction fremitus?
palpable with pleura inflammation
what is crepitus?
coarse, crackling palpable over skin surface
(rice crispies)
*happens when SUBQ air escapes lung and enters SUBQ tissue
what is hyperresonance?
low pitched booming sound when too much air is present
6 min walk?
measures pulmonary rehab
stop if breathlessness or if O2 below 85
what happens during sleep apnea?
tongue falls back and obstructs airway
kyphosis usually from___?
degenerative disease
sighs are purposeful to___?
expand alveoli
tachypnea?
rapid, shallow breathing
bradypnea?
slow rate
hyperventilation?
increased rate AND depth
hypoventilation?
decreased rate AND depth
Cheyne-Stokes breathing?
wax and wane (increase and decrease) until apnea in regular pattern
*seen most commonly with heart failure
Biot’s respiration?
same as CSB but irregular pattern
*seen with head trauma
chronic obstructive breathing?
normal inspiration and prolonged expiration
*leads to air trapping
kidneys make___?
BICARB
lungs drive Co2
Co2 is acidic
pH down when acidic and up when basic
COPD is similar to____?
asthma
*asthma reversible, COPD is not (chronic)
