Ch.19 Thorax and Lungs Flashcards
What is the shape of the thoracic cage?
Conical shape, narrower at the top
What are the components of the thoracic cage?
- Sternum
- 12 Pairs of Ribs
- 12 Thoracic Vertebrae
- Diaphragm
Which ribs attach directly to the sternum?
Ribs 1-7
What is the function of the diaphragm?
Separates thoracic cavity from abdomen
What is the sternal angle also known as?
Angle of Louis
How are the intercostal spaces named?
Named for the rib immediately above the space
What are the lobes of the left lung?
2 Lobes (upper and lower)
Why does the left lung have only two lobes?
Due to the space occupied by the heart
What are the lobes of the right lung?
3 Lobes (upper, middle, and lower)
Define ventilation
The physical act of breathing
What happens during inspiration?
Air rushes into the lungs
What primarily occurs during expiration?
Air is expelled from the lungs
Which muscles are primarily responsible for respiration?
Diaphragm and intercostal muscles
What occurs to the diaphragm during inspiration?
Contracts and flattens
What is the result of diaphragm contraction during inspiration?
Creates a slightly negative pressure, drawing air in
What indicates respiratory distress in terms of muscle use?
Use of accessory muscles
What is impaired gas exchange?
A condition in which oxygen and carbon dioxide are not exchanged effectively between the lungs and the bloodstream
What are some causes of impaired gas exchange?
- Obstructive diseases (e.g., COPD, asthma)
- Restrictive diseases (e.g., pulmonary fibrosis)
- Acute conditions (e.g., pneumonia, ARDS)
- Ventilation-perfusion mismatch
What are some assessment findings of impaired gas exchange?
- Increased respiratory rate
- Use of accessory muscles
- Cyanosis
- Decreased oxygen saturation (SpO2)
- Hypoxia or hypercapnia
What are the interventions for impaired gas exchange?
- Oxygen therapy
- Positioning (e.g., semi-Fowler’s position)
- Monitoring vital signs and SpO2
- Pulmonary hygiene and medications
What is the correct statement regarding intercostal spaces for auscultation?
The intercostal spaces are named for the rib immediately above the space
What is the normal position for a patient during a lung assessment?
Relaxed posture with arms comfortably at sides or lap
What does a barrel chest indicate?
Equal AP and transverse diameter, seen in COPD due to hyperinflation of the lungs
What is tactile fremitus?
A palpable vibration from sounds generated by the larynx
What may cause decreased tactile fremitus?
- Obstructed bronchus
- Pleural effusion
- Pneumothorax
- Emphysema
What indicates increased tactile fremitus?
- Lobar pneumonia
- Consolidation or compression of lung tissue
What is crepitus?
Coarse, crackling sensation felt on the skin surface
What is the expected sound over healthy lungs during percussion?
Resonance
What does hyperresonance indicate?
Excess air (e.g., emphysema, pneumothorax)
What are the normal breath sounds?
- Bronchial
- Bronchovesicular
- Vesicular
What do crackles (rales) signify?
Discontinuous, popping sounds heard during inspiration
What causes wheezes?
Narrowing or obstruction of the airways
What is the significance of adventitious sounds during lung assessment?
Indicate potential underlying pulmonary issues
What is the expected AP diameter to transverse diameter ratio?
About 0.70 to 0.75
What is the effect of pectus excavatum?
Markedly sunken sternum and adjacent cartilages
What does asymmetric chest expansion indicate?
Possible collapse or blockage
What is the effect of COPD on neck muscles?
Hypertrophied neck muscles help with forced respirations
What is the normal finding for skin color during a lung assessment?
Consistent color with genetic background
What are abnormal findings to note during a lung assessment?
- Cyanosis
- Pallor
- Skin lesions or changes
What is the significance of asymmetric fremitus?
May indicate dysfunction and require further auscultation
What causes airflow obstruction in chronic bronchitis?
Mucus and inflammation
Airway collapse can also occur.
What are adventitious sounds?
Abnormal lung sounds produced by airflow obstruction or other lung conditions.
What are wheezes?
Continuous, musical sounds primarily heard during expiration, caused by narrowing or obstruction of the airways.
List some conditions that can cause wheezing.
- Asthma
- COPD
- Bronchitis
- Allergic Reactions
- Respiratory Infections
- Foreign Body Aspiration
- GERD
- Anaphylaxis
What is stridor?
A high-pitched, harsh sound heard primarily during inspiration, caused by upper airway obstruction.
Name common causes of stridor.
- Foreign body aspiration
- Croup
- Anaphylaxis
- Laryngeal edema
What should you do if you think you heard an abnormal lung sound but are unsure?
Ask the patient to cough, then listen again.
What is bronchophony?
An increased transmission of voice sounds due to lung consolidation.
How do you assess egophony?
Ask the person to phonate a long ‘ee-ee-ee-ee’ sound and auscultate the chest.
What is the normal response for egophony?
‘eeeeeeee’ should be heard clearly through the stethoscope.
What does a change to ‘aaaaa’ indicate during egophony assessment?
It indicates areas of consolidation or compression.
What should be observed during the inspection of the anterior chest?
Shape and configuration, level of consciousness, skin color and condition, quality of respirations.
What is a normal respiratory rate for adults?
10-20 breaths per minute.
What is a barrel chest?
A chest shape with horizontal ribs and a costal angle greater than 90 degrees.
What is the significance of clubbing in respiratory assessment?
It is an indicator of chronic obstructive pulmonary disease (COPD).
What is the purpose of palpating the anterior chest?
To assess chest expansion, detect lumps, and confirm symmetric movement.
What does dullness on percussion indicate?
Conditions like pneumonia or cardiac dullness.
What is the normal FEV1/FVC ratio?
Normal is greater than 75%; less than 70% indicates obstruction.
What factors can impact SpO2 measurement?
- Poor circulation
- Nail polish or artificial nails
- Movement
- Carbon monoxide poisoning
- Ambient light
- Skin pigmentation
- Temperature
- Anemia
- Acid-base imbalance
- Ventilatory status
What is the purpose of the 6-Minute Walk Test (6MWT)?
To assess functional status in pulmonary/cardiac disorders.
What respiratory pattern is characterized by rapid, shallow breathing?
Tachypnea.
What is hyperventilation?
Increased rate and depth of breathing.
What are the common causes of bradypnea?
- Drug overdose
- Increased intracranial pressure
- Diabetic coma
What is the significance of prolonged expiration in COPD?
It indicates increased airway resistance.
What are common physical examination findings in COPD?
- Tri-pod position
- Prolonged expiration
- Barrel chest
- Use of accessory muscles
- Decreased breath sounds
- Hyperresonance on percussion
- Cyanosis
What changes occur in the chest characteristics of aging adults?
- Increased AP diameter
- Decreased chest expansion
- Costal cartilage calcification
What is secondhand smoke (SHS)?
A mixture of sidestream and mainstream smoke.
What are the long-term health risks of secondhand smoke exposure?
- Cancer
- Stroke
- Lung disease
- Kidney disease
How can families protect against secondhand smoke?
- No smoking around children
- Avoid public areas that allow smoking
- Ensure daycare and schools are smoke-free
