Chapter 18: Thorax and Lungs Flashcards
The thoracic cage consists of
- sternum
- 12 ribs
- 12 Thoracic Vertebra
What ribs attach to the sternum?
first 7 ribs
What ribs attach to the costal cartilage?
ribs 8, 9, and 10
What ribs are considered floating ribs?
ribs 11 and 12
What are the anterior thoracic landmarks?
- suprasternal notch
- sternum
- costal angle
suprasternal notch
hollow, u shaped depression just above the sternum
What does the sternum consist of?
- manubrium
- body of the sternum
- xiphoid process
- manubriosternal angle
manubriosternal angle is aka
Angle of Louis
Manubriosternal Angle
- good landmark to count ribs (2nd rib).
- corresponds with the upper border of the atria of the heart and above the 4 thoracic vertebra on the back.
Where is the site of tracheal bifurcation into R and L main bronchi?
manubriosternal angle
Costal Angle
right and left costal margins from an angle where they meet at xiphoid process
What are the posterior thoracic landmarks?
- vertebra prominens
- spinous processes
- scapula
The inferior border of the scapula is located …
usually at the 7th or 8th rib
What is the most prominent bony spur at the base of the neck called?
vertebra prominens
What are the reference lines?
- midsternal
- midclavicular
- axillary line
The axillary line consists of
posterior mid and anterior axillary lines
Thoracic Cavity consists of
- Mediastinum
- Pleural Cavities
- Lung Borders
- Lung Lobes
- Pleurae
- Trachea
Mediastinum
middle section containing the esophagus, trachea, heart and great vessels
Pleural Cavities
contain the lungs
Lung Borders
- apex: highest point
2. base: lower border
Lung lobes
anterior posterior and lateral.
Pleurae
- thin, slippery envelope between the lungs and chest wall.
- 2 types
2 Types of Pleurae
visceral and parietal pleura
visceral pleura
lines the outside of the lungs
parietal pleura
lines the inside of the chest wall
Trachea
in front of the esophagus from the cricoid cartilage to sternal angle in R and L bronchi
Function of the trachea
transports gases between the environment and lung parenchyma
What are the four functions of the respiratory system?
- Supply O2 to the body for energy production
- Remove CO2 as a waste product of energy
- Maintain Homeostasis (acid balance of arterial blood)
- Maintain Heat Exchange
How does respiration maintain the pH or the acid/base balance of the blood?
by supplying O2 to the blood and eliminating excess CO2
What cultural variations should a nurse be aware of in regards to the respiratory system?
- TB
- Asthma
- Size of thoracic cavity and vital lung capacity
Why should a nurse be aware of the cultural variations for TB?
foreign born and racial/ethnic minorities have a higher incidence of TB
Why should a nurse be aware of the cultural variations for asthma?
- the incidence of asthma increases every year in the US among all ethnic groups.
- However, asthma is more prevalent in African Americans.
Why should a nurse be aware of the cultural variations for size of thoracic cavity and vital lung capacity?
- Vary by culture.
- Caucasians and African Americans have a larger chest volume than Native Americans and Asians.
What information should a nurse gather during a health history in regards to the respiratory system?
- cough
- shortness of breath, wheezing
- chest pain with breathing
- past hx of respiratory infections: bronchitis, pneumonia, emphysema, asthma
- family hx of allergies, asthma or TB
- smoking hx
- environmental exposure
- self care behavior
In a health history regarding the respiratory system, what additional information should be obtained when asking about a cough?
- productive vs nonproductive
- quality of cough - dry, hacking, bark, loose, wet, congested
- production of phlegm or sputum: color, quantity
- cough up blood? streaks or frank blood? odor?
- does activity make it better or worse?
- does it seem to come with anything (activity, position, fever, congestion, talking, anxiety)?
- treatment?
- does it bring on anything: chest pain, ear pain? tiring? concerned?
In a health history regarding the respiratory system, what additional information should be obtained when asking about self care behavior?
- last TB skin test
- chest x ray
- flu shot
- pneumonia vaccine
What are the steps for the physical exam/assessment in regards to the thorax and lungs?
- inspect posterior chest
- skin color and condition
- palpate symmetric chest expansion
- tactile fremitus
- palpate chest wall for tenderness, skin temperature and/or masses
- percussion
- diaphragmatic excursion
- auscultate lungs
- inspect anterior chest
- palpate anterior chest for symmetric chest expansion
- percuss anterior chest
- auscultate anterior chest
- include oxygen saturation with VS and note any oxygen therapy
What must you look for when inspecting posterior chest?
note symmetry
What must you look for when inspecting skin color and condition?
- normal or abnormal
- color change ex) jaundice, cyanosis, pallor
- note any lesions
What must you look for when palpating symmetric chest expansion?
…
tactile fremitus
palpable vibration (“99”)
What must you look for when palpating the chest wall?
check for tenderness, skin temperature and/or masses
What must you look for when doing percussion?
note resonance or dullness over the lung fields
diaphragmatic excursion
not routinely done and not required
What must you look for when auscultating lungs in all fields?
- note whether clear or adventitious sounds, decreased or absent sounds.
- not necessary to determine - bronchial, bronchiovesicular or vesicular
Adventitious Sounds
abnormal sounds
List the adventitious sounds.
- crackles (rales)
- wheezing
- rhonchi
- bronchophony
- egophony
- whispered pectoriloquy
crackles (rales)
short crackling, popping sounds
wheezing
high pitched squeak
rhonchi
low pitched, harsh sounds, snoring (sometimes clear with cough)
bronchophony
- pt repeats “99” while you auscultate
- should hear sound with stethoscope but can’t distinguish what is actually said.
egophony
- pt repeats “ee-ee-ee-ee” while nurse auscultates
- should hear “ee-ee-ee-ee” through stethoscope
whispered pectoriloquy
- pt whispers a phrase like “1-2-3”
- should be faint, muffled and almost inaudible.
What must you look for when inspecting the anterior chest?
-note shape and configuration: elliptical, downward sloping ribs, AP/transverse diameter (depth
What must you look for when palpating the anterior chest?
- assess for symmetric chest expansion
- palpate for tenderness, masses and skin temperature
How does the nurse palpate the anterior chest?
- Nurse has pt do a deep inhalation while nurse uses thumbs to assess symmetric movement
- tactile fremitis (“99”, avoid female breast tissue)
What must you look for when percussing anterior chest?
resonance, dull, flat, tympany
List the common respiratory abnormalities
- barrel chest
- pectus carinatum
- tachypnea
- bradypnea
- cheyne-strokes respirations
- pleural effusion
- pneumothorax
- tuberculosis
- bronchitis
- pneumonia
- asthma
- atelectasis
The right lung has how many lobes?
3
The left lobe has how many lobes?
2
the anterior chest contains
mostly upper and middle lobes with very little lower lobe
the posterior chest contains
almost all lower lobe
anteroposterior diameter should be __________ than transverse diameter
less
decreased fremitus
occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema.
increased fremitus
occurs with compression or consolidation of lung tissue.
Characteristics of Normal Breath Sounds: Bronchial (tracheal)
Pitch: High
Amplitude: Loud
Duration: Inspiration < Expiration
Quality: Harsh, hollow, tubular.
Normal Location for Bronchial (tracheal) Breath Sounds
trachea and larynx
Characteristics of Normal Breath Sounds: Bronchovesicular
Pitch: Moderate
Amplitude: Moderate
Duration: Inspiration = Expiration
Quality: Mixed
Normal Location for Bronchovesicular Breath Sounds
over major bronchi where fewer alveoli are located:
posterior, between scapulae especially on right, anterior, around upper sternum in 1st and 2nd intercostal spaces.
Characteristics of Normal Breath Sounds: Vesicular
Pitch: Low
Amplitude: Soft
Duration: Inspiration > Expiration
Quality: Rustling, like the sound of the wind in the trees
Normal Locations for Vesicular Breath Sounds
over peripheral lung fields where air flows through smaller bronchioles and alveoli
