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NURS 307 > Chapter 18: Thorax and Lungs > Flashcards

Chapter 18: Thorax and Lungs Flashcards

1
Q

The thoracic cage consists of

A
  1. sternum
  2. 12 ribs
  3. 12 Thoracic Vertebra
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2
Q

What ribs attach to the sternum?

A

first 7 ribs

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3
Q

What ribs attach to the costal cartilage?

A

ribs 8, 9, and 10

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4
Q

What ribs are considered floating ribs?

A

ribs 11 and 12

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5
Q

What are the anterior thoracic landmarks?

A
  1. suprasternal notch
  2. sternum
  3. costal angle
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6
Q

suprasternal notch

A

hollow, u shaped depression just above the sternum

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7
Q

What does the sternum consist of?

A
  1. manubrium
  2. body of the sternum
  3. xiphoid process
  4. manubriosternal angle
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8
Q

manubriosternal angle is aka

A

Angle of Louis

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9
Q

Manubriosternal Angle

A
  • 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.

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10
Q

Where is the site of tracheal bifurcation into R and L main bronchi?

A

manubriosternal angle

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11
Q

Costal Angle

A

right and left costal margins from an angle where they meet at xiphoid process

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12
Q

What are the posterior thoracic landmarks?

A
  1. vertebra prominens
  2. spinous processes
  3. scapula
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13
Q

The inferior border of the scapula is located …

A

usually at the 7th or 8th rib

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14
Q

What is the most prominent bony spur at the base of the neck called?

A

vertebra prominens

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15
Q

What are the reference lines?

A
  1. midsternal
  2. midclavicular
  3. axillary line
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16
Q

The axillary line consists of

A

posterior mid and anterior axillary lines

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17
Q

Thoracic Cavity consists of

A
  1. Mediastinum
  2. Pleural Cavities
  3. Lung Borders
  4. Lung Lobes
  5. Pleurae
  6. Trachea
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18
Q

Mediastinum

A

middle section containing the esophagus, trachea, heart and great vessels

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19
Q

Pleural Cavities

A

contain the lungs

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20
Q

Lung Borders

A
  1. apex: highest point

2. base: lower border

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21
Q

Lung lobes

A

anterior posterior and lateral.

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22
Q

Pleurae

A
  • thin, slippery envelope between the lungs and chest wall.

- 2 types

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23
Q

2 Types of Pleurae

A

visceral and parietal pleura

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24
Q

visceral pleura

A

lines the outside of the lungs

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25
Q

parietal pleura

A

lines the inside of the chest wall

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26
Q

Trachea

A

in front of the esophagus from the cricoid cartilage to sternal angle in R and L bronchi

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27
Q

Function of the trachea

A

transports gases between the environment and lung parenchyma

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28
Q

What are the four functions of the respiratory system?

A
  1. Supply O2 to the body for energy production
  2. Remove CO2 as a waste product of energy
  3. Maintain Homeostasis (acid balance of arterial blood)
  4. Maintain Heat Exchange
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29
Q

How does respiration maintain the pH or the acid/base balance of the blood?

A

by supplying O2 to the blood and eliminating excess CO2

30
Q

What cultural variations should a nurse be aware of in regards to the respiratory system?

A
  1. TB
  2. Asthma
  3. Size of thoracic cavity and vital lung capacity
31
Q

Why should a nurse be aware of the cultural variations for TB?

A

foreign born and racial/ethnic minorities have a higher incidence of TB

32
Q

Why should a nurse be aware of the cultural variations for asthma?

A
  • the incidence of asthma increases every year in the US among all ethnic groups.
  • However, asthma is more prevalent in African Americans.
33
Q

Why should a nurse be aware of the cultural variations for size of thoracic cavity and vital lung capacity?

A
  • Vary by culture.

- Caucasians and African Americans have a larger chest volume than Native Americans and Asians.

34
Q

What information should a nurse gather during a health history in regards to the respiratory system?

A
  1. cough
  2. shortness of breath, wheezing
  3. chest pain with breathing
  4. past hx of respiratory infections: bronchitis, pneumonia, emphysema, asthma
  5. family hx of allergies, asthma or TB
  6. smoking hx
  7. environmental exposure
  8. self care behavior
35
Q

In a health history regarding the respiratory system, what additional information should be obtained when asking about a cough?

A
  1. productive vs nonproductive
  2. quality of cough - dry, hacking, bark, loose, wet, congested
  3. production of phlegm or sputum: color, quantity
  4. cough up blood? streaks or frank blood? odor?
  5. does activity make it better or worse?
  6. does it seem to come with anything (activity, position, fever, congestion, talking, anxiety)?
  7. treatment?
  8. does it bring on anything: chest pain, ear pain? tiring? concerned?
36
Q

In a health history regarding the respiratory system, what additional information should be obtained when asking about self care behavior?

A
  • last TB skin test
  • chest x ray
  • flu shot
  • pneumonia vaccine
37
Q

What are the steps for the physical exam/assessment in regards to the thorax and lungs?

A
  1. inspect posterior chest
  2. skin color and condition
  3. palpate symmetric chest expansion
  4. tactile fremitus
  5. palpate chest wall for tenderness, skin temperature and/or masses
  6. percussion
  7. diaphragmatic excursion
  8. auscultate lungs
  9. inspect anterior chest
  10. palpate anterior chest for symmetric chest expansion
  11. percuss anterior chest
  12. auscultate anterior chest
  13. include oxygen saturation with VS and note any oxygen therapy
38
Q

What must you look for when inspecting posterior chest?

A

note symmetry

39
Q

What must you look for when inspecting skin color and condition?

A
  • normal or abnormal
  • color change ex) jaundice, cyanosis, pallor
  • note any lesions
40
Q

What must you look for when palpating symmetric chest expansion?

A

…

41
Q

tactile fremitus

A

palpable vibration (“99”)

42
Q

What must you look for when palpating the chest wall?

A

check for tenderness, skin temperature and/or masses

43
Q

What must you look for when doing percussion?

A

note resonance or dullness over the lung fields

44
Q

diaphragmatic excursion

A

not routinely done and not required

45
Q

What must you look for when auscultating lungs in all fields?

A
  • note whether clear or adventitious sounds, decreased or absent sounds.
  • not necessary to determine - bronchial, bronchiovesicular or vesicular
46
Q

Adventitious Sounds

A

abnormal sounds

47
Q

List the adventitious sounds.

A
  1. crackles (rales)
  2. wheezing
  3. rhonchi
  4. bronchophony
  5. egophony
  6. whispered pectoriloquy
48
Q

crackles (rales)

A

short crackling, popping sounds

49
Q

wheezing

A

high pitched squeak

50
Q

rhonchi

A

low pitched, harsh sounds, snoring (sometimes clear with cough)

51
Q

bronchophony

A
  • pt repeats “99” while you auscultate

- should hear sound with stethoscope but can’t distinguish what is actually said.

52
Q

egophony

A
  • pt repeats “ee-ee-ee-ee” while nurse auscultates

- should hear “ee-ee-ee-ee” through stethoscope

53
Q

whispered pectoriloquy

A
  • pt whispers a phrase like “1-2-3”

- should be faint, muffled and almost inaudible.

54
Q

What must you look for when inspecting the anterior chest?

A

-note shape and configuration: elliptical, downward sloping ribs, AP/transverse diameter (depth

55
Q

What must you look for when palpating the anterior chest?

A
  • assess for symmetric chest expansion

- palpate for tenderness, masses and skin temperature

56
Q

How does the nurse palpate the anterior chest?

A
  • Nurse has pt do a deep inhalation while nurse uses thumbs to assess symmetric movement
  • tactile fremitis (“99”, avoid female breast tissue)
57
Q

What must you look for when percussing anterior chest?

A

resonance, dull, flat, tympany

58
Q

List the common respiratory abnormalities

A
  1. barrel chest
  2. pectus carinatum
  3. tachypnea
  4. bradypnea
  5. cheyne-strokes respirations
  6. pleural effusion
  7. pneumothorax
  8. tuberculosis
  9. bronchitis
  10. pneumonia
  11. asthma
  12. atelectasis
59
Q

The right lung has how many lobes?

A

3

60
Q

The left lobe has how many lobes?

A

2

61
Q

the anterior chest contains

A

mostly upper and middle lobes with very little lower lobe

62
Q

the posterior chest contains

A

almost all lower lobe

63
Q

anteroposterior diameter should be __________ than transverse diameter

A

less

64
Q

decreased fremitus

A

occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema.

65
Q

increased fremitus

A

occurs with compression or consolidation of lung tissue.

66
Q

Characteristics of Normal Breath Sounds: Bronchial (tracheal)

A

Pitch: High
Amplitude: Loud
Duration: Inspiration < Expiration
Quality: Harsh, hollow, tubular.

67
Q

Normal Location for Bronchial (tracheal) Breath Sounds

A

trachea and larynx

68
Q

Characteristics of Normal Breath Sounds: Bronchovesicular

A

Pitch: Moderate
Amplitude: Moderate
Duration: Inspiration = Expiration
Quality: Mixed

69
Q

Normal Location for Bronchovesicular Breath Sounds

A

over major bronchi where fewer alveoli are located:

posterior, between scapulae especially on right, anterior, around upper sternum in 1st and 2nd intercostal spaces.

70
Q

Characteristics of Normal Breath Sounds: Vesicular

A

Pitch: Low
Amplitude: Soft
Duration: Inspiration > Expiration
Quality: Rustling, like the sound of the wind in the trees

71
Q

Normal Locations for Vesicular Breath Sounds

A

over peripheral lung fields where air flows through smaller bronchioles and alveoli

NURS 307 (29 decks)

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