Chapter 19-Thorax and Lungs Flashcards
Structure & function: position and surface landmarks
-thoracic cage-borders
anterior thoracic landmarks
-suprasternal notch
-sternum
-manubriosternal angle
-costal angle
posterior thoracic landmarks
-vertebra prominens
-spinous processes
-inferior border of scapula
-twelfth rib (posterior)
reference lines: anterior
-midsternal line
-midclavicular line
-anterior axillary line
reference lines: posterior
-scapular line
-vertebral line
reference lines: lateral
-anterior line
-posterior line
-midaxillary line
thoracic cavity
-mediastinum
-lobes of the lungs
-anterior
-posterior
-lateral
-pleurae (in b/w lungs and pleural sac)
-trachea and bronchial tree
-location of trachea and bronchi
-dead space
-function of acinus
mechanics of respiration
4 functions of respiratory system
-changing chest size during respiration
-inspiration
-expiration
-control of respiration (baroreceptors tell body to breathe faster or slower) (brainstem controls respiration)
subjective data: health history questions
-cough
-shortness of breath
-chest pain with breathing
-history of respiratory infections
-smoking history
-environmental exposure
-self-care behaviors
subjective data: shortness of breath (sob)
ever had any shortness of breath or hard-breathing spells? ask about
-precipitating factor, severity, and duration
-impact of change of position and specific timing factor (could signify fluid)
-association with any other clinical symptoms (chest pain?)
-any triggering mechanisms r/t: food, environment, or emotion
-the measures taken when SOB occurs in terms of treatment or medication both Rx and over the counter
-impact of SOB on ADLs
-progression of SOB
subjective data: chest pain with breathing
any chest pain with breathing? please point to exact location. ask about
-onset, timing-constant versus intermittent
-pain characteristics in terms of quality and intensity
-associated clinical symptoms
-treatment interventions used to decrease pain
objective data: the physical exam
preparation
-position
-draping
-timing during a complete examination
-cleaning stethoscope endpeice
equipment needed
-stethoscope
-small ruler marked in centimeters
-marking pen
-alcohol swab
objective data: posterior chest
posterior chest-inspect
-thoracic cage
-shape and configuration of chest wall
-anteroposterior/transverse diameter (AP diameter) 2:1= normal 1:1=barrel chest
-position of person
-skin color and condition
look for…symmetry, rise & fall, rate & depth, use of accessory muscles, lumps/bumps, color changes
objective data: posterior chest (cont)
posterior chest-palpate
-symmetric expansion
-tactile (or vocal) fremitus: using hands to assess for palpable vibrations
-technique (have patient repeat phrases 99 or blue moon)
-factors that affect normal intensity or tactile fremitus
-palpate the entire chest wall (assess for tenderness)
posterior chest-percuss
-predominate note over lung fields: start at apices and precise across the shoulders and move down
-normal healthy lung: resonance will be low pitched, clear, hollow sounds
**inspect, palpate, percuss, auscultate
auscultation
-side to side
-breath sounds
-technique
-bronchial breath sounds: high pitched louder
-bronchovesicular breath sounds
-vesicular breath sounds: soft, low pitched (further from trachea)
adventitious sounds
-use diaphragm for lungs
-crackles (rales): should like rice crispy-pops (CHF)
-wheeze: high pitched whistling (asthma)
-rhonchi: low pitched similar to snoring or congestions (pneumonia)
-stridor: high pitch wheeze but in upper airway (air is closing; Angioedema)
-atelectatic crackles: short popping but short lived..clear after a few breaths (lack of mobility; can lead to pneumonia; have them take a deep breath and cough)
-atelectasis can sound also diminished or absent lung sounds usually at bases of the lungs
voice sounds
-bronchophony: have the patient say 99 while listening, normal is muffled. if clear then possible fluid or mucus in lungs
-egophony: have patient whisper 99 and if clear abnormal
^^listen with stethoscope for both
-whispered pectoriloquy: have patient say ‘e’ and if it sounds like ‘a’ indicates fluid accumulation
objective data: anterior chest: inspect
-shape and configuration of chest wall
-facial expression (grimacing?)
-level of consciousness
-skin color and condition
-quality of respirations
-rib interspaces
-accessory muscles
objective data: palpation/percussion
-anterior chest: palpate
-symmetric chest expansion
-tactile fremitus
-palpate the anterior chest wall
-anterior chest: percuss
-predominate note over lung fields
-bordrs of cardiac dullness
objective data: auscultation
anterior chest: auscultate
-breath sounds
-abnormal breath sounds
-adventitious sounds
objective data-the physical exam (cont)
measurement of pulmonary function status
-forced expiratory time (pulmonary function test)
-pulse oximeter (the tongue falls back)
-6 minute distance walk
abnormal findings configurations of the thorax
-barrel chest
-pectus excavatum: funnel chest (sunken in)
-pectus carinatum: pigeon chest (protrudes out)
-scoliosis
-kyphosis
abnormal findings respiration patterns
-sigh
-tachypnea (over 20 bpm)
-bradypnea (less than 10 bpm)
-hyperventilation (increased depth; deep breaths)
-hypoventilation (not taking deep breaths)
-cheyne-stokes respiration (fast, slow, apnea-head trauma)
-biot’s respiration: irregularity/periods of apnea (brain injury)
-chronic obstructive breathing
abnormal tactile fremitus
-increased tactile fremitus (dense inflamed lung-cord/pneumonia)
-decreased tactile fremitus (hyperinflation?)
-rhonchial fremitus (mucus obstructing airway-upper airway)
-pleural friction fremitus (pleural rub)
adventitious lung sounds
discontinuous
-crackles: fine (softer)
-crackles: coarse (loud; sand paper)
-atelectatic crackles: (cough; deep breath sometimes clear)
-pleural friction rub (hurts to breathe; after upper respiratory infection)
adventitious lung sounds
continuous
-wheeze: sibilant (hissing)
-wheeze: sonorous rhonchi (more congested)
-stridor
abnormal findings common respiratory conditions
-atelectasis (alveolar collapse)
-lobar pneumonia
-bronchitis (inflammatory)
-emphysema
-asthma (reactive airway disease)
-pleural effusion thickening
-congestive heart failure (right=vascular edema; left=lungs)
-pneumothorax
-pneumocystis carinii pneumonia (infection of lung)
-tuberculosis
-pulmonary embolism (blood clot)
-acute respiratory distress syndrome (overall inflammatory device)
summary checklist: thorax & lungs examination
inspection
-thoracic cage, respirations, skin color and condition
-a person’s facial expression and LOC
palpation
-confirm symmetric expansion and tactile fremitus
-detection of any lumps, masses, or tenderness
percussion
-lung fields and estimate diaphragmatic excursion
auscultation
-assess breath sounds and note any abnormal/adventitious breath sounds
-perform bronchophony, whisper pectoriloquy, or egophony as needed
