Chapter 19- Thorax and Lungs Flashcards
A bony structure with a conical shape, which is narrower at top.
Thoracic Cage
Defined by sternum, 12 pairs of ribs, and 12 thoracic vertebrate .
Thoracic cage
What ribs are floating ribs with free palpable tips?
ribs 11 and 12
Points at which ribs join their cartilages; they are not palpable.
Costochondral junctions
U shaped depression just above sternum between clavicles
Suprasternal notch
“breastbone”. manubrium, body, and xiphoid process
Sternum
“Angle of Louis” at articulation of manubrium and sternum, and continuous with second rib.
Manubriosternal angle
The right and left costal margins form an angle where they meet at xiphoid process.
Costal Angle
___ also marks the site of tracheal bifurcation into right and left main bronchi. It also corresponds with upper border of atria of the heart, and it lies above fourth thoracic vertebra on back.
“Angle of Louis” or Manubriosternal angle.
Flex your head and feel for most prominent bony spur protruding at base of neck.
Vertebra prominens
Count down these knobs on vertebrae, which stack together to form spinal column.
spinous process
Scapulae are located symmetrically in each hemothorax.
Inferior border of scapula
Palpate midway between spine and a persons side to identify it’s free tip.
12th rib
Use ___ to pinpoint finding vertically on chest.
Reference lines
anterior chest reference lines:
note midsternal and midclavicular line
posterior chest reference lines:
note vertebral (midspinal) line and scapular line
Lift up the persons arm 90 degrees and divide lateral chest by what 3 lines?
Anterior axillary line
Posterior axillary line
Midaxillary line
middle section of thoracic cavity containing esophagus, trachea, heart, and great vessels
Mediastinum
What cavities contains the lungs?
Right and left pleural cavities
Which lobe of the lung is shorter and why?
The right lung is shorter because of the underlying liver
Which lung is narrower and why?
The left lung is narrower because the heart bulges to the left.
How many lobes in each side of the lungs?
Right side has 3 lobes: upper, middle, and lower.
Left side has 2 lobes: upper and lower
__ form an envelope between lungs and chest wall.
Thin and slippery serous membranes.
Pleurae
__ normally has a vacuum, or negative pressure which holds lungs tightly against chest wall.
Pleural cavity
Pleural cavity is potential space filled with __.
Only a few milliliters of lubricating fluid.
Trachea lies ____ and is ___ inches long.
anterior to the esophagus and is 10-11 cm long.
trachea and bronchi ___ between the environment and lung parenchyma.
Transport gases
Trachea and Bronchi are lined with ___.
goblet cells
Functional respiratory unit consists of bronchioles, alveolar ducts, alveolar sacs and alveoli.
Acinus
4 major functions of the respiratory system:
- Supplying oxygen to the body for energy production.
- Removing carbon dioxide as a waste product of energy reactions.
- Maintaining homeostasis (acid-base balance) of arterial blood.
- maintains heat exchange (less important in humans)
Second most commonly diagnosed cancer
Lung cancer
Affects more than 1/3 of the worlds population, social and migratory disease. Need to identify and actively treat.
Tuberculosis
Most chronic disease in childhood, highest burden seen in those living at or below the federal poverty level, and ethnic and environments factors play significant role.
Asthma
Use __ of the stethoscope and listen to at least one full respiration in each location.
flat diaphragm
3 types of breath sounds heard normally in adults and older child:
Bronchial: sometimes called tracheal or tubular
Bronchovesicular
Vesicular
Added sounds that are not normally heard in lungs
Adventitious sounds
A type of adventitious sound that is not pathological. Short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths.
Atelectatic crackles
Inspection of Anterior Chest
Note shape and configuration of chest wall Note patients facial expression Assess level of consciousness Note skin color and condition Assess quality of respirations
Palpation of Anterior Chest. Palpate for ___ chest expansion.
symmetric
Palpation of Anterior Chest: Asses tactile (vocal) fremitus
Compare vibrations from one side to other as the person repeats “99”
Palpation of Anterior Chest: Palpate anterior chest wall
Note any tenderness or lumps
Note skin mobility, turgor, temperature, and moisture.
Percussion of Anterior Chest: Being percussion in ___ areas.
Supraclavicular
Percussion of Anterior Chest: Note borders of cardiac dullness normally found on anterior chest. T/F?
True
The number of seconds it takes to exhale from total lung capacity to residual volume
Forced expiratory time
Forced expiratory time measures __
Airflow obstruction
SpO2 of healthy person is between :
97%-99%
Normal respiratory rate for newborns are :
30-40 breaths per minute but could spike up to 60 breaths per minute
Brief periods of apnea less than 10-15 seconds are common in newborns. T/F?
True
Discontinuous Lung sounds:
Crackles-fine
Crackles-course
Atelectatic crackles
Pleural friction rub
Continuous lung sounds:
Wheeze-sibilant
Wheeze/sonorous rhonchi
Stridor
Thorax and Lungs Examination:
Inspection: thoracic cage, respiration’s, skin color, condition, facial expressions, and LOC.
Palpation: confirm symmetric expansion and tactile fremitus, detect lumps, masses or tenderness
Percussion: lung fields and estimate diaphragmatic excursion
Auscultation: assess breath sounds
How many ribs do we have?
12
How many thoracic vertebrae do we have?
12
What ribs are the true ribs? false ribs? floating ribs?
1-7 = true 8-10 = false 11-12 = floating
What are false ribs?
Ribs that do not join the sternum
In the anterior chest the ___, or highest point of lung tissue is 3-4 cm above the inner third of the clavicles.
Apex
The __, or lower border, rests on the diaphragm at about the 6th rib in the midclavicular line.
Base
On the anterior chest, the __ (the major or diagonal) fissure crosses the 5th rib of the mdiaxillary line and terminates at the 6th rib in the midclavicular line.
Oblique
The most remarkable point about the posterior chest is that it is almost all ____.
lower lobe
Laterally lung tissues extends from the __ of the axilla down to the __ or __ rib.
apex
7th
8th
The posterior chest includes almost all ___ lobe.
lower
The anterior chest constrains mostly ___ lobes, and very little ___ lobe.
Upper and middle, with very little lower lobe.
The lungs slide smoothly and noiselessly up and down during respiration because they are ____.
lubricated by a few milliliters of fluid.
A potential space; when it abnormal fills with air or fluid, it compromises lung expansion.
Costodiaphragmatic recess.
The __ main bronchus is shorter, wider, and more vertical than the __ main bronchus.
Right
Left
The bronchial ___ also protects alveoli from small particulate matter in the inhaled air.
Tree
Sweep particles upward where they can be swallowed or expelled
Cilia
Secrete mucus that rn traps the particles
Goblet cells
By supplying Oxygen to the blood and eliminating excess carbon dioxide, respiration maintains the __ or the ____ of the blood.
pH
acid-base balance
Humoral regulation, or the change in carbon dioxide and oxygen levels in the blood, and the hydrogen ion level.
The major feedback loop
The normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood
Hypercapnia
A decrease of oxygen in the blood
hypoxemia
air rushes into the lungs and the chest size increases
inspiration
air is expelled from the lungs as the chest recoils
expiration
The mechanical expansion and contraction of the chest cavity alerts the size of the thoracic container in 2 dimensions:
1- the vertical diameter lengthens or shortens
2-the anteroposterior diameter increases or decreases
The enlarging uterus ___ the diaphragm 4cm during pregnancy, which decreases the vertical diameter of the thoracic cage.
elevates
Low-pitched, hollow sound that predominates in heathy lung tissue in the adult
Resonance
a palpable vibration
Fremitus
Outward curvature of the thoracic spine
Kyphosis
A lateral S-shaped curvature of the thoracic and lumbar spine
Scoliosis
Ribs are horizontal instead of normal downward slope.
Barrel chest
A sunken sternum and adjacent cartilages
Percussion Excavatum
a forward protrusion of the sternum, with ribs sloping back at watch side and vertical depressions along costchondral junctions
Pectus Carinatum
Rapid shallow breathing. Rate >24 per minute
Tachypnea
Increase in both rate and depth. It blows off CO2 causing a decreased level in the blood.
hyperventilation
Slow breathing , a decreased but regular rate (<10 per minute)
Bradypnea
An irregular shallow pattern caused by an overdose of narcotics or anesthetics
Hypocentilation
A cycle in which respiration’s gradually wax and wane in a regular pattern
Cheyne-stokes respiration
A series of normal respiration’s (3-4) is followed by a period of apnea.
Biot respiration
Normal inspiration and prolonged expiration to overcome increased airway resistance
Chronic Obstructive Breathing
Collapsed shrunken section of alveoli or an entire lung as a result of airway obstruction, compression on the lung, and lack of surfactant.
Atelectasis (collapse)
Infection in lung parenchyma leaves alveolar membrane edematous and porous.
Lobar Pneumonia
An acute infection of the trachea and larger bronchi characterized by cough
Acute Bronchitis
Caused by destruction of pulmonary connective tissue; characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls.
Emphysema
Collection of excess fluid in intrapleural space, with compression of overlying lung tissue
Pleural Effusion or thickening
Free air in pleural space causes partial or complete lung collapse
Pneumothorax
This virulent form of pneumonia is a protozoal infection associated with AIDS.
Pneumocystis Jiroveci Pneumonia
I dissolved materials originating in legs or pelvis detach and lodge to occlude pulmonary vessels.
Pulmonary Embolism
