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NURS 252 > Chapter 19 - Thorax and Lungs (pg. 964-1048) > Flashcards

Chapter 19 - Thorax and Lungs (pg. 964-1048) Flashcards

1
Q

Thoracic Cage

A

bony structure with a conical shape, narrower at the top

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2
Q

What parts make up the thoracic cage?

A

-sternum
-12 pairs of ribs
-12 thoracic vertebrae

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3
Q

Diaphragm

A

bottom of the thoracic cage, a musculotendinous septum

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4
Q

How do the anterior aspects ribs 1-7 attach?

A

directly to sternum via costal cartilage

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5
Q

How do ribs 8-10 attach?

A

to the costal cartilage above

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6
Q

Ribs 11 and 12 are _________ meaning…

A

floating; have free palpable tips

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7
Q

Costochondral Junctions

A

the points where the ribs join their cartilages, are non-palpable

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8
Q

Suprasternal Notch

A

hollow U-shaped depression just above the sternum, in between the clavicles

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9
Q

Sternum

A

aka breastbone: three parts are the manubrium, body, xiphoid process

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10
Q

Manubriosternal Angle

A

bony ridge

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11
Q

What is another name for the sternal angle?

A

angle of Louis

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12
Q

What is the sternal angle?

A

spot where the manubrium and sternum body articulate, continuous with the second rib

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13
Q

Each intercostal space is numbered by the rib ______ it

A

above

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14
Q

What does the angle of Louis mark?

A

the site of tracheal bifurcation into the right and left main bronchi, upper border of atria, above T4

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15
Q

Costal Angle

A

where the R and L costal margins meet at the xiphoid process

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16
Q

Where is C7 palpable?

A

flex head and most superior bump

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17
Q

Spinous processes align with their same numbered ribs only until ____

A

T4

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18
Q

Midsternal Line

A

middle of sternum

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19
Q

Midclavicular Line

A

bisects the centre of each clavicle halfway between SC and AC joints

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20
Q

Vertebral (midspinal) Line

A

posterior vertical separation

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21
Q

Scapular Line

A

posterior separation that extends through inferior angle of scapula when arms are at sides

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22
Q

Anterior Axillary Line

A

lift patients arm and observe how this extends from anterior axillary fold where pectoralis major inserts

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23
Q

Posterior Axillary Line

A

continues down from posterior axillary fold where latissimus dorsi inserts

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24
Q

Midaxillary Line

A

runs down from apex of the axilla and lies parallel and between the other two

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25
Q

Mediastinum

A

middle section of the thoracic cavity, contains esophagus, trachea, heart, great vessels

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26
Q

Pleural Cavities

A

R and L, contain the lungs

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27
Q

Apex

A

highest point of lung tissue, lies 3-4cm above inner clavicles

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28
Q

Base

A

lower border, rests on diaphragm around 6th rib in midclavicular line

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29
Q

Which lung is shorter? Why?

A

right is shorter due to liver underneath

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30
Q

Which lung is narrower? Why?

A

left is narrower due to heart bulging

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31
Q

The R lung has ___ lobes

A

3

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32
Q

The L lung has ____ lobes

A

2

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33
Q

Fissures

A

separate the lung lobes

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34
Q

Oblique Fissure (R and L)

A

anteriorly crosses fifth rib in midaxillary line and terminates at sixth rib in midclavicular line

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35
Q

Horizontal Fissure

A

R lung, divides R upper and middle lobes, extends from fifth rib in R midaxillary line to third intercostal space or fourth rib at R sternal border

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36
Q

The posterior chest is almost all ___________ lobe

A

lower

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37
Q

Where do the posterior lower lobes begin?

A

T3-T4ish

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38
Q

Which lobe is not present posteriorly?

A

RML

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39
Q

Pleurae

A

thin, slippery envelope between the lungs and chest wall

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40
Q

Visceral Pleura

A

lines the outside of the lungs, dips into fissure

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41
Q

Parietal Pleura

A

lines the inside of the chest wall and diaphragm

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42
Q

Pleural Space

A

filled with lubricating fluid, has negative pressure, holds lungs to chest well

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43
Q

Costodiaphragmatic Recess

A

potential space about 3cm below lungs that can compromise lung expansion if full of fluid or air

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44
Q

Trachea

A

anterior to esophagus, 10-11cm long, begins at cricoid cartilage and bifurcates into R and L main bronchi

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45
Q

Where does tracheal bifurcation occur posteriorly?

A

T4-T5

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46
Q

How does the R main bronchus compare to the L?

A

it is shorter, wider, and more vertical

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47
Q

Dead Space

A

what the trachea and bronchi are, carry air but don’t exchange gas

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48
Q

Capacity of dead space in adults?

A

~150mL

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49
Q

What are the bronchi lined with?

A

goblet cells (secrete mucus) and cilia (filter particles)

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50
Q

Acinus

A

a functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and alveoli

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51
Q

4 Functions of Respiratory System:

A

-oxygen supply
-CO2 removal
-homeostasis
-heat exchange

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52
Q

Hypoventilation causes a __________ of CO2

A

build up

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53
Q

Where is respiratory patterns regulated?

A

pons and medulla

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54
Q

Which particle is most involved in the normal breath stimulus?

A

CO2 increase

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55
Q

Inspiration creates a ________ pressure that allows air to rush in

A

negative

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56
Q

What is the major inspiratory muscle?

A

diaphragm

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57
Q

Expiration is primarily _________

A

passive

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58
Q

When does surfactant present itself in infants?

A

32 weeks gestation

59
Q

Surfactant

A

lipid substance needed for inflation of air sacs

60
Q

When does the foramen ovale in infants close?

A

just after birth

61
Q

Ductus Arteriosus

A

links pulmonary artery and aorta

62
Q

Prenatal smoke exposure =

A

chronic hypoxia and low birth weight, nicotine sensitization, otitis media, SIDs, asthma, LRT infections

63
Q

Enlarging uterus elevates diaphragm ____cm during pregnancy

A

4cm

64
Q

__________ relaxes thoracic cage ligaments

A

estrogen

65
Q

During pregnancy, thoracic cage circumference increases by __cm

A

6cm

66
Q

Increased diaphragm movement during pregnancy results in a 40% increase in ______ _______

A

tidal volume

67
Q

Physiologic Dyspnea during pregnancy:

A

-change in dimensions of thoracic cavity
-increased O2 demand
-affects 75% of women
-does not alter ADLs
-not associated with cough, wheezing, or exercise

68
Q

What reduces the mobility of the thorax in older adults?

A

-calcified costal cartilages
-decreased muscle strength
-decreased elasticity of lungs

69
Q

Older adults have a decreased _______ capacity and increased _________ volume

A

vital; residual

70
Q

Vital Capacity

A

max amount of air a person can exhale from full lungs

71
Q

Residual Volume

A

amount of air remaining in lungs, even after forceful expiration

72
Q

Hemoptysis

A

coughing up blood

73
Q

Orthopnea

A

difficulty breathing in the supine position

74
Q

Paroxysmal Nocturnal Dyspneas

A

awakening from sleep with shortness of breath

75
Q

tactile fremitus

A

vocal vibrations

76
Q

Where is fremitus most prominent?

A

between scapulae and around sternum, sites where major bronchi are closes to the chest wall

77
Q

resonanace

A

low-pitched, clear, hollow sound in healthy lung tissue in adults

78
Q

What are some extraneous noises that can occur when auscultating?

A

-examiner breathing
-tubing bumping together
-patient shivering
-hairy chest
-rustling of paper

79
Q

Bronchial sounds

A

-high pitch
-loud amplitude
-inspiration < expiration

80
Q

Bronchovesicular Sounds

A

-moderate pitch and amplitude
-inspiration = expiration

81
Q

Vesicular sound

A

-low pitch
-soft amplitude
-inspiration > expiration

82
Q

Where are Bv sound heard?

A

near uppper spine posteriorly and near sternum anteriorly

83
Q

Where are v sounds heard?

A

everywhere but scapulae posteriorly, and around rib case anteriorly

84
Q

Where are b sounds heard?

A

only anteriorly on neck near trachea

85
Q

Adventitious sounds

A

additional sounds that aren’t normally heard in lungs

86
Q

What causes adventitious sounds?

A

collision of moving air with secretions or popping open of previously deflated airways

87
Q

Rales

A

crackles

88
Q

Ronchi

A

wheeze

89
Q

Atelectatic Crackles

A

not pathological, short, popping sounds that don’t last beyond a few breaths, heard only in periphery

90
Q

Why is limitation in thoracic expansion easier to assess anteriorly?

A

range of motion of breathing is greater here

91
Q

6 minute walk test

A

monitor O2 sats while patient walks around for 6 minutes safely, patient who walks more than 300m in 6min is more likely to engage in ADLs

92
Q

What does the Apgar scoring system measure?

A

success of transition to extrauterine life

93
Q

When is the apgar score taken?

A

1 min and 5 mins after birth

94
Q

What is a good apgar score?

A

7-10

95
Q

Infants are obligate nose breathers until age…

A

3 months

96
Q

Normal resp rate in newborn:

A

30-40 bpm

97
Q

How do you test for bronchophony?

A

listen to chest wall with stethoscope while patient repeats “ninety-nine” - abnormal finding is when you can clearly hear the words

98
Q

How do you test for egophony?

A

auscultate while patient says “eeeeeeee” - abnormal finding if you hear a bleating, long “aaaaaa”

99
Q

How do you test for whispered pectoriloquy?

A

auscultate while patient whispers a phrase ie. “one-two-three” - abnormal if you can hear it clearly into the stethoscope

100
Q

Diaphragmatic Excursioon

A

measurement of the distance between the base of the lungs on inspiration and expiration

101
Q

Forced Expiratory Time

A

number of seconds it takes for the patient to exhale total lung capacity to residual volume

102
Q

How do you measure forced expiratory time? When?

A

ask patient to inhale then blow it all out as quickly as possible with mouth open while listening over sternum - screens for airflow obstruction

103
Q

What is a normal forced expiratory time?

A

4 seconds

104
Q

Barrel Chest

A

associated with normal aging and chronic emphysema and asthma

105
Q

Normal adult anteroposterior-to-transverse ration:

A

1:2 to 5:7

106
Q

Pectus Excavatum

A

-sunken sternum and adjacent cartilages
-depression begins at second intercostal space
-more noticeable on inspiration
-congenital
-not usually symptomatic

107
Q

Pectus Carinatum

A

forward protrusion of the sternum

108
Q

Scoliosis

A

lateral S-shaped curve of the spine

109
Q

Kyphosis

A

-exaggerated posterior curvature of the thoracic spine (humpback)
-causes back pain and limited mobility

110
Q

Tachypnea

A

rapid, shallow breathing, >24 bpm, a normal response to fever fear or exercise

111
Q

Hyperventilation

A

-increase in rate and depth
-normally occurs with exertion, fear, anxiety
-diabetic ketoacidosis

112
Q

Bradypnea

A

-slow breathing
-<10 per minute
-due to depression of medulla, increased ICP, diabetic coma

113
Q

Hypoventilation

A

-cause by OD of narcotics or anaesthetics, prolonged bed rest

114
Q

Cheyne-Stokes Respiration

A

-cycle where respirations wax and wane in a regular pattern
-periods last 30-45 seconds with periods of apnea
-severe heart failure is common cause along with renal failure, meningitis, drug overdose, increased ICP

115
Q

Biot’s Respirations

A

similar to cheyne-stokes except pattern is irregular

116
Q

Chronic Obstructive Breathing

A

-normal inspiration and prolonged expiration to overcome increase airway resistance

117
Q

Increased Tactile Fremitus

A

-occurs with increased density of lung tissue

118
Q

Decreased Tactile Fremitus

A

-something obstructs transmission of vibrations

119
Q

Rhonchal Fremitus

A

-vibration felt when inhaled air passes through thick secretions

120
Q

Pleural Friction Fremitus

A

-produced when inflammation of pleura causes decrease in normal lubrication

121
Q

Fine Crackles (rales)

A

-discontinuous
-high-pitched short crackling
-during inspiration
-not cleared by coughing
-occur when inhaled air collides with previously deflated airways

122
Q

Coarse Crackles (rales)

A

-loud, low-pitched, bubbling, gurgling
-start early in inspiration and may be present in expiration
-occur when inhaled air collides with secretion in trachea and bronchi

123
Q

Atelectatic Crackles

A

-not indicative of disease

124
Q

Pleural Friction Rub

A

-coarse, low-pitched sound
-sound like crackles but close to the ear
-caused when pleurae become inflamed and lose their normal lubricating fluid

125
Q

Discontinuous Sounds

A

discrete, crackling sounds

126
Q

Continuous Sounds

A

connected, musical sounds

127
Q

High-pitched Wheeze

A

-may occur on inspiration and expiration
-occur when air is squeezed or compressed through narrow passageways due to swelling, secretions, tumours

128
Q

Low-pitched Wheeze

A

-single-note musical snoring
-more prominent on expiration

129
Q

Stridor

A

-high-pitched, monophonic, inspiratory crowing
-louder in neck
-due to upper airway obstruction

130
Q

Atelectasis

A

-collapsed section of alveoli or entire lung as a result of airway obstruction
I - cough, increased resp. rate and pulse, possible cyanosis
Pa - expansion decreased on affected side, tactile fremitus decreased over area, tracheal deviation
Pe - dull over area
A - decrease or absent v sounds, occasional fine crackles

131
Q

Lobar Pneumonia

A

-alveolar membrane edema and porous
-blood cells pass into alveoli
-alveoli fill with bacteria, cell debris, and replace air
I - increased resp. rate, guarding, sternal retraction, nasal flaring
Pa - decreased chest expansion and increased tactile fremitus
Pe - dull
A - increased bronchophony, egophony, whispered pectoriloquy, fine to medium crackles

132
Q

Bronchitis

A

-proliferation of mucous glands resulting in excess secretion
I - hacking, rasping cough with productive sputum, possible dyspnea, fatigue, cyanosis, clubbing
Pa - normal tactile fremitus
Pe - resonant
A - normal v sounds, crackles, maybe wheeze

133
Q

Empysema

A

-caused by destruction of pulmonary connective tissue
-permanent enlargement of air sacs
-90% of cases from smoking
I - barrel chest, use of accessory muscles, tri-poding, shortness of breath, tachypnea
Pa - decreased TF on chest expansion
Pe - hyper-resonant
A - decreased breath sounds, muffled heart sounds, usually no adventitia

134
Q

Asthma

A

-allergic hypersensitivity to inhaled allergens and irritants
-bronchospasm
-increased airway resistance
-wheezing
I - increased resp. rate, shortness of breath, audible wheeze, accessory muscle use, cyanosis, possible barrel chest
Pa - decreased TF
Pe - resonant, chronic = hyper-resonant
A - diminished air movement, breath and voice sounds decreased, bilateral wheezing

135
Q

Pleural Effusion or Thickening

A

-collection of excess fluid in intrapleural space with compressing of lung tissue
I - increased respirations, dyspnea, cough, tachycardia, cyanosis, abd. distension
Pa - decreased or absent TF, decreased chest expansion
Pe - dull to faint
A - decreased or absent breath sounds, voice sounds decreased

136
Q

Heart Failure

A

-pump failure with increased overload
-causes pulmonary congestion
I - increased resp. rate, shortness of breath, exertion, orthopnea, PND, ankle edema, pallor
Pa - skin is moist and clammy, normal TF
Pe - resonant
A - crackles at lung bases

137
Q

Pneumothorax

A

-free air in pleural space causes partial or complete lung collapse
-usually unilateral
-spontaneous (air enters through lung wall rupture) or traumatic (air enters via injury) or tension (trapped air increases)
I - unequal chest expansion, tachypnea, cyanosis
Pa - TF decreased or absent, tachycardia, decreased BP
Pe - hyper-resonant, decreased diaphragmatic excursion
A - decreased or absent breath and voice sounds

138
Q

Pneumocystis jiroveci Pneumonia

A

-viral form of pneumonia
-harmful to immunocompromised patients
I - anxiety, SOB, dyspnea on exertion, tachypnea, nonproductive cough, children (intercostal retractions), cyanosis
Pa - decreased chest expansion
Pe - dull
A - diminished breath sounds, crackles

139
Q

Tuberculosis

A

-initial acute inflammatory response
-tubercle forms around bacilli
-scar tissue forms
I - initially nonproductive, then productive cough then purulent yellow-green sputum, dyspnea, orthopnea, fatigue
Pa - moist skin
Pe - dull over effusion
A - decreased v sounds, crackles over upper lobes

140
Q

Pulmonary Embolism

A

-thrombus detaches and lodges in pulmonary vessels
-95% result from DVT
-chest pain worse on inspiration, dyspnea
I - changed mental status, cyanosis, tachypnea, cough, hemoptysis, resp. alkalosis
Pa - diaphoresis, hypotension
A - tachycardia, crackles, wheeze

141
Q

Do not ___________ a suspected PE

A

percuss

142
Q

Acute Respiratory Distress Syndrome (ARDS)

A

-acute pulmonary insult
-damage to alveolar capillaries
-pulmonary edema
-acute onset of dyspnea
I - disorientation, rapid shallow breathing, productive cough, resp. alkalosis
Pa - hypotension
A - tachycardia, crackles, rhonchi

143
Q
A

NURS 252 (14 decks)

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