Chest and Lungs

Question 1

What is the structure of the chest cavity

Answer 1

12 thoracic vertebrae and 12 pairs of ribs (7 true vertebrocostal pairs and 5 false pairs)

Question 2

Where does the diaphragm insert?

Answer 2

the sternum, the first three lumbar vertebrae, and the lower six ribs

Question 3

What are the three spaces in the thoracic cavity?

Answer 3

the mediastinum, and the right and left pleural cavities

Question 4

What does the mediastinum contain?

Answer 4

heart, esophagus, trachea, main stem bronchi, thymus, and major blood vessels

Question 5

What is the visceral and parietal pleura?

Answer 5

serous membranes that surround the three lobes of the right lung and two lobes of the left lung

Question 6

Where is the anterior axillary line?

Answer 6

Extends from the anterior axillary fold

Question 7

Where is the midclavicular line?

Answer 7

Vertical line through the middle of the clavicle

Question 8

Where is the midsternal line?

Answer 8

Vertical line that bisects the suprasternal notch

Question 9

Where is the nipple line?

Answer 9

horizontal line through the nipples

Question 10

What important things should be noted in the history?

Answer 10

Anomalies noted in maternal ultrasound, gestational age, relevant maternal medical issues that may impact infants respiratory status, any reports of respiratory distress, increased WOB, cyanosis, feeding pattern

Question 11

What is included in a general inspection of the infant?

Answer 11

color, tone, and activity

Question 12

Infants experiencing cold temperature stress will be….

Answer 12

tachypneic or occasionally bradypnea

Question 13

Persistent tachypnea beyond 2 hours of age may indicate what?

Answer 13

transient tachypnea of the newborn, RDS, meconium aspiration, pneumonia, hyperthermia, or pain

Question 14

Bradypnea and shallow respirations may indicate what?

Answer 14

CNS depression secondary to maternal drug ingestion, asphyxia, or birth injury

Question 15

What is the primary muscle of respiration?

Answer 15

Diaphragm

Question 16

How does the body compensate for chest wall instability?

Answer 16

the infants diaphragm is situated higher in the chest and more concave in shape, allowing for more efficient contractions.

Question 17

Deviations to normal respiratory efforts include….

Answer 17

asymmetric chest movement and excessive thoracic expansion. Paradoxical or “seesaw” respirations suggests poor lung compliance and loss of lung volume

Question 18

Nasal flaring indicates what?

Answer 18

an attempt to decrease resistance to airflow by increasing the size of the nostrils

Question 19

What causes grunting or moaning and what does it indicate?

Answer 19

Sound made by the exhalation against a partially closed glottis in an attempt to increase the FRC in the lungs and stabilize the alveoli.

Question 20

What causes retractions?

Answer 20

decreases lung compliance and cartilaginous rib cage

Question 21

Suprasternal retractions may indicate what?

Answer 21

if accompanied by stridor, may indicate an upper airway obstruction i.e. laryngeal webs or cysts, tumors, or vascular rings

Question 22

Asymmetrical chest movement may indicate….

Answer 22

diaphragmatic hernia, cardiac lesions inducing failure, pneumothorax, or phrenic nerve damage

Question 23

Periodic breathing up to 20 sec pause is common in preterm infants and may persist for several days in term infants. true or false?

Answer 23

true

Question 24

Apnea (greater than 20 sec) in the term or late preterm is abnormal and may indicate what?

Answer 24

sepsis, hypoglycemia, cns injury or abnormality, or seizures, maternal drug ingestion

Question 25

Frothy secretions may indicate what?

Answer 25

espohageal atresia

Question 26

nasal stuffiness may be assoc with what?

Answer 26

maternal drug use

Question 27

Rhinitis may be found with what?

Answer 27

congenital syphillis

Question 28

Thick yellow secretions may indicate what?

Answer 28

respiratory infection

Question 29

Copious white nasal secretions may indicate what?

Answer 29

RSV

Question 30

How do the nasal passages contribute to total pulmonary resistance?

Answer 30

Narrow passages so increased resistance to airflow

Question 31

What are the tracheal cartilage and how are they supported?

Answer 31

hyoid, thyroid, and cricoid. supported by superficial fascia, which is underdeveloped in premature infants, increased risk of airway obstruction

Question 32

How are the trachea and bronchi supported?

Answer 32

cartilaginous rings

Question 33

Deviated trachea may indicate what?

Answer 33

pneumothorax, space-occupying lesion, or significant atelectasis

Question 34

What is the average chest circumference?

Answer 34

30-36 or 2 cm less that FOC

Question 35

How does the infant preserve end-expiratory volume?

Answer 35

increasing respiratory rate, shortening the inspiratory time, and closing the larynx

Question 36

What are the sternal deviations?

Answer 36

pectus carinatum = protrusion outward

pectus excavatum= indented

Question 37

Pectus carinatum is associated with which syndromes/defects?

Answer 37

scoliosis, CHD, margan, eagle-barrett, noonan syndromes, osteogenesis imperfecta, mitral valve prolapse

Question 38

What results from dilated lymphatic vessels and may be found in the neck, chest wall, or axillae

Answer 38

cystic hygroma

Question 39

What should the distance of the nipples be?

Answer 39

less than one quarter of chest circumference

Question 40

Where would supernumerary nipples be found?

Answer 40

along vertical line drawn through the nipple

Question 41

When would breath sounds be less readily transmitted?

Answer 41

1. pleural space contains fluid or air
2. bronchus contains secretions or foreign body
3. lungs are hyper inflated

Question 42

Suspect clavicle fracture if what is felt?

Answer 42

crepitus, swelling, or tenderness

most common fracture

Question 43

Larger tidal volumes by infant indicates what?

Answer 43

a readiness for weaning. assesses the neonates ability to generate a spontaneous breathe and the size of that breathe

Question 44

What is the purpose of a preset tidal volume?

Answer 44

delivers varying amounts of pressure with each breathe to deliver desired volume of gas. As lung compliance improves, less pressure is needed to deliver the same amount of volume