Chest and Lungs Flashcards
What is the structure of the chest cavity
12 thoracic vertebrae and 12 pairs of ribs (7 true vertebrocostal pairs and 5 false pairs)
Where does the diaphragm insert?
the sternum, the first three lumbar vertebrae, and the lower six ribs
What are the three spaces in the thoracic cavity?
the mediastinum, and the right and left pleural cavities
What does the mediastinum contain?
heart, esophagus, trachea, main stem bronchi, thymus, and major blood vessels
What is the visceral and parietal pleura?
serous membranes that surround the three lobes of the right lung and two lobes of the left lung
Where is the anterior axillary line?
Extends from the anterior axillary fold
Where is the midclavicular line?
Vertical line through the middle of the clavicle
Where is the midsternal line?
Vertical line that bisects the suprasternal notch
Where is the nipple line?
horizontal line through the nipples
What important things should be noted in the history?
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
What is included in a general inspection of the infant?
color, tone, and activity
Infants experiencing cold temperature stress will be….
tachypneic or occasionally bradypnea
Persistent tachypnea beyond 2 hours of age may indicate what?
transient tachypnea of the newborn, RDS, meconium aspiration, pneumonia, hyperthermia, or pain
Bradypnea and shallow respirations may indicate what?
CNS depression secondary to maternal drug ingestion, asphyxia, or birth injury
What is the primary muscle of respiration?
Diaphragm
How does the body compensate for chest wall instability?
the infants diaphragm is situated higher in the chest and more concave in shape, allowing for more efficient contractions.
Deviations to normal respiratory efforts include….
asymmetric chest movement and excessive thoracic expansion. Paradoxical or “seesaw” respirations suggests poor lung compliance and loss of lung volume
Nasal flaring indicates what?
an attempt to decrease resistance to airflow by increasing the size of the nostrils
What causes grunting or moaning and what does it indicate?
Sound made by the exhalation against a partially closed glottis in an attempt to increase the FRC in the lungs and stabilize the alveoli.
What causes retractions?
decreases lung compliance and cartilaginous rib cage
Suprasternal retractions may indicate what?
if accompanied by stridor, may indicate an upper airway obstruction i.e. laryngeal webs or cysts, tumors, or vascular rings
Asymmetrical chest movement may indicate….
diaphragmatic hernia, cardiac lesions inducing failure, pneumothorax, or phrenic nerve damage
Periodic breathing up to 20 sec pause is common in preterm infants and may persist for several days in term infants. true or false?
true
Apnea (greater than 20 sec) in the term or late preterm is abnormal and may indicate what?
sepsis, hypoglycemia, cns injury or abnormality, or seizures, maternal drug ingestion
Frothy secretions may indicate what?
espohageal atresia
nasal stuffiness may be assoc with what?
maternal drug use
Rhinitis may be found with what?
congenital syphillis
Thick yellow secretions may indicate what?
respiratory infection
Copious white nasal secretions may indicate what?
RSV
How do the nasal passages contribute to total pulmonary resistance?
Narrow passages so increased resistance to airflow
What are the tracheal cartilage and how are they supported?
hyoid, thyroid, and cricoid. supported by superficial fascia, which is underdeveloped in premature infants, increased risk of airway obstruction
How are the trachea and bronchi supported?
cartilaginous rings
Deviated trachea may indicate what?
pneumothorax, space-occupying lesion, or significant atelectasis
What is the average chest circumference?
30-36 or 2 cm less that FOC
How does the infant preserve end-expiratory volume?
increasing respiratory rate, shortening the inspiratory time, and closing the larynx
What are the sternal deviations?
pectus carinatum = protrusion outward
pectus excavatum= indented
Pectus carinatum is associated with which syndromes/defects?
scoliosis, CHD, margan, eagle-barrett, noonan syndromes, osteogenesis imperfecta, mitral valve prolapse
What results from dilated lymphatic vessels and may be found in the neck, chest wall, or axillae
cystic hygroma
What should the distance of the nipples be?
less than one quarter of chest circumference
Where would supernumerary nipples be found?
along vertical line drawn through the nipple
When would breath sounds be less readily transmitted?
- pleural space contains fluid or air
- bronchus contains secretions or foreign body
- lungs are hyper inflated
Suspect clavicle fracture if what is felt?
crepitus, swelling, or tenderness
most common fracture
Larger tidal volumes by infant indicates what?
a readiness for weaning. assesses the neonates ability to generate a spontaneous breathe and the size of that breathe
What is the purpose of a preset tidal volume?
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
