Chest & Lungs Flashcards
what are the FOUR FUNCTIONS OF THE RESPIRATORY SYSTEM?
- SUPPLYING OXYGEN to the body for energy production
- REMOVING CARBON DIOXIDE as a waste product
- MAINTAINING HOMEOSTASIS within the arterial blood **acid-base balance
- MAINTAINING HEAT EXCHANGE
definition of RESPIRATION
- the movement of air BACK & FORTH from the ALVEOLI & the outside environment
- gas exchange within the ALVEOLAR & PULMONARY CAPILLARY MEMBRANES
what is the PHYSICAL EXAM order for evaluating the chest & lungs?
- INSPECTION/EVALUATION
- PALPATION
- PERCUSSION
- AUSCULTATION
(posterior - anterior)
describe how the CHEST SIZE CHANGES during RESPIRATION
INSPIRATION:
-air begins to rush into the lungs;
DIAPHRAGM – CONTRACTS & goes DOWNWARD
EXPIRATION:
- air is expelled from the lungs as the chest recoils
-
how is RESPIRATION CONTROLLED?
- through the RESP. CENTERS within the BRAIN STEM
- also asesses the CO2 levels within the blood
which area is the best for assessing the RIGHT MIDDLE LOBE?
the MID AXILLARY LINE
describe LUNG ANATOMY
- UNGS:
- RIGHT LUNG - has 3 lobes
- LEFT LUNG - has 2 lobes
- has various fissures for division
- contains over 300 million within an adult
describe the ANTERIOR ASPECT VIEW OF LUNGS
- indication of RIGHT & LEFT LOBE CAVITIES
- difficulty to see RIGHT INFERIOR LOBE & LEFT INFERIOR LOBE
describe the POSTERIOR ASPECT VIEW OF THE LUNGS
- clear view of BOTH LOBES IN THE LEFT LUNG
- clear view of SUPERIOR & INFERIOR RIGHT LOBES
**not a clear view for the RIGHT MIDDLE LOBE
describe the LATERAL ASPECT VIEW OF THE LEFT LUNG
- clear view of BOTH LOBES of the LEFT LUNG
describe the LATERAL ASPECT VIEW OF THE RIGHT LUNG
- CLEAR VIEW OF ALL THREE LOBES
- best aspect view to see the RIGHT MIDDLE LOBE
are the LUNGS SYMMETRICAL?
NO
- remember they have different amount of lobes; the right lung is more SHORT/ while the left lung is more NARROW
- auscultating the RIGHT MIDDLE LOBE - often on the LATERAL ASPECT/AXILLARY SITE
pleurae
thin slippery envelope that between the lungs & chest wall
visceral pleura
lining outside of the lungs
parietal pleura
lines the inside of the chest wall & diaphragm
what is the PLEURAL SPACE filled with?
lubricating fluid - want to reduce friction
where is the TRACHEA LOCATED?
- around 10-11 cm long
- is ANTERIOR TO the ESOPHAGUS
- bifuracates at T4/T5
important questions to ask regarding HISTORY OF PRESENT ILLNESS?
- can really vary pertaining between COUGH, SOB, CHEST PAIN
- onset/duration?
- dyspnea?
- location?
- any a/b factors?
- different positioning that helps?
- medications?
what are some RESPIRATORY DISEASES to consider during FAMILY Hx?
- ALLERGIES
- ASTHMA
- ATOPIC DERMATITIS (goes in hand in hand with eczema - genetic)
- CYSTIC FIBROSIS
- CLOTTING DISORDERS (risk of pulmonary embolism
- TB
- EMPHYSEMA/BRONCHITIS/ETC»>
what are some considerations to observe for OLDER ADULTS for respiratory issues?
- can have more difficulty and SOB with ADLs
- more risk for respiratory diseases/exposure; how does this affect them?
- any chest pain/coughing/impact on ADLs/weight loss??
describe CHEST INSPECTION
- inspecting landmarks (shape, color, symmetry)
- inspecting RESPIRATIONS (rate, rhythm)
- any audible sounds?
(nasal flaring, accessory muscle use, retraction etc…) - PULSE OX
what is a NORMAL A/P DIAMETER vs. an ABNORMAL ONE?
NORMAL: 1:2
This means that the distance from the front to the back of the chest is less than the distance from side to side.
ABNORMAL: 1:1
can indicate conditions that cause hyperinflated lungs, such as emphysema or chronic obstructive pulmonary disease (COPD). A 1:1 ratio is also common in children under two years old.
describe CHEST PALPATION
- looking for any tenderness, masses, pulsations
- CREPITUS; a cracking or crinkling sensation–can be heard & palpated
indication of AIR in the SUBQ TISSUE or rupturing or INFECTION
how do we test THORACIC EXPANSION?
- putting thumbs lined up on the posterior aspect of the patient
- looking at expansion & symmetry - through MOVEMENT OF THE HANDS
- thumbs at level of the TENTH RIB
what are the PERCUSSION TONE INDICATORS FOR THE LUNGS?
- RESONANCE; NORMAL
- HYPERRESONANCE; HYPERINFLATION
- DULLNESS; DIMINISHED AIR EXCHANGE
diaphragm vs. bell
DIAPHRAGM;
used to hear HIGH-PITCHED SOUNDS
(often for lungs and heart)
BELL;
used to hear LOW-PITCHED SOUNDS
(often for heart - **murmurs)
what are the BREATH SOUNDS?
- BRONCHIAL
- BRONCHOVESICULAR
- VESICULAR
describe BRONCHIAL BREATH SOUNDS
- these are the HIGHEST IN PITCH & INTENSITY
- often heart only over the TRACHEA
describe BRONCHOVESICULAR BREATH SOUNDS
- these are heard over the MAJOR BRONCHI
- often are MODERATE IN PITCH & INTENSITY
describe VESICULAR BREATH SOUNDS
- these are LOW PITCHED & LOW INTENSITY
- heard over HEALTHY LUNG TISSUE
what are some ADENTITIOUS BREATH SOUNDS?
- CRACKLES/RALES
- RHONCHI (SONOROUS WHEEZES)
- WHEEZES
- FRICTION RUB
crackles
- often heard more during INSPIRATION
- known to be DISCONTINUOUS
- can be EITHER FINE (h. pitched/short) OR COARSE (l. pitched/longer)
rhonchi (sonorous wheezes)
- has a DEEP RUMBLING PRONOUNCED SOUND during EXPIRATION
- more PROLONGED & CONTINUOUS
- caused by OBSTRUCTION (thick secretions, spasm, tumor, pressure)
- can sound like a SNORE
ex. asthma
wheezes
- described as a CONT. HIGH-PITCHED MUSICAL SOUND (almost a WHISTLE)
- can be heard in both INSPIRATION & EXPIRATION
- often due to a HIGH-VELOCITY AIRFLOW through narrow/obstructed airway
- can be caused by a BRONCHOSPASM of asthma/bronchitis
friction rub
- happens OUTSIDE RESPIRATORY TREE
- has a DRY/CRACKLING/LOW-PITCHED SOUND
- caused by inflamed & roughed surfaces rubbing together
asthma
- characterized by SMALL AIRWAY OBSTRUCTION
- can have AIRWAY INFLAMMATION + EXCESSIVE MUCUS
**conditions can worsen if irregular use of inhalers – expensive to buy; many patients are conservative with their means
atelectasis
the incomplete expansion of the lung at birth
collapse of the lung at any age
bronchitis
inflammation of the large airways
pneumonia
the inflammatory response of the BRONCHIOLES & ALVEOLI to an infective agent
- can be either bacterial, fungal, or viral
influenza
- viral infection of the lung; a SECONDARY BACTERIAL INFECTION
covid 19
type of VIRAL INFECTION; caused by SARS COV-2 virus
TB
is an infectious disease that most commonly
affects the lungs. TB is caused by a bacteria called Mycobacterium tuberculosis!
common symptoms and findings of TB
symptoms;
- prolonged cough
- fatigue/weakness
- chest pain
- weight loss
**antibiotic recovery is long; takes around 4 - 6 months/no alcohol allowed
pneumothorax
presence of AIR or GAS in the PLEURAL CAVITY
hemothorax
presence of BLOOD in the pleural cavity
- this is often due to LUNG TRAUMA
lung cancer
type of BRONCHOGENIC CARCINOMA–malignant tumor
- cells grow out of control; form tumors that begin to damage healthy lung tissue
common symptoms/findings of lung cancer
- voice hoarse
- dyspnea
- chest pain
- persistant coughing
- often can hear WHEEZING
- some tenderness, masses, etc…
pulmonary embolism
an EMBOLIC OCCULSION of pulmonary arteries
- can be considered a MEDICAL EMERGENCY
epiglottitis
- type of ACUTE + LIFE-THREATENING INFECTION that involves the epiglottis & surrounding tissue
- can be serious and increase with crying
- consideration of intubation
COPD
- mixture of various resp. issues - coughing, sputum production, dyspnea
- greatest at risk; SMOKERS
emphysema
where lungs lose ELASTICITY; alveoli begin to enlarge
chronic bronchitis
large airway inflammation
