Class notes thorax/lungs Flashcards
Thoracic cage includes:
sternum; 12 pr. ribs; 12 thoracic vertebrae; diaphragm (floor)
Landmarks include:
suprasternal notch, sternum, sternal angle, costal angle
Sternal angle is also called:
angle of Louis
What landmark do you need when doing EKG?
sternal angle
Sternal angle location:
continuous with 2nd rib
also marks the tracheal bifurcation into right and left main bronchi.
How is each intercostal space numbered?
by the rib above it.
Costal angle is formed by?
right and left costal margins where they meet xiphoid process.
When does the costal angle increase?
when rib cage is chronically overinflated seen in emphysema.
What degree is the costal angle?
usually 90 degrees or less
Where is T7 on posterior thoracic?
apex of lung tissue; T10 corresponds to base
Scapula location?
Lower tip at the 7th or 8th rib
12th rib located by?
locate by palpating midway between the spine and the client’s side.
How do you locate Mid-sternal line:
Mid-sternal line is anteriorly down the middle of the chest
How do you locate Mid-clavicular line:
Bisects the center of each clavicle at a point halfway between palpated sternoclavicular and acromioclavicular joints.
How do you locate Anterior axillary line:
Anterior axillary line extends down from the anterior axillary fold
How do you locate Scapular line:
Scapular line extends through the inferior angle of scapula when arms are at sides of body
How do you locate Vertebral line:
Vertebral line is down the spine of the body
How do you locate Mid-axillary line:
Mid-axillary line runs down from the apex of the axilla and lies between and parallel to the other two
How do you locate Posterior axillary line:
Posterior axillary line continues down from the posterior axillary fold
Mediastinum contains:
Contains the esophagus, trachea, heart, great vessels.
Where are the lungs contained?
contained within the pleural cavities.
Does apex extend above the clavicle?
yes
Base of lung rests on diaphragm at:
6th rib, mid-clavicular line
How many lobes in R & L lung?
Right- 3 lobes
Left lung- 2 lobes
Posterior chest is almost all lower lobe.
Right main bronchus is _____, ____, ____ than the left main bronchus.
shorter, wider and more vertical
Trachea and bronchi has dead space means?
Space that is filled with air but is not available for gaseous exchange (150mL in adult)
Resp. function:
Supplies oxygen to the body for energy production.
Removes carbon dioxide as waste product of energy reactions.
Maintains homeostasis (acid-base balance).
Maintains heat exchange.
Forced inspiration (after exercise or during pathology)—
use of accessory neck muscles to heave up sternum and rib cage (sternomastoids, scalene, trapezii)
Forced expiration:
abdominal muscles contract to push abdominal viscera forcefully in and up against diaphragm, making it dome upward and squeeze against the lungs.
Pregnant woman changes:
enlarging uterus elevates diaphragm.
Has a decreased vertical chest diameter,
compensatory increase in the horizontal diameter.
Increased estrogen—relaxes the chest cage ligaments.
Increased total chest circumference
Increased tidal volume to meet oxygen demands of fetus (deeper breathing; little change in RR)
Physiologic dyspnea is:
in pregnancy: increased awareness of need to breathe.
Changes in aging adult:
more rigid structure that is harder to inflate
Costal cartilages become calcified—thorax less mobile.
Respiratory muscle strength decreases.
Decreased elastic properties within lungs; lungs have less tendency to collapse and recoil.
Decreased vital capacity (max amount air that client can expel after first filling lungs to the max).
Increased residual volume (amount of air remaining in the lungs after forceful expiration).
Elderly have increased risk for postoperative pulmonary complications because:
Decreased ability to cough
Loss of protective airway reflexes
Increased secretions
What are the two major pulmonary diseases in which there are greater risks for races other than Whites?
TB, Asthma
Ask about cough:
onset, frequency, duration, timing, productivity, self-care
Ask about SOB:
onset, precipitating factors; ask about exposure to pets, pollen, food , exercise ?
affected by activity or position
Ask about associated factors—sweats, wheezing
Are there any alleviating factors?
Ask about chest pain with breathing:
onset, duration, character (use PQRSTU)
Ask about history of respiratory infections such as:
asthma, pneumonia, bronchitis, TB
What are environmental conditions in Maine that might affect breathing?
^ smoking rate, environment/allergens, Mills?
Ask about ___ in infants and children (Subjective data):
Frequency of URIs, allergies, noisy breathing.
Assess risk for FB aspiration, toxic ingestions.
Ask about exposure to secondhand smoke.
Ask about aging adult (sub):
any new SOB or fatigue, reduced activity level, new immobility, weight change, falls, chest pain while breathing.
Obj data: Inspection:
Assess facial expression to determine comfort of breathing.
Assess LOC, color and skin condition, quality of respirations, respiratory rate.
What position has client taken to breathe.
Look for symmetrical chest expansion.
What should be the relationship between the AP diameter and the transverse diameter?
How can scoliosis and kyphosis limit breathing?
Obj data: Palpation:
for symmetric expansion, tactile fremitus.
Symmetric expansion—unequal with atelectasis, pneumonia, pleural effusion, fractured ribs, pneumothorax
Tactile fremitus—palpable vibration; “ninety-nine” side to side should be symmetrical (if not, investigate further).
Crepitus—palpate to determine if present.
What is crepitus?
coarse, crackling sensation- palpable over the skin surface.
Abnormal finding: in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue (seen after open thoracic injury/surgery)
Obj data: percussion:
Resonance—low-pitched, clear hollow sound over healthy lung tissue
Check for symmetry
Lower-pitched indicates more air (emphysema, pneumothorax)
Higher-pitched indicates increase in density (pneumonia)
Obj data: Auscultation:
Breath sounds—bronchial (tracheal or tubular); bronchovesicular; vesicular
Why can’t you listen to breath sounds just anteriorly or posteriorly?
missing the lobe on the side of the body
Decreased or absent breath sounds caused by:
Bronchial tree obstruction—by what?
Decreased force of inspired air
Hyperinflation
Obstruction between lung and stethoscope
Adventitious sounds is:
Crackles—inspiration
Wheezes—mainly expiration
Describe breath sounds by these characteristics:
On inspiration or on expiration
Loudness
Pitch
Location on chest wall
Spirometer measures:
FEV (forced expiratory volume)
6-minute walk test (6 MWT):
A person who walks >300 meters in 6 minutes is more likely to engage in activities of daily living.
Infant/child chest diameter:
has an equal AP to transverse chest diameter; by age 6, reaches adult ration of 1:2 (AP-to-transverse diameter)
Slight flaring of lower costal margins may occur with ____ ?
respirations.
Should see no ___, ___, ___ in infants/child?
NO nasal flaring, sternal retraction, intercostal retraction.
A newborn’s major respiratory muscle is the
diaphragm
intercostal muscles are not well developed in the?
newborn
______ will bulge with each inspiration; there will be little ______ expansion in infant/child.
abdomen, thoracic
Infants breathe at ___-___ respirations/minute.
30-40
Up to age ___-___, will hear bronchovesicular breath sounds in peripheral lung fields; breath sounds are louder and harsher.
5-6
Stridor is:
high-pitched inspiratory crowing sound; indicates upper airway obstruction (croup, foreign body aspiration, acute epiglottis).
Increased AP diameter is called:
barrel chest
If kyphosis present, will compensate by:
extending and tilting back head.
The aging adult may be ___ during lung exam:
May tire easily. May become dizzy during lung exam.
