gas exchange Flashcards
Thorax
Thorax Extends from the base of the
neck superiorly to the level of the
diaphragm inferiorly
Thoracic cavity contains the
respiratory components
sternum
lies in the center of the chest
anteriorly
has three parts:
* Manubrium, the body, xiphoid
process
12 pairs of ribs—thoracic cage
lungs
Apex-extends slightly above the
clavicle
Base- level of the diaphragm
Right lung has 3 lobes
Left lung has 2 lobes
Trachea-air is transported to and
from lungs
pleura
thin, double-layered serous membrane that lines the thoracic cavity
mediastinum
central area in the thoracic cavity
anterior chest
midsternal, right and left midclavicular lines
posterior thorax
vertebral line, right and left scapular lines
lateral thorax
midaxillary line, anterior and posterior axillary lines
breathing
–Automatic
–Diaphragm-primary muscle of inspiration
inspiration
Inspiration -muscles contract and thorax expands
expiration
Expiration – muscles relax, thorax contracts
accessory muscles
used when there is
extra work of breathing required
Sternocleidomastoids
Scalenes
Abdominal muscles
structures that make up the gas exchange system
Trachea: Lined with ciliated and mucus-
producing epithelium
Bronchi are the two branches of the trachea
that attach to the right and left lung
Bronchioles are lined with muscles that
control the flow of air into the alveoli.
Lungs are multi-lobed organs that are the
center of the respiratory system
Alveoli are the primary site of gas exchange
primary site of gas exchange
alveoli
trachea
lined with ciliated mucous producing epithelium
what are the two main branches of the trachea
bronchi
are lined with muscles that control the flow of air into the alveoli
bronchioles
order of assessment
- History
- Inspection/Observations
Subjective
Objective - Palpation
Tactile fremitus
Symmetric Chest Expansion - Percussion
subjective data collection
History of present health concern—COLDSPA
Dyspnea: difficulty breathing
When did it start? gradual onset may signify lung changes
Is it continuous? may represent copious sputum
You do need to sleep on more then one pillow? Is there fluid in the lung
Orthopnea- difficulty breathing when laying flat- may signal heart failure (CHF)
Do you snore? May signal sleep apnea
Other symptoms –
Cough – productive or non-productive
Sputum – what color and consistency?
Fatigue – worse with activity?
Chest pain – emergency until proven otherwise
past health history
Surgeries – can change lung expansion
and lung sounds
allergies – may have S/S of cough, SOB,
hoarseness
Medications or treatments- breathing
treatments, oxygen
* Some meds may cause cough: beta
blockers, ACE inhibitors
family history
Lung disease?
Smokers in the home – secondary
smoke increases risk of lung cancer
lifestyle
Smokers in the home
Work environment – exposure to
inhalants, paint, pollution, asbestos
tripod position
Tripod position seen in COPD
Client leans forward
Uses arms to support weight
Lifts chest to increase breathing capacity
inspection-general/posterior
Observe color of face, lips and nailbeds- observe for pallor or cyanosis
Inspect for nasal flaring or pursed lips – may indicate dyspnea
Inspect posterior thorax first:
With patient sitting and arms at side:
Position of scapulae and the shape and configuration of the chest wall
Deviation of spine may indicate scoliosis
Barrel chest- may indicate emphysema
inspection
Observe quality and
pattern of respiration
Breathing
characteristics: rate,
rhythm, and depth
Labored and noisy
breathing
Inspect intercostal
spaces.
Ask the client to
breathe normally and
observe the intercostal
spaces.
Observe for use of
accessory muscles.
anterior inspection
Have the patient sit with arms at sides and assess chest for:
Symmetry – should be equal
Equal rise and fall of the chest
Respiration – should be easy and regular rhythm
Accessory muscle use- neck muscles or intercostal muscles
(ABNORMAL)
palpation
Tenderness and sensation
Crepitus: crackling sensation (seen when air
escapes lung and is in the subcutaneous
space)
Palpate in a systematic sequence
palpation of lower thorax
Place hands on posterior chest wall
at the level of T9-T10 and feel for equal rise
and fall of the chest.
Unequal chest rise and fall could indicate
Pneumonia, trauma or lung collapse.
tactile fremitus
Vibrations felt by hand during palpation
Place open palm edge on skin
client repeats 99
Should feel equal vibration bilaterally
Decreases if sound transmission is obstructed by consolidation (pneumonia or sputum)
auscultation of the lungs
Auscultate for breath sounds
Auscultate posteriorly first.
Do not attempt to listen through clothing or other materials.
Always begin with the diaphragm of the stethoscope.
Ask the patient to breathe deeply through the mouth.
Always listen to ONE complete respiratory cycle at each location.
If you note adventitious breath sounds, have the patient cough and re
-listen.
posterior auscultation
Listen for a full respiratory
cycle at each site.
Be aware of the patient
getting dizzy due to
breathing patterns.
Are sounds normal or
abnormal (adventitious).
palpation of anterior thorax
Tenderness and sensation
Crepitus: crackling sensation (seen when air escapes lung and is
in the subcutaneous space)
Palpate in a systematic sequence
percussion
Percussion is an assessment technique where the examiner produces sounds by tapping on the
patient’s chest wall.
Percussion can help to determine if the underlying tissues are filled with fluid, air or solid material.
Utilized in advanced health assessment.
tracheal lung sounds
very loud high pitched, heard over the trachea. inspiratory and expiratory lung sounds equal
bronchial lung sounds
loud relatively high pitched, over the manubrium, inspiratory sound shorter than expiratory
bronchovesticular
medium loudness, sounds equal, between the sternum and scapula
vesticular
soft low pitch, inspires longer than expires, most of lung fields
Rales
- Otherwise known as CRACKLES
- Small clicking, bubbling or rattling sounds
- Occurs when air passes through fluid or mucous
rhonchi
- Snoring sound more continuous then rales
- Occurs when air passes through narrow passage with secretions /
wheezes
:
* High pitched sound produced by narrowed airways
* May be inspiratory or expiratory
stridor
- Loud, high pitched wheeze in the upper airway
- Seen in children with croup, epiglottitis, pertussis
- Many times may be heard without a stethoscope
kussmaul
Kussmaul is
typically seen in
diabetic
ketoacidosis.
fruity breath
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis
biots
abnormal breathing pattern
cheyne stokes
periods of apnea The pattern involves a period of fast, shallow breathing followed by slow, heavier breathing and moments without any breath at all, called apneas.
lung cancer risk factors
Cigarette
smoking/sec
ond-hand
smoke
Genetic
predispositio
n
Exposure to
toxins
History of
previous
lung cancer
Gender
Asbestos,
radon, and
environment
al exposure
Workplace
pollutants
History of
Hodgkin
disease
what is the leading cause of death in the united states and europe
Cigarette
smoking/sec
ond-hand
smoke
Genetic
predispositio
n
Exposure to
toxins
History of
previous
lung cancer
Gender
Asbestos,
radon, and
environment
al exposure
Workplace
pollutants
History of
Hodgkin
disease
lung cancer prevelaince
More men than women affected Black men have higher
incidence and mortality rates
than white males
In 2011, 82% of those living
with lung cancer were 60 years
or older
reduce risk of lung cancer
Avoid smoking cigarettes or
join a tobacco cessation
program if you do smoke.
Check for occupational or
home exposure to asbestos
or radon (have a radon
check of your house or office
if necessary).
Avoid second-hand smoke
exposure.
Seek a medical assessment
for respiratory symptoms
such as prolonged cough or
pain in the chest area
risks of exposure to smoke
Children and Infants:
Frequent and severe asthma attacks, respiratory infections, ear
infections, and sudden infant death syndrome (SIDS).
Pregnancy:
Maternal cigarette smoking correlates with an increased incidence of
perinatal mortality, preterm delivery, premature rupture of
membranes, abruptio placentae, stillbirth, and bleeding during
pregnancy,
In the fetus: decreased fetal size, low birth weight, and SIDS
Adults:
Nasal irritation, coronary heart disease, stroke, and lung cancer
Breathing secondhand smoke can have immediate adverse
effects on your blood and blood vessels, increasing the risk of
having a heart attack.
chronic heart failure or CHF
Dyspnea Cough with pink,
frothy sputum Orthopnea Crackles Low oxygen
saturation Pitting edema
Assessment
CAD / MI Cardiomyopathy (enlarged
heart) Valvular disease Hypertension
Causes:
Left-sided: left ventricular failure Right-sided: right ventricular failure
Inability of the heart to pump sufficient blood resulting in fluid backup in the lungs
pneumonia
Inflammation of the lung caused by infection or
viruses
Fever Chest pain (pleuritic) Dyspnea with
tachypnea
Purulent sputum /
productive cough
Assessment:Assessment:
Infection Virus May be community acquired
or hospital acquired
risk of pneumonia
People most at risk are infants and young children, adults 65 or older
Chronic lung diseases such as COPD, bronchiectasis, or cystic fibrosis that make the lungs more
vulnerable
Heart disease, diabetes and sickle cell disease.
Difficulty swallowing
due to stroke, dementia, Parkinson’s disease, or other neurological conditions, which can result in aspiration of
food, vomit or saliva into the lungs that then becomes infected.
Hospitalizations
Smoking
Drug and ETOH abuse
Exposure to certain chemicals, pollutants or toxic fumes
tuberculosis
TB is an airborne bacterial infection caused by the organism Mycobacterium tuberculosis that primarily
affects the lungs
In the United States, TB is much less common and can almost always be treated and cured if you take
medicine as directed
Can lead to long-lasting permeant lung damage
S/S include:
weakness, weight loss, fever, and night sweats, coughing, chest pain, and the coughing up of blood
Immunization:
Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease
BCG vaccination should only be considered for children who have a negative TB test and who are continually
exposed, and cannot be separated from adults
Healthcare workers who care for a large percentage of TB pts.
asthma
Assessment
Allergies Airway irritants Stress
Common in children
Dyspnea Cough Wheezing – airway
constriction
Dyspnea Cough Wheezing – airway
constriction
common in children
airway irritation
RSV
Fever Runny nose Chest congestion Dyspnea / Wheezing /
Retractions
common lower respiratory tract virus in children
very contagious
older adult considerations
Tenderness or pain at the costochondral junction of
the ribs is seen with fractures, especially in older
clients with osteoporosis.
Older adults may experience dyspnea with certain
activities related to aging changes of the lungs (loss
of elasticity, fewer functional capillaries, and loss of
lung resiliency).
Chest pain related to pleuritis may be absent in older
clients because of age-related alterations in pain
perception.
The ability to cough effectively may be decreased in
the older client because of weaker muscles and
increased rigidity of the thoracic wall.
health history in pediatric clients
*Does your infant become fatigued or short of breath during
feedings? May be a sign of congenital heart defect
*Has your child had vaccinations?
Influenza / Pertussis : have respiratory S/S
* Any exposure to secondhand smoke?
physical exam in children
*Children under 7 are usually abdominal breathers
*Retraction or nasal flaring are clear signs of respiratory distress
*Children who are acutely ill many times present with respiratory
complaints
*Children compensate and appear well longer than adults do
however, when they de-compensate a child can rapidly decline.
*Respiratory distress in a child is always an EMERGENCY.
*Croup- common respiratory virus in children. Sounds like a “barking
seal”.
