Lungs And Thorax Flashcards
When assessing a 75-year-old patient who has asthma, the nurse notes that he assumes a tripod position, leaning forward with arms braced on the chair. On the basis of this observation, the nurse should:
A. recognize that a tripod position is often used when a patient is having respiratory difficulties.
B. assume that the patient is eager and interested in participating in the interview.
C. assume that the patient is having difficulty breathing and assist him to a supine position.
D. evaluate the patient for abdominal pain, which may be exacerbated in the sitting position.
Recognize that the tripod position is often used for a patient that is in respiratory distress
__ are the point where the ribs join their cartilage. What is significant about these?
costochondral junction
they are not palpable
the first seven ribs attach ____ ; ribs 8, 9, and 10 attach to ___, and ribs 11 and 12 are _____.
directly to the sternum via their coastal cartilages above
the coastal cartilage above
“floating” with free palpable tip
feel this hollow U shaped depression just above the sternum, in between the clavicle
suprasternal notch
the “breastbone” has three parts which are __,___,and___.
manubrium
the body
xiphoid process
this is the sternum
The sternal angle is often called the ____, this is the articulation of the manubrium and the body of the sternum, and it is continuous with the second rib.
angle of louis
the right and left coastal margins form an angle where they meet at the xiphoid process . usually 90 degrees or less, this angle increases when the rib cage is chronically overinflated, as in ____.
coastal angle
emphysema
vertebra prominens- flex your head and feel for the most prominent bony spur protuding at the base of the neck . The is the ______. If two bumps seem equally prominent , this is _____.
spinous process of c7
the upper one is c7 and the lower one is t1
What are the reference points on the anterior chest?
midsternal line
midclavicular line p.412
what are the reference points on the posterior chest?
vertebral (or midspinal) line
scapular line
The mediastinum is them middle section of the thoracic cavity containing ______.
esophagus, trachea, heart, and great vessels.
The right and left pleural cavities contain the ___.
lungs
In the anterior chest, the __, or the highest point,of the lung tissue is about 3 to 4 cm above the inner third of the clavicles. The __, or the lower border, rests on the diaphragm at about the sixth rib in the midclavicular line.
apex
base
the right lung is ____ than the left lung because of ___.
shorter
of the underlying liver
the left lung is ____ than the right lung because ____.
narrower
the heart bulges to the left
the right lung has __ lobes and the left lung has __ lobes.
3,2
the left lung has no ___ lobe.
the anterior chest contains mostly _____ lobe with very little ___ lobe.
the posterior chest contains almost all of the ___ lobe.
middle
upper and middle with very little lower
lower
the thin, slippery ____ are serous membranes that form an envelope between the lungs and the chest wall.
pleurae
The ___ pleura lines the outside of the lungs, dipping down into the fissures. it is continuous with the ___ pleura lining the inside of the chest wall and diaphragm.
visceral
parietal
the pleurae extends about 3 cm below the level of the lungs, forming the ____. this is a potential space; when it abnormally fills with air or fluid, it compromises lung expansion
costodiaphragmatic recess
the right main bronchus is __,___, and ____ than the left main bronchus.
shorter
wider
more vertical
the __ and ____ transport gases between the environment and the lung parenchyma,
trachea
bronchi
slow, shallow breathing
hypoventilation
rapid, deep breathing
hyperventilation
increase in carbon dioxide
hypercapnia
decrease in oxygen in the blood
hypoxemia
the maximum amount of air that a person can expel from the lungs after first filling the lungs to maximum
vital capacity
the amount of air remaining in the lungs even after the most forceful expiration
residual volume
acute cough last ____, chronic cough last____.
less than 2 or 3 weeks
last over 2 months
cough continuous throughout the day
acute illness- respiratory infection
cough in the afternoon/ evening
may reflect to irritants at work
cough at night
post nasal drip, sinusitis
cough in early morning
chronic bronchial inflammation of smokers
white or clear mucoid sputum is from what condition:
colds, bronchitis, viral infections
yellow or green sputum
bacterial infections
rust colored sputum
tuberculosis, pneumococcal pnueumonia
pink, frothy sputum
pulmonary edema
hacking cough is associated with?
mycoplasma pneumonia
dry cough is associated with?
early heart failure
barking cough is associated with?
croup; colds, bronchitis, pneumonia – congested
awakening from sleep with SOB and needing to be upright to achieve comfort
paraxysmal nocturnal dyspnea
difficulty breathing when supine
orthopnea
what is significant about when asking a patient their smoking history?
state number of packs per day and the number of years smoked.
what are these symptoms to note that may have signal breathing problems, for carbon monoxide?
for sulfur dioxide?
dizziness, headache, fatigue
cough, congestion
older adults have a less efficient respiratory system (___,____), so they have less tolerance for activity.
decreased vital capacity
less surface area for gas exchange
sedentary or bedridden people are at risk for ___.
respiratory dysfunction
some older people feel ___ less intensely than younger adults.
pleuritic pain
precisely localized sharp pain (points to it with one finger) - consider____.
fractured rib or muscle injury
Inspecting the posterior chest; thoracic cage. What should you do and what is NORMAL?
- **note the shape and configuration of the chest wall.
- the spinous process should be in a straight line
- the thorax is symmetric, in an elliptical shape, with downward sloping ribs, about 45 degrees relative to the spine
- **anteroposterior diameter should be less than transverse diameter
- the ratio is from 1:2 to 5:7
- **note the position the person take a breath
- relaxed posture and the ability to supports own’s weight
- **skin color and condition
- color should be consistent with person’s genetic background .
ribs are horizontal, chest appears as if held in continuous inspiration.
barrel chest
this occurs in chronic emphysema from hyperinflation of the lungs.
neck muscles are hypertrophied in ___ from aiding in forced inspirations.
COPD
people with ____ often sit in a tripod position, leaning forward with arms braced against their knees, chair, or bed.
COPD
to confirm symmetric chest expansion, you should?
place your hands on the posterolateral chest wall with thumbs at level of T9 or T10. slide your hands medically to pinch up a small fold of skin between your thumbs. when the person takes a deep breath, you thumbs should move apart symmetrically.
unequal chest expansion occurs with which conditions?
mark atelectasis lobar pneumonia pleural effusion thoracic trauma such as fractured rib pneumothorax
when accessing tactile fremitus, just between the scapula, fremitus may feel ____ on the right side than on the left because ___.
stronger
the right side is closer to the bronchial bifurcation
coarse, crackling sensation palpable over the skin surface
crepitus; it occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue , as after open thoracic injury or surgery.
the low-pitched, clear, hollow sound that prodominates in healthy lung tissue in adults.
resonance
the resonant note may be modified somewhat in the athlete with a heavily muscular chest wall and in the heavily obese adult in whom subcutaneous fat produces ____.
scattered dullness
lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax
hyperresonance
what is the normal for diaphragmatic excursion?
about 3 to 5 in adults, although it may be up to 7 to 8 cm in well-conditioned people.
added sounds not normally heard in the lungs.
adventitous sounds.
short, popping, crackling sound that sound like fine crackles but do not last beyond a few breaths. not pathologic
atelectatic crackles.
outward curvature of the thoracic spine
kyphosis
markedly sunken sternum and adjacent cartilage. (funnel breast). congential usually not symptomatic. surgery may be indicated.
pectus excavatum
a forward protrusion of the sternum, with ribs sloping back at either side and vertical depression along costochondral juntions (pigeon chest). if severe, surgery may be indicated.
pectus carinatum
a cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and deth and then decreasing. the breathing periods last 30 to 45 seconds, with periods of apnea (20 sec) alternating the cycle.
cheyne-stokes respiration
breathing pattern is irregular. a series of normal respirations (3 to 4) is followed by a period of apnea. the cycle lenght is variable, lasting anywhere from 10 sec to 1 min.
biot’s respiraton
normal inspiration and prolonged expiration to overcome increased airway resistance.
chronic obstructive breathing
vibrations felt when inhaled air passes through thick seccretion in the larger bronchi. this may decrease somewhat by coughing.
rhonchal fremitis
