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NURS125 > Lungs, Thorax and Respiratory Assessment > Flashcards

Lungs, Thorax and Respiratory Assessment Flashcards

1
Q

define ventilation

A

mechanical movement of air

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2
Q

define external respiration

A

exchange of O2 and CO2 at the alveoli and external environment

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3
Q

define internal respiration

A

exchange of O2 and CO2 between the blood and body cells

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4
Q

where does gas exchange occur?

A

at the alveoli

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5
Q

what structures are included in the thoracic cage?

A
  • clavicles
  • manubrium
  • sternum
  • ribs
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6
Q

what structures does the sternum articulate with?

A
  • 12 pairs of ribs anteriorly
  • 12 vertebra posteriorly
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7
Q

where is the costal margin of the ribs located?

A

the inferior rib border

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8
Q

what structures are found in the thoracic cavity?

A
  • heart
  • lungs
  • thymus
  • trachea
  • esophagus
  • aorta and great vessels
  • diaphragm
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9
Q

what nerves innervate the diaphragm?

A

phrenic nerve and CN X

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10
Q

what is the thymus responsible for?

A

T-cell production

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11
Q

what are the layers of plurae?

A

visceral and parietal

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12
Q

what does the visceral pleura line?

A

the lungs

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13
Q

what does the parietal pleura line?

A

the thoracic wall, mediastinum and diaphragm

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14
Q

what is the function of pleura?

A

allows lungs to move without resistance and friction by providing lubrication

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15
Q

what is the pleural space?

A

the thin, fluid-filled space between the visceral pleura and the parietal pleura

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16
Q

why does the right main bronchus have an increased risk for foreign body aspiration?

A

it is shorter, wider and more vertical than the left

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17
Q

how many lobes does the right lung have?

A

3: RUL, RML and RLL

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18
Q

how many lobes does the left lung have?

A

2: LUL AND LLL

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19
Q

where is the apex of the lung located?

A

the top of the lungs

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20
Q

where is the base of the lung located?

A

at the bottom of the lungs

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21
Q

what is inspiration triggered by?

A

rise of blood CO2

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22
Q

what occurs during inspiration?

A
  • Inspiratory muscles (external intercostals and diaphragm) contract
  • Lung fields descend by 2 rib spaces
  • 500-800 mL of air intake
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23
Q

what muscles are used for passive inspiration?

A
  • External intercostal muscles
  • Diaphragm
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24
Q

what muscles are used for passive expiration?

A

none

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25
what muscles are used for forced inspiration?
* Sternocleidomastoids * Pectoralis minor * Serratus posterior superior and erector spinae
26
what muscles are used for forced expiration?
* Abdominal muscles * Internal intercostals * Transversus thoracis and serratus posterior inferior
27
why are breath sounds better heard from the front upper half?
* Thinner muscular layer and no scapula obstructing sounds * Lower area may be obstructed by liver
28
what structures does the horizontal fissure separate?
the RUL from the RML
29
what structures does the oblique fissue seperate?
the RML from the RLL
30
what landmark do we use for the apex of the lung?
supraclavicular
31
what landmark do we use for the base of the lung?
horizontally from 6th rib midclavicular line to 8th rib midaxillary line
32
where is the RUL apex located in relation to the LUL apex?
RUL apex is 2.5 cm higher than the LUL apex
33
what landmark do we use for the RML?
4th to 6th rib at the sternum
34
what is the size of the LUL in relation to the right lung?
RUL + RML = LUL
35
what lung fields do we use to landmark the lungs posteriorly?
C7-T10 vertebrae
36
what landmark do we use for the RUL and LUL posteriorly?
C7-T3 vertebrae
37
whay landmark do we use for the LLL and RLL posteriorly?
T3-T10 vertebrae
38
what do white areas on a chest x ray indicate?
solid parts like bone
39
what do black areas on a chest x ray indicate?
air
40
what do grey areas on a chest x ray indicate?
less solid structures like organs
41
what do we inspect during a general survey?
* skin * overall impression * anatomy * movement * behaviour * position
42
what are common concerns in a symptom hx for respiratory concerns?
* chest or radiating pain * travel, sick contacts and environmental exposures * smoking and/or exposure to 2nd hand smoke
43
what are common concerns in a medical hx for respiratory?
* Asthma, COPD, lung cancer * Immunizations (influenxa, pneumococcal) * Allergies * Smoking * personal or family hx of respiratory conditions
44
what areas can we focus on for a review of systems for respiratory?
* tachypnea, dyspnea, sleep apnea * SOB * Pleuritic pain * Cough * Sputum * Wheezing, stridor
45
central cyanosis is typically caused by an issue in which system?
respiratory system
46
peripheral cyanosis is typically caused by an issue in which system?
cardiovascular
47
what is the expected ratio of chest size AP:transverse?
1:2-5:7
48
what is a 1:1 AP:transverse ratio indicative of?
COPD
49
what pattern do we use for palpating the chest?
1,2,3,4,5 pattern starting supraclavicular
50
what things do we note during palpation?
tenderness, masses, lesions, crepitus and temperature
51
define crepitus
palpable or audible popping, crackling, grating, or crunching sensation that can occur during air trapping
52
when do we perform the tactile fremitus test?
when there are concerns about lung disease
53
how do we perform the tactile fremitus test?
1. Ulnar surface or palm of hand on chest wall 2. Patient Repeats “99” 3. Expected to feel vibrations
54
what are some variations in expected findings during the tactile fremitus test?
* Usually reduced at the bases * Most intense between scapulae
55
what are unexpected findings of the tactile fremitus test and what do they indicate?
* Extra feelings due to denser or inflamed lung tissue (e.g. pneumonia) * Less feelings due to air or fluid in the pleural space (pneumothorax) or due to decrease in lung tissue density (COPD, asthma)
56
when do we assess chest expansion?
when there are concerns about lung volume
57
how do we assess chest expansion?
* Place hands at level of T9 & T10 (posteriorly) or at costal margin (anteriorly) * Slide thumbs medially to raise a skin fold (pinching) between * Ask the patient to inhale deeply * Skin fold should expand/disappear * Note symmetry
58
where do we perform percussion during a chest exam?
in the ICS from the lung apex to the lung base
59
what is the expected finding of percussion of the chest?
Resonance throughout
60
what are some unexpected findings during percussion?
* Hyper resonance (air trapping, e.g. COPD) * Dullness (e.g. fluid)
61
when do we test diaphragmatic excursion?
when there are concerns with chest expansion
62
how do we perform diaphragmatic excursion?
* Instruct to exhale and hold * Percuss down mid-scapular line intercostal spaces * Mark change to dullness * Break (breath normally) * Instruct to inhale and hold * Percuss from first line down * Should be at least 1-2 rib spaces (3-5 cm) lower * Repeat on other side
63
what do we assess during auscultation?
* Intensity and Pitch * Quality * Duration * Adventitious Sounds
64
where do we hear tracheal breaths?
over trachea
65
where do we hear bronchial breaths?
Heard over sternum
66
what is the ratio of I:E of a bronchial breath?
1:2 or 1:3
67
where do we hear bronchovesicular breaths?
Heard over 1st and 2nd intercostal space of the anterior chest
68
what is the ratio of I:E of a bronchovesicular breath?
1:1
69
where do we hear vesicular breaths?
over most lung fields
70
what is the ratio of I:E of a vesicular breath?
3:1 or 4:1
71
what do crackles sound like?
Discontinuous brief popping sounds
72
what does wheezing sound like?
Continuous sounds (high or low)
73
what are red flags of respiratory distress?
* Irritability * Abnormal positioning * Work of breathing, use of accesory muscles

NURS125 (12 decks)

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