nurse 252 thorax and lungs Flashcards
what is the thoracic cage defined ad?
the sternum, 12 pairs of ribs, and 12 thoracic vertebrae
where is the suprasternal notch located?
just above the sternum, between the clavicles
where is the sternum located?
breast bone-three parts:
manubrium, the body, and the xiphoid process
what is the sternal angle useful for
a useful place to start counting ribs, each intercostal space is numbered by the rib above it
where is the vertebra proiminens posterior landmark?
start at the base of your neck, flex your head and fell for the most prominent bony protrusion, this is spinous process C7
where is the spinous processes posterior landmark?
count down the vertebrae, which stack together to form the spinal column. note that the spinous processes align with their same numbered ribs only down to t4
where is the inferior border of the scapula posterior landmark?
the lower tip is usually at the level of the seventh or eight rib
where is the twelfth rib as a posterior landmark
palpate midway between the spine and the pts side to identify the free tip of the twelfth rib
where is the midsternal line?
the center of the chest, cutting the body in half
where is the midsternal line?
just to the side of the midsternal line ( bisects (cuts in two equal parts) the center of each clavicle
posteriorly, where is the midspinal line?
extends through the inferior angle of the scapula when the arms are at the side of the body
where is the mediastinum?
the middle section of the thoracic cavity and it contains the esophagus, trachea, heart and great vessles (area between lungs)
what do the right and left pleural cavities contain?
the lungs
are the lungs symmetrical?
no
what is the difference between the left and right lungs?
- the right lung is shorter than the left because of the underlying kidney
- the left lung is narrower (skinner) than the right lung because the heart bulges to the left
how many lobes does the right lung have?
three lobes
how many lobes does the left lung have?
two lobes
what is the pleurae?
a thin, slippery envelope between the lungs and the chest wall, the lungs slide smoothly up and down during respiration, lubricated with only a few millimeters of fluid
where is the trachea?
it lies anteriorly to the esophagus. it begins at the cricoid cartilage and bifurcates just below the sternal angle into the right and left main bronchi
whats the difference between the left and right bronchus?
the right main bronchis is shorter and wider and more veritcal than the left main bronchus
what do the trachea and the bronchi do?
transport gases between the enivorment adn the lungs. they make up the dead space that is filled with air but no gas exchange occurs
what are the three major functions of the respiratory system?
1) supplying 02 to the body for energy production
2) removing C02 as a waste produce of energy reactions
3) maintaining homeostatis (acid base balance)
what subjective data should be gathered about the respiratory system?
cough- do u cough up sputum? any vblood (hemoptysis), does cough seem to come with activity, positioning, or talking?
- you should have shortness of breath? how many pillows does it take to fall asleep? (related to heart issues) history of infecc? does you feel pain when breathing?
- ask about history of smoking or thier work enviroment
what are the types of sputum?
Green phelgm: indicative or viral or bacterial infecc
white or clear: colds, bronchitis, viral infecc
rust color: tubuerculosis, pneumoccoal pneumonia
pink, frosty: pulmonary edema
what is orthopnea?
difficulty breathing in the supine position, state # of pillowd needed to achieve comfort (eg, two pillow orthopnea”
what is paroxysmal noctunal dyspnea?
is when pt is woken from sleep with shortness of breath and needed to be upright to acheive comfort
how to attain objective data for resp system?
perform inspection, palpation, percussion, ausculation on the posterior and lateral thorax. then move to face the pt and repeat thse four manoevers on the anterior chest
how to inpect the posterior chest?
- note the shape and configuration of the chest wall
- note skeletal deformities such as scoliosis and kyphosis
- “barrel chest” occurs in and COPD chronic emphysema as a result of hyperinflation of the lungs
- tripod positioning - pts with COPD who sit leaning forwards with arms braced against there knees
how to palpate the posterior chest?
- confirm symmetrical chest expansion by placing your hands on the back with your thumns at T9 or T10
- slide your hands medially and pincj a small fold of skin between your thumbs
- as pt takes deep breaths, ur thumbs should move apart symmertrically
what should u suspect about an unequal posterior chest?
-if unequal, suspects atelectasis, pneumonia or thoaracic trauma
what percussion notes could be expected for posterior chest?
1) resonance (normal)
2) hyperresonacne (hollow sound)
3) Dull notes (abnormal finding)
what does resonance sound like?
low pitched, clear, hollow sound that predominated healthy lung tissue in adults
what does hyperresonace sound like?
lower pitched, booming sound found when too much air is present in lungs, as in emphysems or pneumothorax
what does dull note sound like?
abnormal- soft, muffled, thud signals abnormal density in the lungs as with pneumonia, pleural effusion, atelectiasis ot tumor
how to ausculate the posterior chest?
evaluate the presense and quality of normal breath sound
- while stanfing behind pt, listen to the following lung areas: posterior from the apices at C7 to the bases at T10 and laterally from the axilla down to the seventh or eight rib
- ask pt to take beep breaths, in through nose and out through mouth, just letting air out of mouth
what are some abnormal findings wih auscultations of lungs?
- decreased breath sounds
- hear dullness when auscultating
- obstruction of the bronchial tree by secretions, mucous plug or foreign body
- emphysema (as result of loss of elasticity in lung fibers
- obstruction of the transmission of sounds ( pneuthorax or pleurl effusion)
what does an absence of breath sounds indicate?
a silent chest means no air is moving in or out which is an ominous sign for impending respiratory failure
is it a good sign when a wheezing pts who as asthma stops wheezing?
no- wheezing means air is still going in and out, when it suddently stops- its because now thier bronchials are so constricted, they cant get air in and out
wheezing does not mean severe asthma attack
02 stats less than ____ on room air must be attended to immediately
93%
what should a nurse do before putting a pt on 02?
put pt in high fowlers (takes weight of fat off of chest) tell them to take some deep breaths, if that doesnt improve, put them on 02
what should you ensure about a pt before putting them on 02?
make sure they arent a CO2 retainer (COPD). normla levels for such pts range from 88% to 92%
what are adventitous sounds?
abnormal sounds - ones that are not normally heard by the lungs
-always notes presense of these sounds
what are adventitous sounds made by?
caused by the collision of moving air with secretions in the tracheobroncial passageways or by the popping open of previous defalted airways
what is a crackle noise from the lungs? caused by what?
a low pitched, bullbing and gurgling, caused by pulmonary edema (fluid in lungs), pneumonia, pulmonary fibrosis
what does a wheeze sounds like? caused by what?
low pitched, heard throughout respiration but more prominent on expiration, caused by bronchitis, bronchus obstruction from airway tumor, asthma
what is a stridor sounds like? cause?
loud and high pitched , inspiratory, cause by croup and epiglottis in children, foreign body inhalation and obstructed airway (all may be life threatening)
what is tachypnea?
rapid, shallow breathing
- more than 24 breaths per min
- normla response to fever or excersise
- resp tate also increases with pneumonia, alkalosis, and pleurisy
what is bradypnea?
slow breathing
resp reates less than 10 per min
caused by drug induced depression of the resp center
what is hyperventilation?
Increase in both rate and depth; causes by extreme exertion, fear, anxiety salicyalte overdose, and lesions of the midbrain. hyperventilation causes the level of carbon dioxide in the blood to decrease (alkalosis)
what is hypoventilation?
an irregular shallow pattern caused by an overdose of narcotics or anesthesia
what is cheyne strokes and what is cause
a cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing
- most common cause is severe heart failure, drug overdose or increased intracranial pressure
- pts who are breathin like this are often at the end of thier life
what is kussumal breathing?
occurs with diabetic ketoacidosis- deeo, laboured breathing
-we have to fix the underlying cause to fix the breathing
