Practical 2 Flashcards
What does a mediastinal shift indicate?
Changes in pressure in the pleural cavity
Where does the mediastinum usually shift?
Shift is usually to the unaffected side & may cause compression of the lung on that side
Interventions for limitations in chest and diaphragm motion?
Directed breathing, manual cues/resistance, lateral costal breathing, thoracic chest exercises
What does increased vibration (fremitus) indicate?
increased secretions
What does decrease vibration (fremitus) indicate?
decreased secretions
Dull sounds with percussion?
normal if heard over liver, sternum, heart and visceral organs (posteriorly)
Where are tympanic sounds heard?
over the stomach
Normal diaphragmatic excursion?
3-5 cm
What conditions would diaphragmatic excursion be less?
Obstructive disease where the pt has hyperinflated lungs, flattened diaphragm, & barrel chest
Sternal precautions:
i. No Pulling, No pushing, & no lifting more than 5 pounds
ii. Limit arm motion if pain is present
iii. Do not sleep with hands behind head
iv. Hug pillow to chest to help remind them not to use arms and help with coughing
Apical segment (Right upper lobe)
a. Anterioinferior border: clavicle
b. Posterior Inferior border: a horizontal line drawn at the level of the upper lateral border of the spine of the scapula
Apicoposterior Segment (Left upper lobe)
a. Anterioinferior border: clavicle
b. Posterior Inferior border: a horizontal line drawn at the level of the upper lateral border of the spine of the scapula
Posterior Segment (Right upper lobe)
a. Upper border: a horizontal line at the level of the upper lateral border of the spine of the scapula
b. Lower border: a horizontal line at, or approximately 1 inch below the inferomedial aspect of the spine of the scapula
Anterior Segment (right upper lobe)
a. Upper Border: Clavicle
b. Lower border: horizontal line at level of 3rd intercostal space, or 4th rib anteriorly
Anterior Segment (left upper lobe)
a. Upper Border: Clavicle
b. Lower border: horizontal line at level of 3rd intercostal space, or 4th rib anteriorly
MIddle lobe R (lateral and medial segments)
a. Upper border: a horizontal line at the level of the 3rd ICS or 4th rib anteriorly
b. Lower and lateral borders: the oblique fissure ( a horizontal line at the level of the 6th rib anteriorly) extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 4th rib at the posterior axillary line
c. The midclavicular line separates the medial and lateral segments of the right middle lobe
d. A horizontal line at the level of the 5th rib, anteriorly, separates the superior and inferior lingular segments
Lingula (Left superior)
a. Upper border: a horizontal line at the level of the 3rd ICS or 4th rib anteriorly
b. Lower and lateral borders: the oblique fissure ( a horizontal line at the level of the 6th rib anteriorly) extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 4th rib at the posterior axillary line
c. The midclavicular line separates the medial and lateral segments of the right middle lobe
d. A horizontal line at the level of the 5th rib, anteriorly, separates the superior and inferior lingular segments
Anterior basal (right lower lobe)
a. Upper border: the oblique fissure (horizontal line at the level of the 6th rib anteriorly, extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 5th fib at the midaxillary line
b. Lateral Border: the midaxillary line
Anteriomedial Basal (left lower lobe)
a. anteriorly, extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 5th fib at the midaxillary line
b. Lateral Border: the midaxillary line
Superior Basal Segment (Right lower lobe):
a. Upper border: a horizontal line at, or approximately 1 inch below the inferomedial aspect of the spine of the scapula (T4)
b. Lower border: a horizontal line at or approximately 1 inch above, the inferior angle of the scapula (T7)
Superior Basal Segment (Left lower lobe)
a. Upper border: a horizontal line at, or approximately 1 inch below the inferomedial aspect of the spine of the scapula (T4)
b. Lower border: a horizontal line at or approximately 1 inch above, the inferior angle of the scapula (T7)
Lateral basal segment (right lower lobe)
a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Medial Border: a “plumb line” bisecting the inferior angle of the scapula
c. Lateral border: the midaxillary line
d. Lower border: a horizontal line at the level of the 10th ICS posteriorly
Lateral Basal Segment (left lower lobe)
a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Medial Border: a “plumb line” bisecting the inferior angle of the scapula
c. Lateral border: the midaxillary line
d. Lower border: a horizontal line at the level of the 10th ICS posteriorly
Posterior Basal segment (right lower lobe)
a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Lateral border: a “plumb line” biscecting the inferior angle of the scapula
c. Lower border: a horizontal line line at the level of the 10th ICS posteriorly
Posterior Basal Segment (Left lower lobe)
a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Lateral border: a “plumb line” biscecting the inferior angle of the scapula
c. Lower border: a horizontal line line at the level of the 10th ICS posteriorly
