Quiz 3 Chapter 18 no pic lungs and thorax Flashcards
Suprasternal notch; Sternum; Manubriosternal angle (“sternal angle” or “angle of Louis”); Costal angle (should be 90 degrees or less; ribs join at angle at xiphoid process.)
Anterior thoracic landmarks
Angle of Louis -
important for listening for heart and lung sounds, also for 2nd rib, ICS’s. Point where trachea bifurcates (at T4 posteriorly)
Vertebra prominens C7 (Feel the bony spur on neck -most prominent one is C7, next one down is T1); Spinous processes (T1-T3); Inferior border of scapula; Twelfth rib
Posterior Thoracic Landmarks
Useful when documenting findings: Midsternal line, Midclavicular line, Scapular line (back), Vertebral line (spine), *Anterior-, posterior-, and midaxillary lines
Location of reference lines
Mediastinum (behind sternum and b/w lungs), Lobes of lungs (3 on right, 2 on left), pleurae (protective layer), tracheal and bronchial tree (check location)
Thoracic cavity
Down to T10 on exhalation; T12 during inhalation
How far down lungs extend
Irregular respiratory pattern; obligatory nose breathers to 3 months; asthma, bronchitis, pneumonia frequent; Cheyne-Stokes respiration in sleep. Don’t base everything on APGAR
Infants resp
Thin chest wall - hyperresonance is normal
Children resp
Increased transverse diam. of chest; diaphragm elevated b/o growing fetus. Deeper breathing, same RR, may feel like they have “dyspnea”
Pregnant resp
Barrel-shaped in COPD. Dec vital capacity, muscle strength & elastic properties. Dyspnea w/ exertion due to less ventilation in lung bases. Cheyne-Stokes pattern in sleep may be normal
Older adult resp
Coughing (dry, productive, sputum, quantity, color), SOB, fever, chest pain with breathing, hx of resp infection, smoking, hoarseness, environmental, self-care
Health History Questionnaire
Sputum and condition
Colds, virus, bronchitis =
clear/white
Sputum and condition
Bacterial infection =
yellow / green
Sputum and condition
TB / pneumococcal pneumonia =
rust-colored/bloody
Sputum and condition
Pulmonary edema =
frothy
Cough*, Hemoptysis, Dyspnea, Wheezing, Cyanosis, Chest pain, Sleep apnea, Sputum production, Clubbing
Chronic bronchitis = x3 months of yr for 3 yrs in a row
Pulmonary disease symtoms
Observe shape of chest wall. Transverse > anteroposterior (not barrel). Symetrical, ribs slope down about 45 degrees from spine
Posterior thoracic cage inspection
__ __: Assess for symmetric expansion of the chest with inspiration. Normal = 4-5 cm. change
Chest expansion:
Place ulnar side of hands on chest wall while pt. says “99” or “blue moon”; Should feel (equal) vibration not incor diminish; air trapping and consolidation affect normal intensity
Tactile (or vocal) fremitus
Abnormal tactile fremitus
increased=
consolidation
Abnormal tactile fremitus
decreased=
emphysema, pneumothorax, pleural effusion
Abnormal tactile fremitus
rhonchial fremitus
thick secretions in bronchi
pleural friction fremitus
creaky; pleuritis
Palpate the entire chest wall for
crepitus, tenderness
Side to side and compare. Avoid bones. Go down to about T10
Pattern for percussion
Best if they sit up, Slightly forward, crossing arms; Lie to side if lying down; Have them breathe and little deeper and through the mouth. Left to right, drop down, back to left, etc. Avoid bone
Auscultation
