Respiratory system Flashcards
Thoracic cage
The outer structure of the thorax
Thoracic cage consists of:
The sternum 12 pairs of ribs 12 thoracic vertebra Muscles Cartilage
Sternum
Lies in the center of the chest and is divided into the manubrium, the body and the xiphoid process
Manubrium
Connects laterally w/ the clavicles and the first 2 pairs of rib
Suprasternal notch
U-shaped indentation on the superior proud of the manubrium
Manubriosternal angle
“Angle of Louis”
Few centimeters below the suprasternal notch
Location of the second pair of ribs
Reference point for counting ribs and intercoastal spaces
1st - 7th pair of ribs articulate with
The sternum
8th - 10th pair of ribs connect to
Cartilages of the pair lying superior to them rather than to the sternum.
This forms an angle called the costal angle
11th and 12th pair are called
“Floating” ribs
Because they do not connect to either the sternum or another pair of ribs.
They are connected to the vertebrae and their posterior tips are free and palpable.
Three vertical imaginary landmarks of the anterior chest
Midsternal line
Right midclavicular line
Left midclavicular line
Three vertical imaginary landmarks of the posterior chest
Vertebral line
Right scapular line
Left scapular line
Three vertical imaginary landmarks of the lateral chest
Anterior axillary line
Midaxillary line
Posterior axillary line
Thoracic cavity
Consists of the mediastinum, lungs and is lined by the pleural membranes
The bronchi enter the lungs at the
Hilum
TRUE OR FALSE: The right lung has three lobes and the left lung has only two lobes
TRUE
Parietal pleura
Lines the chest cavity
Visceral pleura
Covers the external surfaces of the lungs
TRUE OR FALSE: The lubricating serous fluid between the layers allows movement of the visceral layer over the parietal layer during ventilation without friction
TRUE
Ventilation
The mechanical act of breathing which is accomplished by expansion of the chest.
Inspiration
The inflow of air into the lungs as a result of a slight negative pressure created in the lungs in relation to the atmospheric pressure
Expiration
The forcing of air out of the lungs as a result of positive pressure within the lungs
Expiration
The forcing of air out of the lungs as a result of positive pressure within the lungs
Respiration is involuntarily controlled by the
Medulla and pons, located in the brainstem
Hypothalamus and the SNS also play a role
Actual Nursing Diagnoses for the Respiratory System
Anxiety Activity intolerance Ineffective airway clearance Impaired gas exchange Disturbed sleep pattern Impaired breathing patterns
Pleural cavity
A potential space between visceral and parietal pleura that is filled only with a few milliliters of lubricating fluid.
TRUE OR FALSE: Trachea and bronchi transport gases between the environment and lung parenchyma.
TRUE
Constitute dead space, or space that is filled with
air but is not available for gaseous exchange.
Acinus
a functional respiratory unit that consists
of bronchioles, alveolar ducts, alveolar sacs, and the
alveoli.
Four major functions of respiratory system
- Supplying oxygen to the body for energy production
- Removing carbon dioxide as a waste product of
energy reactions - Maintaining homeostasis (acid-base balance) of
arterial blood
(-) By supplying oxygen to blood and eliminating
excess carbon dioxide, respiration maintains pH
or acid-base balance of blood. - Maintaining heat exchange (less important in
humans)
Hypercapnia
excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration
Equipment
Stethoscope
Small ruler
Marking pen
Alcohol wipe
Preparation
Client should remove all clothing from the waist up and put on examination gown or drape.
Position
Client should sit in an upright position with arms relaxed at the sides.
Inspection of Posterior Thoracic Cavity
Scapulae and the shape as well as the configuration of the chest wall should be assessed, noting symmetry.
- Shoulders and scapulae should be equally horizontal
- Anteroposterior to transverse diameter should also be noted (Anterior posterior should be less to transverse)
Assess use of accessory muscles, chest expansions and client’s positioning; if they are relaxed and can breath easily
Assess skin color and condition; note any lesions
Palpation of Posterior Thoracic Cavity
Confirm symmetric chest expansion by placing hands on posterolateral chest wall with thumbs at level T9 or T10, pinching a small fold of skin between thumbs
Fremitus is a palpable vibration, touch back with palmar base of fingers and ask patient to repeat “ninety-nine”
Start at lung apices and move to intercoastal spaces and do this for light palpation of entire chest wall.
Percussion of Posterior Thoracic Cavity
Percuss across the apices of the scapulae and across the tops of the shoulders before moving the intercoastal spaces.
Sound should be resonance on lung tissue not hyperresonance and flat on scapulae
Percuss diaphragmatic excursion.
- Ask client to exhale forcefully and hold the breath.
- Percuss starting from the scapular line and down towards the intercoastal spaces until the tone changes from resonance to dull
- Mark this with a marker and repeat on the other side
- Then ask the client to inhale and hold the breath
- Repeat and mark this with a marker. The measurement should be 3 - 5 cm or 7 to 8cm
Auscultation of Posterior Thoracic Cavity
Auscultate from the apex at C7 and down the intercoastal spaces until you reach T10 comparing both sides.
Normal breath sounds should be heard
Normal lung sounds
Tracheal - Over trachea
Bronchial - Over the manubrium
Broncho vesicular: Next to sternum, between scapulae
Vesicular - Rest of the lung
Adventitious Sounds
Crackles
- Fine
- Coarse
Rhonchi
- Wheezes
- Ronchi
- Stridor
- Friction rub
Crackles (fine)
Occurrence: End of inspiration
Quality: High pitched, short, crackling
Causes: Collapsed or fluid filled alveoli
Crackles (coarse)
Occurrence: End of inspiration
Quality: Loud, moist, low-pitched, bubbling
Causes: Collapsed or fluid filled alveoli
- Bronchitis
- Pneumonia
- Fibrosis
- CHF
Wheezes (musical)
Occurrence: Expiration, inspiration when severe
Quality: High pitched, continuous
Causes: Blocked airflow
- Asthma
- COPD
- Foreign object
Ronchi (sonorous)
Occurrence: Expiration/ inspiration, change or disappear w/ cough
Quality: Low pitched, continuous, snoring, rattling
Causes: Fluid- blocked airflow
Stridor
Occurrence: inspiration
Quality: Loud, high-pitched crowing
Causes: Obstructed upper airway
Pleural friction rub
Occurrence: Expiration/ inspiration
Quality: Low pitched, grating rubbing
Causes: Pleural inflammation
Inspection of Anterior Thoracic Cavity
Assess jugular venous pulse
- Client positioned lying down in supine with torso elevated to 30 degrees
- Pulsations may be visible
Inspect shape and configuration
- Anteroposterior less than the transverse diameter
- Ribs pulled downward and symmetrical to intercoastal spaces
- Sternum straight and midline
Inspect color and for lesions
Normal respirations 1-2
Palpation of Anterior Thoracic Cavity
Any tenderness, warmth or sensations, especially at costochondral junction of ribs
Crepitus which is abnormal
Tactical fremitus by patient repeatedly saying ninety nine
Chest expansions
- Hands on anterolateral wall with thumb along the costal margins, pointing towards xiphoid process
Percussion of Anterior Thoracic Cavity
Start at the apices of the lungs and continue along the intercostal spaces across and down to compare both sides
- Sound should be resonance over lung tissue
- Dull over the breast tissue, heart and liver.
- Tympany over gastric space
Auscultation of Anterior Thoracic Cavity
Normal breath sounds
No adventitious sounds
Tachypnea
More than 24 breaths/min and regular
Bradypnea
Less than 10 breaths/min and regular
Hyperventilation
Increased rate and increased depth
Kussmaul
Rapid, deep, labored
Hypoventilation
Decreased rate, decreased depth, irregular pattern
Cheyne-Stokes
respiration
Regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea
Biot’s respiration
Irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea
