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NSG 1610 Post Midterm > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What is the midclavicular line?

A

The midclavicular line bisects the center of each clavicle at a point halfway between
the palpated sternoclavicular and acromioclavicular joints

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2
Q

What are the 3 sections of the Thoracic Cavity?

A
  • Mediastinum: middle cavity
  • Right pleural cavity
  • Left pleural cavity
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3
Q

How many pairs of ribs make up the sternum?

A

12

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4
Q

How many pairs of ribs make up the thoracic vertebrae?

A

12

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5
Q

Anterior Thoracic Landmarks

A

1) Suprasternal Notch

2) Sternum

3) Sternal Angle

4) Costal Angle

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6
Q

Anterior Thoracic Landmarks: Suprasternal Notch

A

Feel this hollow U-shaped depression just above the sternum, between the
clavicles.

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7
Q

Anterior Thoracic Landmarks: Sternum

A

The “breastbone” has three parts: the manubrium, the body, and the xiphoid
process. Walk your fingers down the manubrium a few centimeters until you feel
a distinct bony ridge, the sternal angle

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8
Q

Anterior Thoracic Landmarks: Sternal angle

A

Often called the angle of Louis, this is the articulation of the manubrium and
body of the sternum, and it is continuous with the 2nd rib. The angle of Louis is
a useful place to start counting ribs, which helps localize a respiratory finding
horizontally

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9
Q

Anterior Thoracic Landmarks: Costal Angle

A

The right and left costal margins form an angle where they meet at the xiphoid process

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10
Q

What are the Posterior Thoracic Landmarks?

A

1) Vertebral Prominens

2) Spinous Process

3) Inferior Border of the Scapula

4) Twelfth Rib

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11
Q

Posterior Thoracic Landmarks: Vertebral Prominens

A

Flex your head and feel for the most prominent bony spur protruding at the base of the neck. This is the spinous process of C7

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12
Q

Posterior Thoracic Landmarks: Spinous Processes

A

Count down these knobs on the vertebrae, which stack together to form the
spinal column

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13
Q

Posterior Thoracic Landmarks: Inferior Border of the Scapula

A

The scapulae are located symmetrically in each hemithorax. The lower tip is
usually at the 7th or 8th rib

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14
Q

Posterior Thoracic Landmarks: Twelfth Rib

A

Palpate midway between the spine and the person’s side to identify its free tip

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15
Q

Reference Lines on the Anterior Chest

A
  • Anterior Axillary Line
  • Midsternal Line
  • Midclavicular Line
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16
Q

Reference Lines on the Posterior Chest

A
  • Scapular Line
  • Vertebral Line
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17
Q

Reference lines on the lateral side of the chest

A
  • Anterior Axillary line
  • Posterior axillary line
  • Midaxillary line
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18
Q

What is the apex of the anterior chest?

A

the anterior chest the apex, or highest point, of lung tissue is 3 to 4 cm above
the inner third of the clavicles.

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19
Q

What is the base of the anterior chest?

A

lower border, rests on the diaphragm
at about the 6th rib in the midclavicular line

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20
Q

Where does lateral lung tissue extend from?

A

Laterally lung tissue extends from the apex of the axilla down to the 7th or 8th rib

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21
Q

How many lobes does the right lung have?

A

3

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22
Q

How many lobes does the left lung have?

A

2 (upper and lower)

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23
Q

What are 3 things to keep in mind when assessing the lungs?

A
  1. The left lung has no middle lobe
  2. The anterior chest contains mostly upper and middle lobe with very little lower lobe
  3. The posterior chest contains almost all lower lobe
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24
Q

Pleurae

A

are serous membranes that form an envelope between
the lungs and the chest wall

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25
Q

What are the 4 major functions of the respiratory system?

A

(1) supplying oxygen
to the body for energy production;

(2) removing carbon dioxide as a waste
product of energy reactions;

(3) maintaining homeostasis (acid-base balance) of
arterial blood; and

(4) maintaining heat exchange

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26
Q

What controls respirations?

A

Mediated by the brainstem (pons and medulla)

The normal stimulus to
breathe for most of us is an increase of carbon dioxide in the blood, or
hypercapnia.

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27
Q

What are older adult considerations with the respiratory system?

A

The costal cartilages become calcified- thus the thorax is less mobile

Respiratory muscle strength declines

Elasticity of the lungs changes and makes them less distensible and lessening their tendency to collapse and recoil

The aging lung is a more rigid structure that is harder to inflate

Increase in small airway closure

Less surface area is available for gas exchange

Thorax more rounded

Alveoli more rigid

Decreased function of cilia leads to pooling secretions

Risk for pneumonia

Smaller breaths

Lung bases become less ventilated as a result of closing off a number of airways (increases risk for dyspnea)

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28
Q

What is subjective data that the examiner can ask when assessing the respiratory system?

A
  1. Cough (Productive or non-productive? sputum colour?)
  2. Shortness of breath
  3. Chest pain with breathing
  4. History of respiratory infections
  5. Smoking history
  6. Environmental exposure
  7. Patient-centered care
  8. Orthopnea
  9. Change in functional ability
  10. SOBOE?
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29
Q

What are some things that you can chart for the respiratory system?

A

Inspection: AP < transverse diameter. Resp 16/min, relaxed and even.

Palpation: Chest expansion symmetric. Tactile fremitus equal bilaterally.
No tenderness to palpation. No lumps or lesions.

Percussion: Resonant to percussion over lung fields.

Auscultation: Vesicular breath sounds clear over lung fields and =
bilaterally. No adventitious sounds.

30
Q

What is the role of pleural fluid?

A

Pleural fluid prevents friction
with the movement of
inspiration and expiration

31
Q

What is the visceral pleura?

A

hugs the lungs and their surfaces.

32
Q

What is the Parietal Pleura?

A

lines the chest wall and diaphragm

33
Q

What is the trachea?

A

Trachea lies anteriorly to the
esophagus- approx. 10-11 cm long.

Extends and divides into two main
bronchi just below the sternal angle.

34
Q

What is tracheal bifurcation?

A

Tracheal bifurcation is at the level of T4 or T5 posteriorly

35
Q

What is the role of the broncioles?

A

Bronchioles deliver air to alveoli sacs for gas exchange

36
Q

What are the alveoli?

A

Primary units for the lungs to absorb oxygen and
excrete carbon dioxide.

Bunches arranged like grapes to increase the surface area for gas exchange

37
Q

How do you intervene for a patient exhibiting SOB?

A

Ask only the essential questions

May need to intervene while
assessing (elevate HOB, O2, meds, positioning, call for help)

Calm the patient because
anxiety increases work of
breathing

38
Q

What do we always assume about chest pain?

A

Assume chest pain is cardiac until proven otherwise

39
Q

What is apart of the General Inspection for the Respiratory System?

A

What is the Position/posture of patient?

Facial expression and signs of distress

Pursed lips or nasal flaring

LOC (changes may result from respiratory
compromise)

Skin color: pink, cyanosis, pallor, grey

Respiratory Rate

Oxygen saturation

Check for clubbing

Which muscles are doing the work? Any retractions?

Audible respirations

40
Q

How do you inspect the posterior chest?

A

Shape of posterior thoracic cage

  • Spinous processes midline
  • scapulae symmetrical
  • Anteroposterior/
    transverse diameter
  • Inspect the colour of the skin and condition (any lesions, pallor, cyanosis?)
41
Q

What is a barrel chest?

A
  • AP equal to Transverse diameter
  • Horizontal ribs
42
Q

What is funnel chest (Pectus Excavatum)?

A
  • Sunken sternum
  • Noticeable on inspiration
43
Q

why do you palpate the posterior chest?

A
  • Confirm Symmetrical Chest Expansion
  • Assess for tenderness, lesions, masses, lumps,
    bumps, crepitus (if recent rib fractures or
    trauma)

-Tactile Fremitus

44
Q

How do you assess for symmetrical chest expansion?

A

With fingerpads, begin above scapula and move side to side, ending at the base of lung and laterally to midaxillary line

45
Q

How do you assess tactile fremitus?

A

Technique (“99”)

Vibrations of air are transmitted to chest wall

Usually more intense between the scapula and less at the bases

46
Q

What does it indicate when tactile fremitus is not able to be palpated?

A

Decreased or absent when lung tissue is obstructed or when the chest is large

An increase in tactile fremitus indicates denser or inflamed lung tissue, which can be caused by diseases such as pneumonia. A decrease suggests air or fluid in the pleural spaces or a decrease in lung tissue density, which can be caused by diseases such as chronic obstructive pulmonary disease or asthma.

47
Q

Resonance

A

low-pitched, clear, hollow sound- healthy lung

48
Q

Hyper-resonance

A

lower-pitched, booming sound-too much
air present, e.g. emphysema

49
Q

Dull Note

A

soft, muffled thud- abnormal density in lung, e.g.
tumor, pleural effusion, pneumonia

50
Q

What does posterior chest percussion determine?

A

Determines whether tissues contain air, fluid,
or are solid

51
Q

What is diaphragmatic Excursion?

A

A measurement of distance between the base of the lungs on inspiration and
expiration as the diaphragm recoils

52
Q

How do you assess Diaphragmatic Excursion?

A

Patient exhales and holds

Percuss in ICS down scapular line

Mark level of lung tissue on deep
exhalation at last resonant note (sound
changes from resonant to dull)

Repeat after patient breathes deeply
and holds

Difference should equal and bilateral, measuring 1-2 rib spaces (3-5 cm)

53
Q

What are bronchial sounds?

A

loud, high pitched

around the trachea

54
Q

What are bronchovesicular sounds?

A

Medium pitched sounds
over major bronchi

It is normally heard anteriorly over 1st and 2nd intercostal spaces and between scapulae posteriorly. It is abnormal in other locations.

55
Q

What are vesicular sounds?

A

Soft, low pitched

In a normal air-filled lung, vesicular sounds are heard over most of the lung fields

56
Q

What are you inspecting on the anterior chest?

A

Shape of anterior
thoracic cage

Symmetry

Quality of respirations

Retractions of
supraclavicular space
and/or ICS

Accessory muscles

57
Q

What are you palpating on the Anterior chest?

A

Tenderness, masses, lesions

Palpate the anterior chest wall beginning
at apices, above the clavicles

Tactile fremitus

Fremitus is decreased over breast tissue

Decreased over heart

Greatest over large airways (2-3 ICS)

Symmetrical chest expansion

58
Q

Adventitious

A

added sounds

59
Q

Crackles/rales

A

excess mucous; fluid filled
alveoli

60
Q

Wheeze

A

narrowed bronchioles

a higher-pitched sound that happens on the exhale, though it can occasionally happen on the inhale.

61
Q

What is the most common cause of wheezing?

A

The most common causes of wheezing are asthma, and reactive airway disease, a condition that can occur in children, and is often triggered by a viral infection

62
Q

Rhonchi

A

course wheezes and louder
resulting from secretions moving around narrowed airways

63
Q

Stridor

A

partially obstructed airway
(foreign object or laryngeal spasm)

64
Q

What is the normal respiration rate for an adult

A

12-20 per minute

65
Q

What is a normal SPO2 for an adult?

A

95-100% RA

66
Q

Where do you begin to auscultate on the anterior chest?

A

Above the clavicles (apices)

67
Q

How many places do you auscultate on the posterior and anterior chest?

A

8-10 between the intercostal spaces

68
Q

What piece of your had do you use to assess tactile fremitus?

A

palmer or ulnar surface of the hand touch the client’s chest or back as they repeat the word “99” and then move downwards both anteriorly and posteriorly

69
Q

What could abnormal symmetrical expansion indicate?

A
  • atelectasis
  • Pneumonia
  • Pneumothorax
  • Thoracic trauma
70
Q

What lung fields do you auscultate?

A
  • Anterior
  • Posterior
  • Lateral
71
Q

What is Egophony?

A

listen to “eeeee” and expect hear “eeeee”

increased resonance of voice sounds heard when auscultating the lungs.

72
Q

What is bronchophony?

A

Listen to “99” and expect muffled sounds

Normally, the sound of the patient’s voice becomes less distinct as the auscultation moves peripherally; bronchophony is the phenomenon of the patient’s voice remaining loud at the periphery of the lungs or sounding louder than usual over a distinct area of consolidation, such as in pneumonia.

NSG 1610 Post Midterm (5 decks)

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