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NUR 502 > Thoracic and Lung (complete) > Flashcards

Thoracic and Lung (complete) Flashcards

1
Q

Functions of the Respiratory System

A
  • supplies oxygen to the body
  • eliminates carbon dioxide
  • maintain homeostasis
  • maintain heat exchange
  • alveoli: exchange of oxygen and carbon dioxide
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2
Q

Oxygenation depends on:

A
  • airway system to transport air to and from lungs
  • alveolar system to exchange oxygen and carbon dioxide
  • cardiovascular system and blood supply to carry nutrients and wastes to and from body cells
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3
Q

Anatomy of the upper respiratory tract

A

nose
oropharynx

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4
Q

Anatomy of the lower respiratory tract

A

trachea
bronchi: left and right
bronchioles
alveoli

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5
Q

Physiology of the lungs

A

control blood pH

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6
Q

what is the diaphragm

A

a dome-shaped muscle that separates pleural and abdominal cavities

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7
Q

Anterior chest wall landmarks (I can’t input a photo so just a list)

A

suprasternal notch
sternum:
- manubrium
- body
- xiphoid process
sternal angle (angle of Louis)
costal angle

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8
Q

What are the thoracic landmarks?

A

thoracic cage:
- sternum
- ribs (12 pairs)
thoracic vertebrae - 12
diaphragm

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9
Q

What are the 12 pairs of ribs

A
  • ribs 1-7: attach to sternum - costal cartilages
  • ribs 8, 9, and 10: attach costal cartilage above
  • ribs 11 and 12: floating

costochondral junctions (joint): connect the ribs to the costal cartilage

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10
Q

What do the costochondral junctions (joints) do?

A

connect the ribs to the costal cartilage

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11
Q

Chest circumference

A

midsternal line
midclavicular line
anterior axillary line
midaxillary line
posterior axillary line
scapular line
vertebral line

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12
Q

Where is the midsternal line

A

vertical along the sternum

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13
Q

Where is the midclavicular line

A

vertical from the midpoint of the clavicle

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14
Q

Where is the anterior axillary line

A

vertical from the anterior axillary fold

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15
Q

Where is the midaxillary line

A

vertical from the apex of the axilla

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16
Q

Where is the posterior axillary line

A

vertical from the posterior axillary fold

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17
Q

Where is the scapular line

A

from the inferior angle of the scapula

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18
Q

Where is the vertebral line

A

overlie the thoracic spinous processes

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19
Q

Lungs: lobes and fissures anteriorly

A

apex: approximately 2-4cm above the inner third of the clavicle

lower border of the lung crosses the 6th rib at the midclavicular line and the 8th rib at the midaxillary line

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20
Q

Lungs: lobe and fissures posteriorly

A

lower border of the lung lies at the level of the T10 spinous process

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21
Q

Lungs: lobes and fissures lateral

A

right and left side of the lungs located under the axillae

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22
Q

Lungs lobes and fissures on inspiration

A

lungs and diaphragm descends

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23
Q

Lungs: right lobes and fissures

A

Right upper lobe (RUL), right middle lobe (RML), and right lower lobe (RLL)

oblique (major) fissure
horizontal (minor) fissure

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24
Q

Where does the oblique (major) fissure run?

A

From the T3 spinous process obliquely down and around the chest to the 6th rib at the midclavicular line

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25
Q

Where does the horizontal (minor) fissure run?

A

anteriorly; fissure runs close to the 4th rib and meets the oblique fissure in the midaxillary line near the 5th rib

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26
Q

Lungs: left lobes and fissure

A

left upper lobe (LUL) and left lower lobe (LLL)

oblique fissure

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27
Q

Anatomic descriptors of the chest

A
  • supraclavicular (above the clavicles)
  • infraclavicular (below the clavicles)
  • interscapular (between the scapulae)
  • infrascapular (below the scapulae)
  • apices of the lungs (uppermost portions)
  • bases of the lungs (lowermost portions)
  • upper, middle, and lower lung fields
28
Q

Respiratory development during pregnancy

A
  • diaphragm elevated 4cm
  • decrease vertical diameter thoracic cage
  • increase horizontal diameter, increase tidal volume
29
Q

Infant respiratory development

A

body systems develop in utero; respiratory system alone does not function until birth

30
Q

Children respiratory development

A

respiratory development continues throughout childhood

31
Q

Developmental Considerations - older adults

A

less mobile thoracic cavity: calcified costal cartilages

decreased elastic properties within lungs (decreases recoil)

increase risk of pneumonia

32
Q

Developmental considerations

A

decreased number of alveoli - less surface area available for gas exchange

lung bases become less ventilated as a result of closing off a number of airways

33
Q

Focused questions to ask patients regarding shortness of breath (SOB) or dyspnea?

A
  • have you had any difficulty breathing
  • rest, exertion, how much exertion
  • supine (orthopnea) or at night (paroxysmal nocturnal dyspnea), relieved by sitting?
34
Q

Focused questions to ask patients regarding cough

A
  • what brings on a cough
  • hemoptysis: do you cough up blood
    – if so, what does it look like, what brings it on, when did it start, quantity
  • do you have any allergies? what kind and what happens?
35
Q

Focused questions to ask patients regarding chest pain (CP) with breathing

A

do you have any chest pain or chest discomfort

36
Q

Focused questions to ask patients regarding respiratory infection

A

have you had any respiratory infections? how often?

37
Q

Focused questions to ask patients regarding smoking?

A

packs per day (PPD)? when did you start? cough with it, what kind?

38
Q

Focused questions to ask patients about their environment

A

about work, animals, chemicals

39
Q

Other focused questions/topics to ask about

A

medications (like ACE-inhibitor); self-care behaviors (cleaning; fragrances)

40
Q

Focused questions to ask parents regarding infants and children

A
  • any colds? frequency? are they very severe colds?
  • allergy history
    – children under 2: at what age were new foods introduced? breastfed or bottle-fed? any allergies?
  • cough or congested? noisy breathing or wheezing?
  • does anyone smoke in home and/or in the car with the child?
  • environmental or household hazards?
  • has anyone taught you emergency care measures in case of accidental choking or a hard-breathing spell?
41
Q

Focused questions to ask aging adult patients

A
  • have you noticed any SOB or fatigue with your daily activities?
  • tell me about your usual amount of physical activity
  • history of COPD, lung cancer, or TB
    – how are you getting along each day? any weight change in the last 3 months? increase or decrease? how much?
  • how is your energy level? do you tire more easily? how does your illness affect you at home and at work?
  • do you have any chest pain with breathing?
  • do you have any chest pain after a bout of coughing or after a fall?
42
Q

Assessment of the lungs - survey respiration

A
  • rate, rhythm, depth, effort of breathing, signs of respiratory distress
  • describe size and shape of the chest
  • relate findings to landmarks
43
Q

Inspection (usually starting back working towards front)

A
  • symmetry, deformities
  • muscle retraction: intercostal spaces during inspiration
  • lag: delay
  • chest shape: normally wider than it is deep
  • AP diameter to the lateral chest (AP:L): 1:2 - increases with age
  • patient’s position
  • skin: cyanosis, pallor, clubbing of fingers
44
Q

Inspection: rate and rhythm of breathing

A

normal 10-20 breaths per minute, even pattern, normal depth (told us to stick with 10-20 for test)

tachypnea (>25 per minute; rapid, shallow)
bradypnea (<10 per minute)
apnea - periods of not breathing
hyperventilation (increase rate and depth)
hypoventilation (irregular shallow)
adventitious breath sounds

45
Q

Palpation

A

tenderness
intercostal tenderness: over inflamed pleurae
crepitus: fractures
bruising
sinus tract: inflammatory, tube-like structures opening onto the skin
chest expansion
tactile fremitus

46
Q

Palpation: how to assess chest expansion

A
  • place thumbs at level of 10th ribs with fingers loosely grasping and parallel to the lateral rib cage
  • position hands and slide them medially just enough to raise a loose fold of skin; thumbs over spine
  • ask patient to inhale deeply
  • watch the distance between your thumbs as they move apart during inspiration
  • feel for the range and symmetry of the rib cage as it expands and contracts
47
Q

Palpation: Assessing for Tactile Fremitus

A
  • assess for symmetry
  • use either the ball or ulnar surface of hand
  • ask the patient to repeat the words “99” or “one one one”
  • initially use for a side-by-side comparison
  • both hands to palpate and compare symmetric
  • identify and locate any areas of increased, decreased or absent fremitus

decreased/absent: voice is higher pitched or soft
– something obstructs the transmission of vibration
– COPD, pleural effusion, fibrosis, pneumothorax, infiltrating tumor, emphysema

increased
- compression or consolidation of lung tissue
- lobar pneumonia

48
Q

Palpation: tactile fremitus - crepitus

A

coarse, crackling over skin surface
subcutaneous emphysema - when air gets into tissue and can feel it; happens with chest tubes

assess:
temperature
lesions
masses
wounds

49
Q

Percussion - advanced assessment

A
  • producing audible sound and palpable vibrations
  • establish whether the underlying tissues are air-filled, fluid-filled, or consolidated

Normal: resonance
Abnormal: hyperresonance (COPD); dull (pneumonia)

50
Q

Auscultation

A

assessing air flow through the tracheobronchial tree

listening for:
- breath sounds
- adventitious (added) sounds
- abnormalities

diaphragm on chest wall

listen to one full respiration: inspiratory and expiratory, side to side
- C7-T10
- lateral from axilla to 7th rib

51
Q

Assessment of breath sounds (normal)

A

bronchial: over trachea and large bronchi; tubular sound, high pitched hollow sounds

bronchovesicular: medium- pitched sounds

vesicular: inspiration louder and longer than expiration, low pitched sounds

52
Q

Auscultation: adventitious breath sounds

A

added sounds: caused by moving air colliding with secretions in tracheobronchial passageways or by popping open of previously deflated airways

53
Q

Auscultation - adventitious breath sound type

A

crackles (rales)
wheezes
rhonchi
stridor
diminished/decreased, absent
pleural friction rub
abnormal vocal sounds

54
Q

What are crackles and types

A

discontinuous nonmusical, early inspiratory (COPD), late inspiratory (pulmonary fibrosis), or biphasic (pneumonia)

popping sound - inspiration; deflated - expiration

fine crackles
– softer, higher pitched, more frequent per breath than coarse crackles
– mid to late inspiration, dependent areas of the lung, varies with positioning –> fluid shifts

coarse crackles
– popping sound, are heard over any lung region, and do not vary with body position
– early inspiration and last throughout expiration

55
Q

Adventitious breath sounds - wheezes

A

continuous musical sounds, occur during rapid airflow when bronchial airways are narrowed
heard throughout the lung
inspiratory, expiratory, or biphasic
asthma, mucous plug, tumor

56
Q

Adventitious breath sounds - Rhonchi

A

variant of wheezes, same mechanism
lower in pitch
disappear with coughing

57
Q

Adventitious breath sounds - stridor

A

high-frequency, high-pitched musical sound produced during airflow through a narrowing in the upper respiratory tract

obstruction - foreign body

58
Q

Adventitious breath sounds - pleural friction rub

A

inflammation of the lung tissues
raspy breathing sounds

59
Q

Abnormal assessment findings

A

SOB or dyspnea

Cough
– mucus, pus, blood as well
– allergens: dust, foreign bodies, hot or cold air

Chest pain (CP) w/ breathing

Respiratory infection
– viral upper airway, bacterial infection
– pneumonia

Orthopnea - supine

Cheyne-Stokes respirations
– periods of deep breathing alternate with periods of apnea; severe state

Biot’s (ataxic) breathing
– severe; irregular Cheyne-Stokes
– periods of apnea alternate with regular deep breaths which stop suddenly for short intervals

Abnormal vocal sounds - advanced

60
Q

Abnormal vocal sounds (advanced assessment)

A

egophony, bronchophony, whispered pectoriloquy

61
Q

Anterior chest wall

A

shape, symmetry, configuration
facial expression
difficulty breathing
level of consciousness
color
quality of respirations
respiratory rate - 30s x 2
- w/ pulse ox

62
Q

Palpation - Anterior Chest Expansion

A
  • place thumbs along each costal margin and hands along the lateral rib cage
  • position your hands, slide them medially a bit to raise loose skin folds between your thumbs
  • ask the patient to inhale deeply
  • observe how far thumbs diverge as the thorax expands
  • feel for the extent and symmetry of respiratory movement
63
Q

Palpation: anterior tactile fremitus

A
  • begins over supraclavicular areas for apices (have patient say 99 or “one one one”)
  • compare both sides of the chest
  • use the ball or ulnar surface of the hand
  • fremitus is usually decreased or absent over the precordium
  • for woman, gently displace the breasts
64
Q

Percussion: anterior - advanced assessment

A
  • percuss the anterior and lateral chest, comparing both sides
  • the heart produces dullness to the left of the sternum from the 3rd to the 5th interspaces
  • gently displace the breasts for women
65
Q

Infant Auscultation

A
  • diaphragm is newborn’s major respiratory muscle
  • count respiratory rate for 1 full minute
  • normal rates 30-40 breaths (may spike up to 60)
  • most accurate respiratory rate when the infant is asleep
  • brief periods of apnea (less than 10-15 seconds) are common
    – is more common in premature infants
66
Q

Pediatric auscultation

A
  • bowel sounds are easily heard in the chest
  • use smaller pediatric diaphragm end piece, or place bell over infant’s interspaces and not over ribs
  • bronchovesicular breath sounds in peripheral lung fields of infant and young child up to ages 5-6 years
  • fine crackles are commonly heard in immediate new born period from opening of airways and clearing of fluids
67
Q

Older adults and illness

A

older adults:
- tire easily (don’t hyperventilate)
- increase AP diameter

illness:
- may need to roll from side to side
- limits comparison

NUR 502 (10 decks)

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