Thorax and Lungs Flashcards
What is the thin membrane that covers the lungs?
Visceral pleura
What is the membrane that covers the thoracic cage?
Parietal pleura
What are the 4 major functions of the respiratory system?
Supplying O2 to the body for energy production
Removing CO2 as a waste product of energy reactions
Maintaining homeostasis (acid-base balance) of arterial blood
Maintaining heat exchange (less important in humans)
Describe a newborns lungs
A newborn has lungs which are fluid filled and should be cleared with the first few breaths. The alveoli will open properly if adequate surfactant is present.. usually after 32 weeks of gestation.
Explain a pregnant women’s breathing
Pregnant women breathe more deeply to compensate for the added demands of a growing fetus.
The downward expansion of the lungs is somewhat impinged by the pressure of the growing fetus on the diaphragm.
Increased levels of estrogen help to relax the ligaments of the thoracic cage so that the lungs can expand more in a horizontal direction.
Describe breathing for aging adults
Aging adults are more vulnerable to breathing difficulties.
The thoracic cage becomes calcified and less mobile.
Respiratory muscles decrease in strength
Lungs become less elastic, and there are a decreased number of alveoli available for gas exchange
What is subjective data collection for the lungs?
Cough
Shortness of breath
Chest pain with breathing
History of respiratory illnesses
Smoking history
Environmental exposure
Patient centered care: ask about last TB test, chest X-Ray, pneumonia vaccine, flu immunization
What is objective collection for the lungs?
Inspection
Palpitation
Percussion
Auscultation
How would you inspect the thorax?
Respiratory rate and pattern, ease of breathing
Retractions, use of accessory muscles
Pallor or cyanosis
Symmetry and shape of thoracic cage
Anteroposterior to transverse diameter should be ratio of 1 to 2
Normal infants and older adults with chronic lung conditions such as asthma or emphysema may have skewed ratio or barrel chest
What is tripod?
Physical stance by people experiencing respiratory distress or people out of breath.
How do you palpate the thorax?
Confirm symmetric chest expansion
Palpate for tactile fremitis
Detect lumps, masses, tenderness
When you percuss the lung fields, what are the typical sounds you here?
Tone over lung fields should be resonant
Tone over bone is typically flat
Tone over organs is dull
Tone over stomach is tympany
What are bronchial sounds?
Over the trachea and are high pitched and harsh
What are bronchovesicular sounds
Over the major bronchi and are moderate in pitch
What are vesicular sounds
Sounds over peripheral lung fields and are low pitched, soft and rustling like “the wind in the trees”
What are crackles?
Crackles are discontinuous, brief, popping sounds. They can often be cleared by coughing when caused by secretions.
What are wheezes?
Wheezes are continuous, musical sounds, high or low pitched. Usually more pronounced on expiration. Wheezes usually indicate narrowed or partially obstructed airways.
What are pleural rubs
Creaking or grating sounds that are described as being similar to walking on fresh snow.
Occurs whenever the chest wall moves like in pneumonia, pulmonary embolism, and pleurisy.
What is stridor?
A loud, high pitched sound heard over the upper airways.
It usually indicates an obstruction in the upper airways.. something in you throat.. or chocking.
What is tachypnea
Shallow breaths
> 25 breaths per min
What is Bradypnea?
Regular breaths but < 10 per min
What is hyperventilation and hypoventilation
Hyper— increased rate and depth
Hypo—- irregular, shallow pattern
What is Cheyne stokes
Unusual pattern associated with serious problems, breaths become shallow, then stop for a period of time (apnea) before restarting.
How to measure pulmonary function?
Pulse oximeter: a healthy person without lung problems or anemia typically has a reading of 95% or higher.
Forced expiratory time: number of seconds it takes for patient to exhale forcefully with mouth open. Healthy adult should take no longer than 4 seconds to exhale completely.
6 min walk test: ask patient to walk as far as possible in 6 minutes on smooth, level indoor surface. > 300 meters in 6 mins indicates a person who is more likely to engage in activities of daily living.
What would be the cause of a cough that occurs continuously throughout the day?
Acute illnesses such as respiratory infection.
What would be the cause of a cough that occurs in the afternoon/evening?
May be exposed to irritants at work
What would be the cause of a cough that occurs worse at night?
Postnasal drip, sinusitis
What would be the cause of a cough that occurs in the early morning
Chronic bronchial inflammation of smokers
What are atelectatic crackles?
Sounds like fine crackles but do not last and are not pathologic; disappear after the first few breaths.
What is the significance of any lag of unequal chest expansion?
A lag in expansion occurs with atelectasis, pneumonia, and postoperative guarding. It implies decreased ventilation to one side such as part of the lung is obstructed or collapsed. It could also be from guarding to avoid postoperative or pleurisy pain.
Findings for atelectasis
Condition: collapsed shrunken section of alveoli or an entire lung.
Inspection: cough. Lag on expansion on affected side.
Palpation: chest expansion decreased on affected side. Tactile fremitus decreased or absent over area.
Percussion: dull
Auscultation: breath sound decreased
Findings for lobar pneumonia
Subjective: fever, cough, chills, SOB, fatigue.
Inspection: increased respirations. Guarding and lag on affected side.
Palpitation: chest expansion decreased on affected side.
Percussion: dull over lobar pneumonia
Auscultation: tachycardia.. and crackles at lung bases
Findings for asthma
Inspection: during severe attack: increased respiratory rate, SOB with audible wheeze, use of accessory neck muscles. Expiration labored.
Percussion : resonant. May be hyperresonant if chronic
Auscultation: diminished air movement. Wheezing
Findings for tuberculosis
Subjective: initially asymptomatic, showing as positive skin test or on X-Ray. Progressive TB involves weight loss, anorexia, easy fatiguability, weakness, low grade fever.
Inspection: cough initially nonproductive.
Palpation: skin moist at night from night sweats
Percussion: resonant initially, dull over any effusions
Auscultation: decreased vesicular breath sounds. Crackles
