Thorax and Lungs

Question 1

What is the thin membrane that covers the lungs?

Answer 1

Visceral pleura

Question 2

What is the membrane that covers the thoracic cage?

Answer 2

Parietal pleura

Question 3

What are the 4 major functions of the respiratory system?

Answer 3

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)

Question 4

Describe a newborns lungs

Answer 4

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.

Question 5

Explain a pregnant women’s breathing

Answer 5

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.

Question 6

Describe breathing for aging adults

Answer 6

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

Question 7

What is subjective data collection for the lungs?

Answer 7

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

Question 8

What is objective collection for the lungs?

Answer 8

Inspection
Palpitation
Percussion
Auscultation

Question 9

How would you inspect the thorax?

Answer 9

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

Question 10

What is tripod?

Answer 10

Physical stance by people experiencing respiratory distress or people out of breath.

Question 11

How do you palpate the thorax?

Answer 11

Confirm symmetric chest expansion

Palpate for tactile fremitis

Detect lumps, masses, tenderness

Question 12

When you percuss the lung fields, what are the typical sounds you here?

Answer 12

Tone over lung fields should be resonant

Tone over bone is typically flat

Tone over organs is dull

Tone over stomach is tympany

Question 13

What are bronchial sounds?

Answer 13

Over the trachea and are high pitched and harsh

Question 14

What are bronchovesicular sounds

Answer 14

Over the major bronchi and are moderate in pitch

Question 15

What are vesicular sounds

Answer 15

Sounds over peripheral lung fields and are low pitched, soft and rustling like “the wind in the trees”

Question 16

What are crackles?

Answer 16

Crackles are discontinuous, brief, popping sounds. They can often be cleared by coughing when caused by secretions.

Question 17

What are wheezes?

Answer 17

Wheezes are continuous, musical sounds, high or low pitched. Usually more pronounced on expiration. Wheezes usually indicate narrowed or partially obstructed airways.

Question 18

What are pleural rubs

Answer 18

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.

Question 19

What is stridor?

Answer 19

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.

Question 20

What is tachypnea

Answer 20

Shallow breaths

> 25 breaths per min

Question 21

What is Bradypnea?

Answer 21

Regular breaths but < 10 per min

Question 22

What is hyperventilation and hypoventilation

Answer 22

Hyper— increased rate and depth
Hypo—- irregular, shallow pattern

Question 23

What is Cheyne stokes

Answer 23

Unusual pattern associated with serious problems, breaths become shallow, then stop for a period of time (apnea) before restarting.

Question 24

How to measure pulmonary function?

Answer 24

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.

Question 25

What would be the cause of a cough that occurs continuously throughout the day?

Answer 25

Acute illnesses such as respiratory infection.

Question 26

What would be the cause of a cough that occurs in the afternoon/evening?

Answer 26

May be exposed to irritants at work

Question 27

What would be the cause of a cough that occurs worse at night?

Answer 27

Postnasal drip, sinusitis

Question 28

What would be the cause of a cough that occurs in the early morning

Answer 28

Chronic bronchial inflammation of smokers

Question 29

What are atelectatic crackles?

Answer 29

Sounds like fine crackles but do not last and are not pathologic; disappear after the first few breaths.

Question 30

What is the significance of any lag of unequal chest expansion?

Answer 30

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.

Question 31

Findings for atelectasis

Answer 31

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

Question 32

Findings for lobar pneumonia

Answer 32

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

Question 33

Findings for asthma

Answer 33

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

Question 34

Findings for tuberculosis

Answer 34

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