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HEALTH ASS RLE > Thorax and lungs > Flashcards

Thorax and lungs Flashcards

1
Q

identifies the position of the body extending from the base of the neck superiorly to the level
of the diaphragm inferiorly.

A

Thorax

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2
Q

is constructed of the sternum, 12 pairs of ribs, 12 thoracic
vertebrae, muscles, and cartilage.

A

Thoracic Cage

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3
Q

lies in the center of the chest anteriorly

A

The sternum or breastbone

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4
Q

the divided three parts of the breastbone and sterum

A

manubrium
body
xiphoid process

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5
Q

extends from the manubrium of the scapula to the acromion.

A

The clavicles (collar bones)

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6
Q

connects laterally with the clavicles and the first two pairs of ribs.

A

manubrium

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7
Q

A U-shaped indentation located on the superior border of the manubrium is an important landmark known as
the

A

suprasternal notch.

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8
Q

A few centimeters below the suprasternal notch, a bony ridge can be palpated at the
point where the manubrium articulates with the body of the sternum. This landmark is referred to as the

A

sternal angle (angle of Louis).

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9
Q

Ribs (7 through 10) connect to the cartilages of the pair lying superior to them rather than to the sternum. This
configuration forms an angle between the right and left costal margins meeting at the level of the xiphoid
process, referred to as

A

the costal angle.

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10
Q

Each pair of the ribs articulates with its respective thoracic vertebra. The spinous process of the seventh
cervical vertebra (C7), also called

A

vertebra prominens,

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11
Q

can be easily felt with the client’s neck flexed.

A

vertebra prominens,

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12
Q

Equipment used for Thorax and lung assessment

A

Stethoscope
Skin marker/pencil
centimeter ruler

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13
Q

Determine client’s history of the
following:

A

Family history of illness,
including cancer.
Allergies
Tuberculosis
Smoking and occupational
hazards.
Any medications being
taken.
Current problems such as
swellings, coughs,
wheezing, pain.

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14
Q

Deviation from normal of shape and symmetry of the thorax posterior from lateral views and the normal findings

A

Deviations: Barrel chest; increased anteroposterior diameter to the transverse diameter chest is asymmetric

Normal: Anteroposterior diameter to the transverse diameter in ratio 1:2
Chest is symmetric

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15
Q

Normal and deviation from normal findings on inspecting the spinal alignment for deformities

A

Normal: spine is vertically aligned
Deviation: Exaggerated spinal curvatures (kyphosis, lordosis, scoliosis)

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16
Q

To assess for lateral
deviation of the spine (scoliosis),

A

observe the standing client from
the rear. Have the client bend
forward at the waist and observe
from behind.

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17
Q

Palpate the posterior thorax.
normal and deviation from normal

A

Normal: Skin intact; uniform
temperature
Deviation: Skin lesions; areas of
hyperthermia

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18
Q

For clients who do have
respiratory complaints,

also the normal and deviation from normal findings

A

palpate all
chest areas for bulges, tenderness,
or abnormal movements. Avoid
deep palpation for painful areas,
especially if a fractured rib is
suspected.

normal: Chest wall intact; no
tenderness; no masses

Deviation: Lumps; bulges; depressions; areas
of tenderness; movable
structures

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19
Q

Palpate the posterior chest for
respiratory excursion.

also normal and deviation

A

Place the palms of both your
hands over the lower thorax, with
your thumbs adjacent to the spine
and your fingers stretched laterally. Ask the client to take a
deep breath while you observe the
movement of your hands and any
lag in movement.

N: Full and symmetric chest
expansion (that is, when the
client takes a deep breath,
your thumb should move apart
at an equal distance and at the
same time; normally the
thumb separate 3 to 5 cm

D: Asymmetric and/or decreased
chest expansion

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20
Q

what do we palpate the chest for

what is the normal and deviation

A

Vocal (tactile) fremitus

N: Bilateralsymmetry of vocal
fremitus

D: Decreased or absent fremitus
(pneumothorax)

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21
Q

how to palpate chest for tactile fremitus

A

Place the palmar surfaces of
your fingertips or the ulnar aspect
of your hand or closed fist on the
posterior chest, starting near the
apex of the lungs.

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22
Q

what does increased fremitus indicate

A

pneumonia

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23
Q

where is fremitus heard most clearly

A

Apex of the lungs

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24
Q

Percuss the thorax Normal and deviation

A

N: Percussion notes resonate,
except overscapula

D: Asymmetry in percussion

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25
where is the lower point of resonance
at the diaphragm at level of the 8th and 10th ICS
26
what is associated with areas of dullness or flatness over the lung tissue
Consolidation of lung tissue or a mass
27
what is percussed Normal and Deviation
Diaphragmatic excursion N: Excursion is 3 to 5 cm (1 1⁄2 to 2 in.) bilaterally in women and 5 to 6 cm (2 to 3 in.) in men D: Restricted excursion (associated with lung disorder)
28
Excursion measurement that is normal for women and what is the one for men
3 - 5 cm bilaterally in women 6cm in men
29
Diaphragm is usually higher on which side
right side
30
Auscultate the chest using the
flat-disc diaphragm of the stethoscope.
31
what are we listening for during auscultation of the chest
Vesicular and Broncho vesicular breath sounds
32
Deviation from normal findings of sound during auscultation or adventitious sound
crackles, rhonchi, wheeze, friction
33
what does absence of sound indicate or is associated with
collapsed and surgically removed lung lobes
34
normal findings during inspection of breathing patterns in anterior thorax and deviation from normal
N: Quiet, rhythmic, and effortless respiration D :Abnormal breathing patterns and sounds
35
what is inspected in the anterior chest
Breathing patterns costal angle angle at which the ribs enter the spine
36
Normal and deviation from normal costal angle and ribs insert into the spine
N: Costal angle is less than 90°, and the ribs insert into the spine at approximately at 45° angle D: Costal angle is widened (associated with COPD)
37
what is associated if costal angle is widened
COPD
38
what is palpated in the anterior chest
respiratory excursion skin integrity temp skin uniformity
38
How is palpation of respiratory excursion performed
Place the palms of both your hands on the lower thorax, with your fingers laterally along the lower rib cage and your thumbs along the costal margins Ask the client to take a deep breath while you observe the movement of your hands.
39
Fremitus is normally decreased over
heart and breast tissue
40
If the breasts are large and cannot be retracted adequately for palpation, this part of the examination usually
is omitted.
41
Percussion notes resonate down to the
6th rib at the level of the diaphragm but are flat over areas of heavy muscle and bone,
42
where is it usually dull when percussing
dull on areas over the heart and the liver, and tympanic over the underlying stomach
43
what are we trying to hear during auscultation of trachea
Bronchial and tubular breath sounds
44
deviation from normal when auscultating the trachea and anterior chest
Adventitious breath sounds
45
what is being heard during auscultation of anterior chest
Broncho vesicular and vesicular breath sounds
46
Lifespan Considerations: infants
The thorax is rounded; that is, the diameter from the front to the back (anteroposterior) is equal to the transverse diameter. It is also cylindrical, having nearly equal diameter at the top and the base. To assess tactile fremitus, place over the hand of the crying infant’s chest. Auscultated sounds will be louder and harsher. Infants tend to breathe more abdominally than thoracically.
47
Lifespan Considerations: Children
By 6 years of age, the anteroposterior diameter has decreased in proportion to the transverse one. Children tend to breathe more abdominally than thoracically up to age 6.
48
Lifespan Considerations: Elders
The thoracic curvature may be accentuated (kyphosis) because of osteoporosis and changes in cartilage, resulting in collapse of the vertebrae. This can also compromise and decrease normal respiratory effort. Kyphosis and osteoporosis alter the size of the chest cavity as ribs move downward and forward. The anteroposterior diameter of the chest widens, giving the person a barrel-chested appearance. This is due to the loss of skeletal muscle strength in the thorax and diaphragm and constant lung inflation from excessive expiratory pressure on the alveoli. Breathing rate and rhythm are unchanged at rest; the rate normally increases with exercise but may take longer to return to the pre exercise rate. Inspiratory muscles become less powerful and the inspiration reserve volume decreases. A decrease in depth of respiration is therefore apparent. Expiration may require the use of accessory muscles. The expiratory reserve volume significantly increases because of the increased amount of air remaining in the lungs at the end of a normal breath. Deflation of the lungs is incomplete. Small airways lose their cartilaginous support and elastic recoil; as a result; they tend to close, particularly in basal or dependent portions of the lung. Elastic tissue of the alveoli loses its habitability and changes to fibrous tissue. Exertional capacity decreases. Cilia in the airways decrease in number and are less effective in removing mucus; elderly clients are therefore at greater risk for pulmonary infections.
49
Desc: Fine,short, interrupted crackling sounds; alveolarrales are high -pitched. Sound can be simulated by rolling a lock of hair near the ear. Best heard on inspiration and expiration. May not be cleared by coughing.
Crackles
50
cause and location of crackles
C: Air passing through fluid or mucus in any air passage. L: Most commonly heard in the bases of the lower lung lobes
51
Continuous, low-pitched, coarse, gurgling, harsh,loudersounds with a moaning or snoring quality.Best heard on expiration but can be heard on both inspiration and expiration. May be altered by coughing
Gurgles (rhonchii)
52
cause and location of Gurgles (rhonchii)
C: Air passing through narrowed air passages as a result ofsecretions, swelling, tumors L: Loud sounds can be heard over most lung areas but predominate over the trachea and bronchi.
53
Superficial grating or creaking sounds heard during inspiration and expiration. Not relieved bycoughing.
Frictionrub
54
Cause and location of Frictionrub
C: Rubbing together of inflamed pleural surfaces L: Heard most often in areas of greatest thoracic expansion (e.g., lower anterior and lateral chest)
55
Continuous, high-pitched, squeaky musicalsounds. Best heard on expiration. Not usually altered by coughing.
Wheeze
56
cause and location of wheeze
C: Air passing through a constricted bronchus as a result of secretions,swelling, tumors L: Heard over all lung fields
57
ADVENTITIOUS BREATH SOUNDS
Crackles Gurgles (rhonchii) Frictionrub Wheeze
58
NORMAL BREATH SOUNDS
Vesicular Broncho- vesicular Bronchial (tubular)
59
Soft-intensity, low-pitched, “gentle sighting” sounds created by air moving through smaller airways (bronchioles and alveoli) if answered give location and characteristics
Vesicular L: Over peripheral lung: best heard at base of the lungs Char:Best heard on inspiration,which is about 2.5 times longer than the expiratory phase (5:2 ratio)
60
Moderate-intensity, moderate- pitched, blowing sounds created by airmoving through larger airways (bronchi) if answered give location and characteristics
Broncho- vesicular L: Anteriorly over the trachea; not normally heard over lung tissue Char: Louder than vesicular sounds; have a short inspiratory phase and long expiratory phase (1:2 ratio)
61
Percussion of the thorax is performed to determine
whether underlying lung tissue is filled with air, liquid or solid material and to determine the positions and boundaries of certain organs.
62
percussion penetrates to a depth of
5 to 7 cm (2 to 3 in.),
63

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