Thorax and lungs Flashcards
identifies the position of the body extending from the base of the neck superiorly to the level
of the diaphragm inferiorly.
Thorax
is constructed of the sternum, 12 pairs of ribs, 12 thoracic
vertebrae, muscles, and cartilage.
Thoracic Cage
lies in the center of the chest anteriorly
The sternum or breastbone
the divided three parts of the breastbone and sterum
manubrium
body
xiphoid process
extends from the manubrium of the scapula to the acromion.
The clavicles (collar bones)
connects laterally with the clavicles and the first two pairs of ribs.
manubrium
A U-shaped indentation located on the superior border of the manubrium is an important landmark known as
the
suprasternal notch.
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
sternal angle (angle of Louis).
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
the costal angle.
Each pair of the ribs articulates with its respective thoracic vertebra. The spinous process of the seventh
cervical vertebra (C7), also called
vertebra prominens,
can be easily felt with the client’s neck flexed.
vertebra prominens,
Equipment used for Thorax and lung assessment
Stethoscope
Skin marker/pencil
centimeter ruler
Determine client’s history of the
following:
Family history of illness,
including cancer.
Allergies
Tuberculosis
Smoking and occupational
hazards.
Any medications being
taken.
Current problems such as
swellings, coughs,
wheezing, pain.
Deviation from normal of shape and symmetry of the thorax posterior from lateral views and the normal findings
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
Normal and deviation from normal findings on inspecting the spinal alignment for deformities
Normal: spine is vertically aligned
Deviation: Exaggerated spinal curvatures (kyphosis, lordosis, scoliosis)
To assess for lateral
deviation of the spine (scoliosis),
observe the standing client from
the rear. Have the client bend
forward at the waist and observe
from behind.
Palpate the posterior thorax.
normal and deviation from normal
Normal: Skin intact; uniform
temperature
Deviation: Skin lesions; areas of
hyperthermia
For clients who do have
respiratory complaints,
also the normal and deviation from normal findings
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
Palpate the posterior chest for
respiratory excursion.
also normal and deviation
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
what do we palpate the chest for
what is the normal and deviation
Vocal (tactile) fremitus
N: Bilateralsymmetry of vocal
fremitus
D: Decreased or absent fremitus
(pneumothorax)
how to palpate chest for tactile fremitus
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.
what does increased fremitus indicate
pneumonia
where is fremitus heard most clearly
Apex of the lungs
Percuss the thorax Normal and deviation
N: Percussion notes resonate,
except overscapula
D: Asymmetry in percussion
where is the lower point of resonance
at the diaphragm at level of the 8th and 10th ICS
what is associated with areas of dullness or flatness over the lung tissue
Consolidation of lung tissue or a mass
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)
Excursion measurement that is normal for women and what is the one for men
3 - 5 cm bilaterally in women
6cm in men
Diaphragm is usually higher on which side
right side
Auscultate the chest using the
flat-disc diaphragm of the
stethoscope.
what are we listening for during auscultation of the chest
Vesicular and Broncho
vesicular breath sounds
Deviation from normal findings of sound during auscultation or adventitious sound
crackles, rhonchi, wheeze, friction
what does absence of sound indicate or is associated with
collapsed and surgically removed lung lobes
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
what is inspected in the anterior chest
Breathing patterns
costal angle
angle at which the ribs enter the spine
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)
what is associated if costal angle is widened
COPD
what is palpated in the anterior chest
respiratory excursion
skin integrity
temp
skin uniformity
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.
Fremitus is normally decreased
over
heart and breast tissue
If the breasts are large and
cannot be retracted adequately
for palpation, this part of the
examination usually
is omitted.
Percussion notes resonate
down to the
6th rib at the level
of the diaphragm but are flat
over areas of heavy muscle
and bone,
where is it usually dull when percussing
dull on areas over
the heart and the liver, and
tympanic over the underlying
stomach
what are we trying to hear during auscultation of trachea
Bronchial and tubular breath
sounds
deviation from normal when auscultating the trachea and anterior chest
Adventitious breath sounds
what is being heard during auscultation of anterior chest
Broncho vesicular and
vesicular breath sounds
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.
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.
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.
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
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
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)
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.
Superficial grating or creaking sounds
heard during inspiration and expiration.
Not relieved bycoughing.
Frictionrub
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)
Continuous, high-pitched,
squeaky musicalsounds.
Best heard on expiration.
Not usually altered by coughing.
Wheeze
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
ADVENTITIOUS BREATH SOUNDS
Crackles
Gurgles (rhonchii)
Frictionrub
Wheeze
NORMAL BREATH SOUNDS
Vesicular
Broncho- vesicular
Bronchial (tubular)
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)
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)
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.
percussion penetrates to a depth of
5 to 7 cm (2 to 3 in.),
