Thorax And Lungs Flashcards
What is the stimulus to breathe
Increase in CO2 (hypercapnia)
When do we do an acute assessment
-shortness of breath
-decreased O2 sat
-asthma attack
-pulmonary complications
-pulmonary embolism
Acute SOB assessment
-lungs auscultation
-simultaneously give O2, inhalers, reposition
-fatigue limits, base of lungs
-ask minimal questions: allergies, meds, pulmonary condition, trauma
What does the thoracic cage consist of
Sternum, 12 pairs of ribs, 12 thoracic vertebrae adn the diaphragm
(Anterior thorax landmark or posterior thorax landmark) the suprasternal notch
Anterior thorax
(Anterior thorax landmark or posterior thorax landmark) the twelfth rib
Posterior thorax
(Anterior thorax landmark or posterior thorax landmark) sternum
Anterior thorax
(Anterior thorax landmark or posterior thorax landmark) the sternal angle (angle of Louis)
Anterior thorax
(Anterior thorax landmark or posterior thorax landmark) vertebra promineus
Posterior thorax
(Anterior thorax landmark or posterior thorax landmark) Spinous processes
Posterior thorax
(Anterior thorax landmark or posterior thorax landmark) inferior border of the scapula
Posterior thorax
(Anterior thorax landmark or posterior thorax landmark) the costal angle
Anterior thorax
On the anterior chest use the
Midsternal and midclavicular lines
On the posterior chest use the
Vertebral and scapular lines
On the lateral chest use the
Anterior axillary and posterior axillary and mid axillary lines
Mediastinum
The middle section of the thoracic cavity
-contains: esophagus, trachea, heart and great vessels
What contains the lungs?
The right and left pleural cavities
-either side of the mediastinum
The apex of the lungs lies
3 or 4 cm above the inner third of clavicles
The base rests on the
Diaphragm
-about the firth intercostal space in the right midclavicular line and at the sixth rib in the left midclavicular line
Laterally the lungs extend form the
Apex of the axilla to the seventh or eighth rib
Posteriorly ___ marks the apex
C7
what usually corresponds to the base?
T10
The base descends to
T12
Right lung versus the left lung
Right- shorter, three lobes
Left- narrower, two loves
Lobes are separated by ___ that run ___
Fissures that run obliquely
Tactile fremitus
Using palmar surface of hand to feel for vibrations (air moving through lung tissue)
Pleurae
Forms an envelope between the lungs and the chest
Pleural cavit contains
A few milliliters of lubricating fluid
The cavity normally has a
Vacuum that holds the lungs tightly against the chest
The lubricating fluid prevents
Friction
The trachea lies anterior to the
Esophagus
Right bronchus versus the left bronchus
Right- shorter, wider, more vertical than left
Bronchial tree
Protects the alveoli from small particulate matter using mucus and cilia
Four major functions of respiratory system
-supplies oxygen
-removes carbon dioxide
-maintains homeostasis
-maintain heat exchange
The respiratory system develops in utero but does not function until
Brith
During pregnancy the growing uterus elevates the diaphragm by
4 cam
Suprasternal notch
Hollow u shaped depression just above the sternum, imbetween the clavicles
Sternum
Contains three parts: manubrium, body, xiphoid
-contains the manubriosternal angle
Manubriosternal angle
Part of the manubrium of the sternum
-walk fingers down until you feel a distinct bony ridge
Sternal angle
Angle of Louis
-continuous with the second rib
-helpful to start counting ribs
The angle of Louis also marks the
Tracheal bifurcation into the right/left main bronchi
Costal angle
Right/left costal margins from an angle where they meet at the xiphoid process
-90 degrees or less
Vertebra prominens
Start at the base of your neck, flex your head and feel fo rate most prominent bony protrusion there
-this is C7
-if there are two bony prominens, the upper one is C7, lower is T1
Spinous processes
Spinous process align with their same numbered ribs only down to T4
-after T4 angle downward from their vertebral bodies
Inferior border of the scapula
These are located symmetrically in each hemithorax
-lower tip is usually at the level of the seventh or eight rib
Twelfth rib
Palpate midway between the spine and patients side to identify the free tip of the twelfth rib
Chest reference lines
Midsternal line (imbetween both clavicles), midclavicular line (center of each clavicle), anterior axillary line (end of clavicle)
Reference lines of the posterior chest wall
Vertebral line (down the spine), scapular line (extends through inferior angle of scapula when arms are at the side)
Reference lines of the lateral chest
-anterior axillary line (extends down form anterior axillary fold)
-posterior axillary line (down from posterior axillary fold)
-midaxillary line (down from apex of axilla, parallel to other two)
Acinus
Functional respiratory unit that consist of the bronchioles, alveolar ducts, alveolar sacs and alveoli
Hypercapnia vs hypoxemia
Hypercapnia- increase of carbon dioxide in the blood (the normal stimulus to breathe)
Hypoxemia- decrease of oxygen in the blood (also increases respirations but is less effective)
Surfactant
Complex liquid substance needed for sustained inflation of air sacs
-at 32 weeks there is a sufficient amount
When does the respiratory system begin function
At birth
Prenatal exposure to cigarettes can cause
-chronic hypoxia
-low birth weight
-sensitized fetal brain to nicotine (inc risk of addition at a later age)
Postnatal exposure to tobacco smoke
-otitis media
-sudden infant death syndrome
-lower respiratory tract infections
-asthma
An enlarging uterus elevates the diaphragm how many cm?
4 cm
Physiologic dyspnea
An increased awareness of the need to breathe
-pregnancy
-not associated with cough, wheezing or exercise
What reduces the mobility of the thorax?
The costal cartilage becomes calcified and decrease in elastic properties within the lungs (more rigid)
In older adults there is a increase in small airway closure, and this causes
-Decreased vital capacity (maximum amount of air exhaled after maximum filling)
-increased residual volume (amount of air remaining in lungs after forceful expiration)
Hemoptysis
Coughing up blood
Orthopnea
Shortness of breath associated with a position
-supine piston
Paroxysmal nocturnal dyspnea
Awakening in the night unable to breathe, and Alicia ting this by changing position (sitting upright)
Important to note the ___ the patient takes the breathe
Position
Assessing ___ color and condition may assist with amount of oxygen patient is receiving
Skin
Symmetrical expansion
Placing hands on the posterolateral chest wall, with your thumbs at level of T9/10
-as patient breathes hands should move symmetrically
Shortness of breath symptoms in babies
Headbobbing, suprasternal, intercostal contractions, abdominal breathing, subcostal
Shortness of breath symptoms
1-2 word answers, panting, tripod position, I CANT BREATHE
Initial assessment (acute)
Loss of consciousness, skin color (cyanosis = hypoxemia), rhythm, RR,
Intital assessment (chronic)
Clubbing, chest wall changes
Palpation
-symmetry (size, shape, expansion)
-lesions, lumps, masses
-subcutaneous emphysema
-tactile fremitus
Subcutaneous emphysema
Air trapped under skin, bubbly feeling
-leak in the system (injury, surgery, chest tube)
Tactile fremitus
Palpable Vibration of chest wall
-sound thru lung tissue
Lung consolidation
Increases risk of fremitus
-air in healthy lung replaced with something else
-increased density
Hyper resonance in lungs
More air than should be
Dull sound in lungs
Fluid in lungs, consolidation
Bronchiovesicular
Even intake and output
-found around sternum, and upper spinal processes on back
Bronchial
Shorter intake, longer outtake
-anterior neck region around trachea
Vesicular
Long intake, short outtake
-around lung area p/a
Adventitculous sounds
-crackles (fine, coarse)
-wheezes
-rhonchi
When are crackles normal?
After laying down/napping
-alvolectic crackles (alveoli popping back open)
***disapears after a couple breaths
Asthma is heard
In both lungs q
Pregnant women
Costal angle increases, rib injury —>
Resonance
Low pitched, clear hollow sound
-healthy lung tissue
Chest physiotherapy
Encourages breakup and movement of lung secretions
-for sticky secretions
-cystic fibrosis
Kyphosis
Outward curvature of the thoracic spine
Pectins excavatum vs carinatum
Excavatum - sunken sternum
Carinatum- forward protrusion
Decreased tactile fremitus
Any obstructs transmission of vibrations
Increased tactile fremitus
Increased density of lung tissue
-better conduction for vibrations
Pleural friction fremitus
Inflammation of parietalor visceral pleura
-coarse grating sound when rubbing together
Atelectasis
Collapsed or shrunken section of the alveoli as a result of airway obstruction
Lobar pneumonia
Infection of the lung parenchyma leaves alveolar membrane edema and porous, full of fluid, bacteria, RBC and WBC
Emphysema
Destruction of pulmonary connective tissue
-enlargement of air sacs
Pleural effusion
Collection of excess fluid in trapleural space
Pneumothorax
Partial or complete lung collapse due to free air in the pleural space
Acute respiratory distress syndrome
Acute pulmonary insult damages alveolar capillary membrane
Acute respiratory distress syndrome
Acute pulmonary insult damages alveolar capillary membrane
