Thorax and Lungs Flashcards
Subjective Data
1) cough
2) SOB
3) chest pain
4) Hx respiratory infections
5) Smoking hx
6) environmental exposures
7) self-care behaviors
Cough - subjective
Do you have a cough? When did it start? Gradual or sudden? How long have you had it?
Phlegm or sputum? Streaks or odor in sputum? Time of day? Wake you up at night? Come with anything e.g. anxiety, fever, congestion, activity, position? Activity make it better or worse? Does the cough bring on anything e.g. chest pain, ear pain? Tiring? Are you concerned about it?
SOB - subjective
Ever had SOB or hard-breathing spells? How severe? How long did it last?
Position? Time of day? Associated with acitivity? Night sweats? Cough chest pain, bluish color around lips? Related to food, pollen dust animals season or emotion?
What do you do when you have a hard-breathing attack? Oxygen, inhalers? Does it help? How does it affect your ADLs?
Chest pain with breathing - subjective
Any chest pain with breathing? Please point to exactly where? When? Constant or fleeting? Describe the pain: burning, stabbing? Brought on by infection, coughing or trauma? Anything help, medications or heat application?
Hx of respiratory infections - subjective
Any past hx of breathing trouble or lung dz such as bronchitis, emphysema, asthma, pneumonia? Unusual or frequent colds? Any family hx of allergies TB or asthma?
Smoking hx - subjective
Do you smoke? What age did you start? How many packs per day? What activities do associate with smoking? Live with someone who smokes?
Environmental exposures - subjective
Any environmental conditions that may affect your breathing? Where do you work? Factory, chemical plant. coal mine, farming, outdoors? Live
Self-care behaviors - subjective
Last TB skin test, CXR, pneumonia vaccine or influenza vaccine?
Hx for aging adults - subjective
1) Have you noticed, any shortness of breath or fatigue with your ADLs?
2) Tell me about your usual amount of physical activity
3) With hx of COPD, lung CA, or TB: how are you getting along? Any weight change in past 3 mos? How much? How about energy level? Do you tire more easily? How does you illness affect you at home?
4) Any chest pain w breathing? After coughing?
Thorax and lung preparation and order
Begin just after palpating the thyroid gland when standing behind the person.
1) perform inspection, palpation, percussion and auscultation on posterior and lateral thorax
2) move to face person and repeat procedures on anterior thorax
thoracic cage
Defined by: sternum 12 pairs of ribs (1st seven attach directly to sternum; 8-10 attach to costal cartilage above) 12 thoracic vertebrae diaphragm
costochondral junctions
point at which ribs join their cartilage
What are the anterior thoracic landmarks?
1) Suprasternal notch
2) Sternum
3) Sternal angle
4) Costal angle
Three parts of the sternum
Manubrium
Body
Xyphoid process
Sternal angle
aka angle of louis
continuous with second rib
marks site of tracheal bifurcation into the right and left main bronchi
lies above T4 on back
Costal angle
Right and left costal margins form an angle at the xyphoid process
usually 90 degrees
angle is increased in dz where lungs are chronically inflated e.g. emphysema
What are the posterior thoracic landmarks?
Vertebra Prominens
Spinous processes
Inferior border of the scapula
Twelfth rib
Vertebra prominens
spinous process of C7, felt when flexing neck
Spinous process
correlate with ribs until T4 only
Inferior border of scapulae
lower tip at 7th or 8th rib
What are the anterior reference lines?
Midsternal
Midclavicular - palpated between the sternoclavicular and acromioclavicular joints
What are the posterior reference lines?
Vertebral line
Scapular line
What are the lateral reference lines?
Anterior axillary - extends down from where the pectoralis major inserts
Posterior axillary - extends down from where the latissimus dorsi inserts
midaxillary - runs between and parallel
What organs and tissues does the mediastinum contain?
Esophagus
Trachea
Heart
Great vessels
Pleural cavities
Located on either side of the mediastinum
Contain the lungs
What are the anterior borders of the lungs?
Apex is approx. 3-4cm above inner third of clavicle
Base rests on diaphragm at about the 6th rib midclavicular line
What are the posterior borders of the lungs?
Apex at C7
T10 base, T12 base on deep inspiration
Location of oblique fissure, anterior chest
Divides lower lobes
5th rib midaxillary to 6th rib midclavicular
Location of horizontal (minor) fissure, right lung, anterior chest
divides upper right lobe and middle lobe
5th rib midaxillary line to 3rd intercostal space at right sternal border
Location of lobes, posterior thorax
Apex at C7/T1 down to T3 or T4
Inferior border of lower lobe extends to T10, T12 on inspiration
Location of lobes, lateral thorax
Apex of axilla to 7th or 8th rib
Right upper lobe: Apex down to horizontal fissure at 5th rib
Right middle lobe: 4th rib at anterior axillary line, 5th rib at midaxillary line to 6th rib at midclavicular line
Right lower: Spinous process at T3 to 8th rib midaxillary line
Left upper: Apex to 5th rib midaxillary line
Left lower: 5th rib midaxillary line to 8th rib midaxillary
Pleurae
Thin, slippery serous membranes that form an envelope between the lungs and chest wall
Lubricating fluid that allows easy movements of pleural linings up and down during respiration
Visceral pleura
Lines lungs, dips into fissures
Parietal pleura
Lines inside of chest wall and diaphragm
Costodiaphragmatic recess
Pleurae extend 3 cm below lungs; potential space that could fill abnormally with fluid or air and compromise lung expansion
Location of trachea
Anterior to esophagus, 10-11 cm long in adults
Begins at cricoid process and bifurcates at sternal angle into right and left main bronchi
Posteriorly - Bifurcation at T4 or T5
Four major functions of respiratory system
1) Supplying oxygen to the body for energy production
2) Removing carbon dioxide as waste product of energy reactions
3) Maintains homeostasis (acid-base balance) of arterial blood
4) maintaining heat exchange
Mechanism by which the lungs regulate pH
Adjusting the level of carbon dioxide via respiration
Hypoventilation - causes carbon dioxide to build up in the blood
hyperventilation - causes CO2 to be blown off
Primary feedback loop for respiration (controlled in respiratory center in brain - pons and medulla)
Change in carbon dioxide and oxygen levels in the blood (also hydrogen ions)
Normal stimulus to breathe is an increase in CO2 in the blood (hypercapnia)
A decrease in oxygen in the blood (hypoxemia) also increases respirations but not as effectively as CO2 levels
Inspiration
More space in thoracic container, less pressure than atmosphere so air enters to fill partial vacuum
Major muscle responsible: diaphragm, which contracts, lengthens, descends
External intercostal muscles,
Forced inspiration - e.g. respiratory distress or heavy exercise -sternocleidomastoid, scalenus and trapezii lift sternum, elevate ribs
Increase anteroposterior diameter
Expiration
Passive process
Diaphragm relaxes, elastic forces case it to dome up and create relatively positive pressure within alveoli, and air flows out
Internal intercostals depress ribs, external oblique and Forced expiration - abdominus rectus depress lower ribs and compress viscera up against diaphragm
