thorax and lungs Flashcards
T7-8
interspace for thoracentesis
floating ribs
rib 11 and 12
articulate with costal cartilage above them
rib 8, 9, and 10
manubrium of sternum
attached to sternum
suprasternal notch
notch on top of the manubrium
xyphoid process
on the end of the sternum
right lung has how many lobes
3
left lung has how many lobes
2
apex of lungs found where
above clavicles
c7 and t1
landmarks
Five “A”s
Ask about tobacco use Advise to quit Assess willingness Assist to quit Arrange follow-up and support
*Angle of Louis
sternal angle that joins the manubrium and sternum
Dyspnea
shortness of breath
*Wheezing
a continuous, course,whistling sound produced in the respiratory airways during breathing. Wheezes suggest narrowed airways, as in asthma, COPD, or bronchitis.
cough
a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi
hemoptysis
the expectoration of blood (or blood stained sputum) from the bronchi, larynx, trachea, or lungs
parasthesias
sensations of tingling or “pins and needle” around the lips or extremities
Hyperventilation
rapid, shallow breathing
How to assess breathing
Rate - total number in one minute
Rhythm - cadence, regular vs. irregular
Depth - observed volume of air
Effort - objective measure of stress
*Fremitus
palpable vibrations felt on the human body
Lung Resonation
on percussion the note like sound that are measures by intensity, pitch, and duration in order to objectively determine the lungs volume of air
*Crackles
Also called rales. Intermittent and brief explosive breath sounds. Usually leads to the Dx of cardiac or pulmonary conditions. Suggest abnormal lung tissue. Crackles may be from abnormalities of the lungs (pneumonia, fibrosis, early congestive heart failure) or of the airways (bronchitis, bronchiectasis)
*Rhonchi
a low-pitched breath sound with snoring quality. Rhonchi suggest secretions in large airways.
Normal Breathing
Normal Breathing 12 - 20 in adults
44 in infants
Slow breathing
Bradypnea
Bradypnea
Slow breathing. May be secondary to such causes as diabetic coma, drug induced respiratory depression, and increased intracrainal pressure.
Sighing Respiration
Breathing punctuated by frequent sighs should be alert you to the possibility of hyperventilation syndrome - a common cause of dyspnea and dizziness. Occasional sighs are normal.
Rapid Shallow Breathing
Tachypnea
Tachypnea
Has a number of causes, including restrictive lung disease, pleuritic chest pain, and an elevates diaphragm
Periods of deep breathing alternate with periods of apnea
Cheyne-Stokes Breathing
Obstructive Breathing
Expiration is prolonged because narrow airways increase the resistance to airflow
Causes of Obstructive breathing
Asthma, chronic bronchitis and COPD
What rib does the Angle of Louis articulate with
rib 2
2nd intercostal space
used during needle decompression for tension pneumothorax
4th - 6th intercostal space
used for chest tube insertion
Posterior Landmarks
c7 & t1; 12th rib; inferior tip of scapula (leads to the 7th rib)
Pleximeter finger
Middle finger of your non-dominate hand. The finger that is struck during percussion.
Plexor finger
The striking finger during percussion. Middle of your dominate hand.
Chest expansion
Check chest expansion at the 10th rib
bronchophony
Ask pt to say “99”. Normal sound is muffled and indistinct.
egophony
ask pc to say “ee”. Normal is a muffled EE. Abnormal is a “ay” sound
whispered pectoriloquy
Ask Pt to whisper “99”. You should not be able to hear it well.
Number of auscultation fields
14 posterior fields
12 anterior fields
Leading cause death preventable
Smoking
Flu Shot Immunizations
For healthy people between 5 - 49 years
Two types
inactive vaccine
nasal spray containing a live virus
General techniques : lungs & thorax
- Examine posterior while px is sitting & arms are folded. If px cannot sit then roll the px from one side to the other in the supine position slide 35
- Examine anterior while px is supine.
- IAPP
Stridor
High pitched wheeze most likely from airway obstruction in the larynx or trachea
AP diameter
AP diameter anteroposterior diameter
AP diameter of chest
May increase with age, or COPD
Auscultation of chest
Listen for
- sounds generated by breathing
- adventitious sounds
- if abnormalities are present listen to the transmitted sounds as the px speaks
The px should breath via their _____ during auscultation
mouth
Normal breathing sounds : Vesicular
soft and low pitched; usually heard over most of both lungs
Normal breathing sounds : Bronchial
louder and higher in pitch; usually heard over the manubrium
Normal breathing sounds : Bronchovesicular
intermediate intensity and pitch;
usually heard over the 1st and 2nd interspaces
Test chest expansion from ___ rib
the 10th
When percussing the lower posterior you should stand somewhat to the ____ rather than directly behind
side
When comparing two percussion’s
Use the same percussion technique in both areas
Five percussion notes
Flatness - thigh dullness - liver resonance - healthy lung hyperresonance - not normal, COPD lung tympany - gastric air bubble, puffed cheek
Percussion of the anterior chest - heart
the heart normally produces an area of dullness to the left of the sternum from the 3rd to 5th intercostals
Palpation 4 potential uses
- Identification of tender areas
- Assessment of observed abnormalities
- Further assessment of chest expansion
- Assessment of tactile fremitus
“Walk test”
- assesses the pulmonary function
- ask the px to walk 8 feet at patients pace, repeat and note a faster time
- normal 3.1 seconds; geriatrics 5.6 seconds
- Observe px rate; effort; breathing sounds
Forced expiratory time
Test for COPD
use diaphragm of stethoscope over trachea;
time duration of audible expiration;
get 3 readings;
norm >8 seconds;
>60 y/old w/time of 6 - 8 seconds are twice as likely to have COPD
*Ask the patient to take a deep breath in and then breathe out as quickly and completely as possible with mouth open. Listen over the trachea with the diaphragm of a stethoscope and time the audible expiration. Try to get three consistent readings, allowing a short rest between efforts if necessary.
Identification of fractured rib
Posterior/anterior compression;
squeeze palms on sternum and thoracic spine;
Rule out fracture vs. soft injury
With one hand on the sternum and the other on the thoracic spine, squeeze the chest. Is this painful, and where?
Crackles wheezes or Rhonchi clears with cough with this infection
Bronchitis
