Thorax and Lungs Assessments Flashcards
what is the thoracic cage?
bony structure with a conical shape, which is narrower at the top. identified by the sternum, 12 pairs of ribs, and 12 thoracic vertebrae
which two ribs are floating
11 and 12
costochondral junctions
the points at which the ribs join their cartilages
Sternal Angle
- angle of Louis
- the articulation of the manubrium and body of the sternum, it is continuous with the 2nd rib
how is each intercostal space numbered?
by the rib above it
Costal Angle
- where you put your hands on the anterior chest
- right and left costal margins from an angle where they meet at the xiphoid process
- usually 90 degrees or less
Mid sternal line
in center of chest
midclavicular line
middle of clavicle
vertebral (midspinal) line
down spine on back
scapular line
down middle of scapula
what are the three reference lines under the armpit?
- anterior axillary
- midaxillary
- posterior axillary
what is the mediastinum?
middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels
pleural cavities
on either side of the mediastinum, contain the lungs
apex
highest point of the lung
- 3 to 4 cm above the inner third of the clavicles
- posteriorly - C7
base
lower boarder
- rests on the diaphragm at about the 6th rib in the midclavicular line
- posteriorly: at rest- T10, inspirations - T12
What lobe is not visible posteriorly?
middle lobe of the right lung
Pleurae
are serous membranes that form an envelope between the lungs and the chest wall
visceral pleurae
lines the outside of the lungs, dipping down into the fissure
parietal pleura
lining the inside of the chest wall diaphragm
acinus
a functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the membrane in the alveolar duct in the millions of alveoli.
GASEOUS EXCHANGE
what are the 4 major functions of the respiratory system
- supplying oxygen to the body for energy production
- removing carbon dioxide as a waste product of energy reactions
- maintaining homeostasis (acid-base balance) of arterial blood
- maintaining heat exchange (less important in humans)
hypercapnia
increase of carbon dioxide in the blood
hypoxemia
decrease of oxygen in the blood
chest size increases with
inspiration
chest size decreases with
expiration
infants and lungs
- 32 weeks surfactant is present in adequate amounts
- respiratory system alone does not function until birth
- exposure to smoke!!!
- rounded chest, just shy of head circumference
- Harrison groove
Pregnant women and lungs
- enlarging uterus elevates the diaphragm 4 cm
- decrease vertical diameter, but is compensated for an increase in horizontal diameter
- increase in estrogen relaxes chest cage ligaments
- diaphragm moves with breathing even more during pregnancy, which results in an increase in tidal volume
aging adult and lungs
- aging lung is more rigid in structure and harder to inflate
- histological changes (decrease # of alveoli) create less surface area available for gas exchange
- risk for dyspnea with exertion beyond normal workload
Asthma
-African americans who reside in inner cities and premature/LBW babies have higher risk
who has the largest thoracic cavity?
whites
who has the smallest thoracic cavity?
American indians
describe the cough related to acute illness
- continuous throughout day
ex: Respiratory infection
describe what would cause an afternoon cough?
exposure to pollutants throughout the day
what kind of cough is associated with sinusitis?
night-post nasal drip
what is a cough early in the morning suggestive of?
chronic bronchial inflammation of smokers
orthopnea
difficulty breaking with supine
-state number of pillows needed “two pillow orthopnea”
paroxysmal nocturnal dyspnea
awakening from sleep with shortness of breath and needing to be upright to achieve comfort
Describe the normal relationship between the anteroposterior diameter and the transverse diameter
- AP should be less than tranverse
- ratio of 1:2 or 5:7
what is the tripod position?
- people with COPD often sit in a tripod position
- leaning forward with arms braces against their knees, chair or bed
how do you confirm symmetric chest expansion?
- posteriorly- thumbs at level of T9 or T10, pinch up skin watch hands move
- anteriorly- costal angle but same thing
tactile fremitus
- palpable vibrations
- 99
- may be stronger on the right side between the scapulae, because the right side is closer to the bronchial bifurcation
decreased fremitus
occurs when anything obstructs transmission of vibrations
ex: pneumothorax, emphysema
increased fremitus
- occurs with compression or consolidation
- ex: pneumonia
rhonchal fremitus
palpable with thick bronchial secretions
pleural friction rub
palpable with inflammation of the pleura
crepitus
- coarse, crackling sensation palpable over the skin surface
- after open thoracic injury or surgery
what is resonance
love pitches, clear, hollow sound that predominates in healthy lung tissue in the adult
what is hyperresonance?
- a lower, pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax
what does a dull note signal?
- soft, muffled thud
- abnormal density in the lungs as with pneumonia, pleural effusion, atelectasis or tumor
Normal Bronchial breath sounds
- high pitch, loud amplitude, inspiration is shorter than expiration
- harsh, hollow tubular
- location: trachea and larynx
Normal bronchovesicular breath sounds
- moderate pitch, moderate amplitude, inspiration= expiration, mixed quality
- over center
normal vesicular breath sounds
- low pitch, soft amplitude, inspiration is longer than expiration, rustling like the sound of the wind in the trees
- over peripheral lung fields (majority of lungs)
atelectatic crackles
- non pathological
- disappear after a few breaths
- only heard in the periphery
describe normal voice transmission
- soft, muffled, and indistinct
- you can hear sound through the stethoscope but cannot distinguish exactly what was said
Barrel chest
- horizontal ribs and a costal angle >90
- AP = Transverse
cutaneous angiomas
spider nevi, associated with liver disease or portal hypertension
when does unequal chest expansion occur?
-part of the lung is obstructed or collapsed
what does a pleural friction rub feel like?
palpable grating sensation with breathing indicates pleural friction fremitus
how many areas do you percuss over the anterior chest?
-10; 5 on each side
pulse oximeter
a noninvasive method to assess arterial oxygen saturation
Harrison groove
- occurs normally in some children
- a horizontal groove in the rib cage at the level of the insertion of the diaphragm, extending from the sternum to the midaxillary line
Kyphosis
- hunchback
- compensates by holding head extended and tilted back
stridor
a high pitched inspiratory crowing sound hear without the stethoscope, occurring with upper airway obstruction
ex: foreign body obstruction, croup, aspiration, acute epiglottis
pectus excavatum
- sucken sternum and adjacent cartilages
- congenital, not symptomatic
pectus carinatum
- forward protrusion of the sternum with ribs sloping back
- requires no treatment
scoliosis
- S shaped curvature of the thoracic and lumbar spine, usually involved vertebrae rotation
- if severe, >45 degrees, it may reduce lung volume and then the person is at risk for impaired cardiopulmonary function
- primary impairment is cosmetic deformity
sigh (respiratory pattern)
occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli
-may indicate emotional dysfunction
tachypnea
rapid shallow breathing
- increase rate >24 minute
- fear, fever, exercise
bradypnea
slow breathing
- decreased but regular rate (<10 per min)
- intercranial pressure, diabetic coma
cheyne stokes respiration
- a cycle in which respirations gradually wax and wane in a regular patter, increasing in rate and depth and then decreasing.
- breathing periods last 30-45 seconds with periods of apnea (20 secs)
- renal failure, drug overdose, intracranial pressure increase
hyperventilation
- increase in both rate and depth
- extreme fear/anxiety, DKA
- causes alkalosis/blows off CO2
hypoventilation
-shallow pattern caused by overdose of narcotics of anesthetics
Biots respiration
similar to cheyne stokes but irregular
-brain abscess, head trauma, heat stroke, spinal meningitis, encephalitis
chronic obstructive breathing
normal inspirations and prolonged expirations to over come increased airway resistance.
kussmal respirations
-compensatory mechanism for the acid.base imbalance of DKA
fine crackles
- rales
- rolling strand of hair between your fingers near your ear
- late inspiration:restrictive diseases (heart failure, pneumonia)
- early inspiration: obstructive disease (chronic bronchitis, asthma, emphysema)
- posturally induced: fine crackles from change of positions
coarse crackles
- bubbling, low pitched
- pulmonary edema, terminally ill who have depressed cough reflex
high pitched wheeze (sibilant)
- musical squeaking
- diffuse airway obstruction from acute asthma or chronic emphysema
low pitched wheeze ( sonorous rhonchi)
- single note
- bronchitis, single bronchus obstruction
