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Health Assessment Exam 3 > Thorax and Lungs Assessments > Flashcards

Thorax and Lungs Assessments Flashcards

1
Q

what is the thoracic cage?

A

bony structure with a conical shape, which is narrower at the top. identified by the sternum, 12 pairs of ribs, and 12 thoracic vertebrae

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2
Q

which two ribs are floating

A

11 and 12

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3
Q

costochondral junctions

A

the points at which the ribs join their cartilages

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4
Q

Sternal Angle

A
  • angle of Louis

- the articulation of the manubrium and body of the sternum, it is continuous with the 2nd rib

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5
Q

how is each intercostal space numbered?

A

by the rib above it

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6
Q

Costal Angle

A
  • 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
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7
Q

Mid sternal line

A

in center of chest

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8
Q

midclavicular line

A

middle of clavicle

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9
Q

vertebral (midspinal) line

A

down spine on back

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10
Q

scapular line

A

down middle of scapula

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11
Q

what are the three reference lines under the armpit?

A
  • anterior axillary
  • midaxillary
  • posterior axillary
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12
Q

what is the mediastinum?

A

middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels

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13
Q

pleural cavities

A

on either side of the mediastinum, contain the lungs

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14
Q

apex

A

highest point of the lung

  • 3 to 4 cm above the inner third of the clavicles
  • posteriorly - C7
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15
Q

base

A

lower boarder

  • rests on the diaphragm at about the 6th rib in the midclavicular line
  • posteriorly: at rest- T10, inspirations - T12
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16
Q

What lobe is not visible posteriorly?

A

middle lobe of the right lung

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17
Q

Pleurae

A

are serous membranes that form an envelope between the lungs and the chest wall

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18
Q

visceral pleurae

A

lines the outside of the lungs, dipping down into the fissure

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19
Q

parietal pleura

A

lining the inside of the chest wall diaphragm

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20
Q

acinus

A

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

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21
Q

what are the 4 major functions of the respiratory system

A
  1. supplying oxygen to the body for energy production
  2. removing carbon dioxide as a waste product of energy reactions
  3. maintaining homeostasis (acid-base balance) of arterial blood
  4. maintaining heat exchange (less important in humans)
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22
Q

hypercapnia

A

increase of carbon dioxide in the blood

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23
Q

hypoxemia

A

decrease of oxygen in the blood

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24
Q

chest size increases with

A

inspiration

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25
Q

chest size decreases with

A

expiration

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26
Q

infants and lungs

A
  • 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
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27
Q

Pregnant women and lungs

A
  • 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
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28
Q

aging adult and lungs

A
  • 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
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29
Q

Asthma

A

-African americans who reside in inner cities and premature/LBW babies have higher risk

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30
Q

who has the largest thoracic cavity?

A

whites

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31
Q

who has the smallest thoracic cavity?

A

American indians

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32
Q

describe the cough related to acute illness

A
  • continuous throughout day

ex: Respiratory infection

33
Q

describe what would cause an afternoon cough?

A

exposure to pollutants throughout the day

34
Q

what kind of cough is associated with sinusitis?

A

night-post nasal drip

35
Q

what is a cough early in the morning suggestive of?

A

chronic bronchial inflammation of smokers

36
Q

orthopnea

A

difficulty breaking with supine

-state number of pillows needed “two pillow orthopnea”

37
Q

paroxysmal nocturnal dyspnea

A

awakening from sleep with shortness of breath and needing to be upright to achieve comfort

38
Q

Describe the normal relationship between the anteroposterior diameter and the transverse diameter

A
  • AP should be less than tranverse

- ratio of 1:2 or 5:7

39
Q

what is the tripod position?

A
  • people with COPD often sit in a tripod position

- leaning forward with arms braces against their knees, chair or bed

40
Q

how do you confirm symmetric chest expansion?

A
  • posteriorly- thumbs at level of T9 or T10, pinch up skin watch hands move
  • anteriorly- costal angle but same thing
41
Q

tactile fremitus

A
  • palpable vibrations
  • 99
  • may be stronger on the right side between the scapulae, because the right side is closer to the bronchial bifurcation
42
Q

decreased fremitus

A

occurs when anything obstructs transmission of vibrations

ex: pneumothorax, emphysema

43
Q

increased fremitus

A
  • occurs with compression or consolidation

- ex: pneumonia

44
Q

rhonchal fremitus

A

palpable with thick bronchial secretions

45
Q

pleural friction rub

A

palpable with inflammation of the pleura

46
Q

crepitus

A
  • coarse, crackling sensation palpable over the skin surface

- after open thoracic injury or surgery

47
Q

what is resonance

A

love pitches, clear, hollow sound that predominates in healthy lung tissue in the adult

48
Q

what is hyperresonance?

A
  • a lower, pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax
49
Q

what does a dull note signal?

A
  • soft, muffled thud

- abnormal density in the lungs as with pneumonia, pleural effusion, atelectasis or tumor

50
Q

Normal Bronchial breath sounds

A
  • high pitch, loud amplitude, inspiration is shorter than expiration
  • harsh, hollow tubular
  • location: trachea and larynx
51
Q

Normal bronchovesicular breath sounds

A
  • moderate pitch, moderate amplitude, inspiration= expiration, mixed quality
  • over center
52
Q

normal vesicular breath sounds

A
  • 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)
53
Q

atelectatic crackles

A
  • non pathological
  • disappear after a few breaths
  • only heard in the periphery
54
Q

describe normal voice transmission

A
  • soft, muffled, and indistinct

- you can hear sound through the stethoscope but cannot distinguish exactly what was said

55
Q

Barrel chest

A
  • horizontal ribs and a costal angle >90

- AP = Transverse

56
Q

cutaneous angiomas

A

spider nevi, associated with liver disease or portal hypertension

57
Q

when does unequal chest expansion occur?

A

-part of the lung is obstructed or collapsed

58
Q

what does a pleural friction rub feel like?

A

palpable grating sensation with breathing indicates pleural friction fremitus

59
Q

how many areas do you percuss over the anterior chest?

A

-10; 5 on each side

60
Q

pulse oximeter

A

a noninvasive method to assess arterial oxygen saturation

61
Q

Harrison groove

A
  • 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
62
Q

Kyphosis

A
  • hunchback

- compensates by holding head extended and tilted back

63
Q

stridor

A

a high pitched inspiratory crowing sound hear without the stethoscope, occurring with upper airway obstruction
ex: foreign body obstruction, croup, aspiration, acute epiglottis

64
Q

pectus excavatum

A
  • sucken sternum and adjacent cartilages

- congenital, not symptomatic

65
Q

pectus carinatum

A
  • forward protrusion of the sternum with ribs sloping back

- requires no treatment

66
Q

scoliosis

A
  • 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
67
Q

sigh (respiratory pattern)

A

occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli
-may indicate emotional dysfunction

68
Q

tachypnea

A

rapid shallow breathing

  • increase rate >24 minute
  • fear, fever, exercise
69
Q

bradypnea

A

slow breathing

  • decreased but regular rate (<10 per min)
  • intercranial pressure, diabetic coma
70
Q

cheyne stokes respiration

A
  • 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
71
Q

hyperventilation

A
  • increase in both rate and depth
  • extreme fear/anxiety, DKA
  • causes alkalosis/blows off CO2
72
Q

hypoventilation

A

-shallow pattern caused by overdose of narcotics of anesthetics

73
Q

Biots respiration

A

similar to cheyne stokes but irregular

-brain abscess, head trauma, heat stroke, spinal meningitis, encephalitis

74
Q

chronic obstructive breathing

A

normal inspirations and prolonged expirations to over come increased airway resistance.

75
Q

kussmal respirations

A

-compensatory mechanism for the acid.base imbalance of DKA

76
Q

fine crackles

A
  • 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
77
Q

coarse crackles

A
  • bubbling, low pitched

- pulmonary edema, terminally ill who have depressed cough reflex

78
Q

high pitched wheeze (sibilant)

A
  • musical squeaking

- diffuse airway obstruction from acute asthma or chronic emphysema

79
Q

low pitched wheeze ( sonorous rhonchi)

A
  • single note

- bronchitis, single bronchus obstruction

Health Assessment Exam 3 (4 decks)

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