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Health Assessment > Thorax & Lungs > Flashcards

Thorax & Lungs Flashcards

1
Q

What is the thoracic cage composed of?

A

sternum + 12 pairs of ribs + 12 thoracic vertebrae

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2
Q

Which ribs attach directly to the sternum? And how does it attach?

A
  • ribs 1-7 attach directly to the sternum via costal cartilages
  • ribs 8-10 attach directly to the costal cartilages above
  • ribs 11-12 are floating
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3
Q

Costochondral junctions

A

the points at which ribs join their cartilages

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4
Q

why is the angle of Louis a good landmark?

A
  • continuous w/ 2nd rib
  • site of tracheal bifurcation
  • upper border of the atria of the heart
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5
Q

What happens to the costal angle w/ emphysema

A

angle increases due to chronic inflammation

Normal costal angle should be less than 90 degrees

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6
Q

When the head is flexed, the most prominent bony protrusion at the neck is ___

A

spinous process of C7

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7
Q

What is the mediastinum and what does it contain?

A
  • Middle section of the thoracic cavity

- includes the esophagus, trachea, heart, great vessels

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8
Q

What are the borders of the lungs?

A

apex

  • highest point
  • 3-4 cm above the inner third of the clavicles

base

  • rests on the diaphragm
  • 6th rib in the midclavicular line

lateral

  • axilla
  • 7th-8th rib

posterior

  • C7 = apex of lung
  • T10 = base of lungs –> extends to T12 w/ deep inspiration
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9
Q

How do you locate the right oblique fissure

A

crosses the 5th rib in the midaxillary line, and terminates at the 6th rib at the midclavicular line

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10
Q

How do you locate the right horizontal fissure?

A

extends from the 5th rib in the right midaxillary line to the 3rd intercostal space or 4th rib at the right sternal border

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11
Q

How do you landmark the lower lobe of the lungs

A
  • assess from posterior back
  • begins at T3/T4
  • ends at T10 during expiration
  • ends at T12 during inspiration
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12
Q

What is pleura?

A

The thin membrane that forms an envelope between the lungs and chest wall
- visceral pleura: lines the outside of the lungs and dips down into the fissures

  • parietal pleura: continuous w/ visceral pleura, lines the inside of the chest wall and diaphragm
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13
Q

T/F: the trachea and bronchi is involved in gas exchange

A

FALSE - only transports the gas between the environment and lung parenchyma

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14
Q

What is the functional respiratory unit?

A

Acinus

  • includes bronchioles, alveolar ducts, alveolar sacs, and aveoli
  • gas exchange occurs in the alveolar ducts
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15
Q

List the FNs of the respiratory system

A

1) supply O2 to body
2) removes CO2 from body
3) maintains homeostasis of arterial blood
4) maintains heat exchange

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16
Q

What is the dominant stimulus to breathe?

A

Hypercapnia = increase in CO2 in the body

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17
Q

What is postnatal exposure to environmental tobacco smoke linked to?

A

increased rates of otis media, SIDS, lower respiratory tract infections, and childhood asthma

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18
Q

What are the risks of prenatal exposure to tobacco smoke

A
  • chronic hypoxia and low birth rate

- sensitizes fetal brain to nicotine; increases risk for addiction later on in life

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19
Q

What are the changes associated with pregnancy?

A
  • decreased vertical diameter of thoracic cage due to increased uterus
  • increased estrogen relaxes the thoracic cage ligaments, allowing increase in transverse diameter by 2 cm
  • widened costal angle
  • increased tidal volume (deeper breathing)
  • physiological dyspnea (increased awareness to breathe)
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20
Q

Changes in older adults

A
  • calcification of costal cartilage = reduced mobility of thorax
  • decreased strength of respiratory muscles
  • decreased elasticity of lungs
  • increase in small airway closure
  • decreased vital capacity and increased residual volume
  • less SA available for gas exchange
21
Q

How long does a cough need to last for it to be acute vs chronic?

A

acute: less than 2-3 weeks
chronic: more than 2 months

22
Q

What does the timing of cough suggest?

A

continuous throughout day - acute illness

afternoon/evening - may reflect exposure to irritants

night - nasal drip, sinusitis

early morning - chronic bronchial inflammation (common in smokers)

23
Q

common causes of white/clear sputum

A

cold, bronchitis, viral infection

24
Q

common causes of yellow/green sputum

A

bacterial infections

25
Q

common cause of rust-colored sputum

A

TB, pneumonia

26
Q

common cause of pink/frothy sputum

A

pulmonary edema, some medications

27
Q

What is the expected AP to transverse diameter in adults?

- what do deviations suggest?

A

2: 1

- Any deviations suggest more effort is being put into breathing

28
Q

During the inspection, you notice the pt’s neck and trapezius muscles are enlarged, and pt is sitting in a tripod position. What does this suggest?

A

COPD

29
Q

How would you assess the symmetrical expansion of the chest?

- what does unequal chest expansion suggest?

A
  • hands on posterolateral aspect of chest wall
  • Place thumps tight @ level of T9/T10
  • ask pt to take a deep breathe in, note the movement of your thumbs.

unequal chest expansion:
- atelectasis, pneumonia, fractured ribs, pneumothorax

30
Q

What and why do we assess for tactile fremitus?

A
  • feeling for vibration using the palmar or ulnar aspect of hand
  • vibrations should be symmetrical on both sides

decreased fremitus occurs when anything obstructs the transmission of vibrations
- obstructed bronchus, pleural effusion, pneumothorax, emphysema

31
Q

what is crepitus

A

coarse crackling sensation palpable over the skin surface

  • occurs w/ subcutaneous emphysema
  • air escapes lungs and enters the subcutaneous tissue
32
Q

what should be heard when percussing the chest?

What are abnormal sounds and what do they suggest?

A

resonance
- low pitch, clear, hallow

hyper-resonance

  • lower pitch, booming sound
  • occurs when too much air is present
  • emphysema or pneumothorax

Dull

  • abnormal density in lungs
  • pneumonia, pleural effusion, atelectasis, tumor
33
Q

When would hyper-resonance or dullness in the chest wall be considered a normal finding?

A
  • H-R: in children under the age of 6

- D: lower regions (spleen and liver)

34
Q

When listening to breath sounds, do you use the bell or diaphragm?

A

diaphragm

35
Q

what are the 3 types of breath sounds?

A

Bronchial

  • high pitch, loud
  • inspiration < expiration
  • heard over the neck area (trachea and larynx)

Broncho-vesicular

  • moderate pitch and amplitude
  • inspiration = expiration
  • heard over major bronchi, posterior between scapulae, anterior around upper sternum in 1st-2nd ICS

Vesicular

  • low pitch, soft
  • inspiration > expiration
  • rustling noise
  • heard over the peripheral lung fields
36
Q

Causes of decreased or absent breath sounds

A
  • obstruction of bronchial tree
  • emphysema: lungs already hyper-inflated, so the very little inhaled air makes very little sound
  • obstruction of the transmission of the sound between the lung and stethoscope (pneumothorax = air, pleural effusion = fluid)
37
Q

Characteristics and Causes of increased breath sounds

A
  • high pitch, tubular quality, prolonged expiratory phase w/ a distinct pause between inspiration and expiration
  • occurs with consolidation (pneumonia) or compression (fluid in inter-pleural space) increases the density in a lung area
38
Q

When would an anteroposterior to transverse diameter of 1:1 be normal?

A

infants and children < 6 years old

older adults - barrel chest is common
- kyphosis also changes the diameter, making it closer to 1:1

39
Q

All crackles are abnormal except for which one?

A

Atelectatic crackles are non-pathological

- short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths

40
Q

Does an SpO2 < 93% require intervention?

A

Yes

41
Q

a slight flaring of lower costal margin is seen with breathing in a 2-month-old infant. Is this normal?

A

Normal

42
Q

What is the normal RR for an adult vs an infant?

A

adults: 10-14
infants: 30-40

43
Q

An infant experiences brief periods of apnea lasting 10-15 seconds. Is this normal or abnormal?

A

normal

44
Q

How are breath sounds different in infants and young children?

A
  • More bronchovesicular sounds in the peripheral lung fields rather than vesicular
  • louder and harsher sounds
  • fine crackles are common in neonates
45
Q

crackles in the upper lung fields only occur with __

A

cystic fibrosis

46
Q

crackles in the lower lung fields only occur with ___

A

heart failure

47
Q

Wheezing occurs with __

A
  • obstruction of lower airway

- asthma

48
Q

Stridor occurs with __

A

upper airway obstruction

Health Assessment (7 decks)

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