Thorax & Lungs Flashcards
A pneumothorax occurs when air leaks into the pleural space.
True or false?
True
A pt is experiencing hypoxia related to an ineffective airway.
Which assessment findings support the presence of hypoxia?
Cyanotic nail beds
Nasal flaring
A pt is reporting symptoms and demonstrating signs associated with dyspnea.
What is the nurse’s initial action?
Begin administering supplemental oxygen
a) Palpate/Anterior Chest
b) Percuss/Anterior
a) Symmetric chest expansion
Palpate the anterior chest wall
b) Predominant note over lung fields
Borders of cardiac dullness
a)________ is a functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli.
This bunched arrangement creates surface area for b)_______ that is as large as a tennis court.
a) Acinus
b) Gas exchange
a)________is potential space filled only with few milliliters of lubricating fluid
Pleural cavity
Abnormal findings for the lungs
Respiratory patterns,
Tactile Fremitus,
Lung sounds
Airway
Structure and Functions
- to act as a conductor of air
- to humidify and warm or cool the inspired air
- to prevent foreign materials from entering the tracheobronchial tree
Alveoli
Structure and function
Structure
Tiny air sacs at the end of the bronchioles
Covered in tiny blood vessels called capillaries
- *Function**
- Storage of air for a shorter period
- Permits absorption of oxygen into the blood
- Gas exchange(02 and CO2) When breath in and out
An elderly pt reports a feeling of dyspnea with normal activities of daily living.
What is an action by the nurse?
Observe the client’s respiratory rate and pattern
An old pt respiratory assessment.
The nurse should attribute what finding to age-related changes?
Slight kyphosis
Atelectasis
- The collapse of part or all of a lung
- Caused by a blockage of the air passages or by pressure on the lung
Auscultation
Listen to one full respiration in each location
Side-to-side comparison is most important
Note any abnormal/adventitious breath sounds.
Do not confuse background noise with lung sounds
Breathing
Anteroposterior diameter a) or b), which is accomplished by elevation or depression of ribs
a) increases
b) decreases
Breathing
Vertical diameter a) or b), which is accomplished by downward or upward movement of the diaphragm
a) lengthens
b) shortens
Common abnormal lung sounds 5
- *Wheeze**
- high-pitched whistle sound
- something is making airways narrow, blocking(COPD, asthma)
- Foreign body obstruction
- *Rhonchi**
- low-pitched,continuous sounds like snoring
- Fluid-blocked airways
- *Stridor**
- Loud,High pitched
- Obstructed upper airway
- Common in infants/larynx is soft and floppy
Crackles (rales)
Crackles-rales:small clicking, bubbling, or rattling sounds
Crackles - fine: usually high in pitch; soft
Crackles - coarse: low in pitch
- *Crepitus**
- Rubbing of parts one against the other
a) Tachypnea?
b) Bradypnea?
a) Respiratory rate that is greater than the normal for age
Asthma,pneumonia,COPD
More than 20 breaths
b) Respiratory rate that is lower than normal for age
lightheadedness,dizziness, tiredness
COPD changes the costal angle, how?
Angle increased
Cyanosis signals __________
hypoxia
Developmental Competence: Pregnancy
- Enlarging uterus elevates diaphragm 4 cm
- Respirations are deeper allowing for a 40% increase in tidal volume
- Diaphragm is elevated, it is not fixed
Developmental Competence:The Aging Adult
- Costal cartilages become calcified/which produces a less mobile thorax
- The lunge rigid that is harder to inflate.
- Histologic changes/less surface area is available for gas exchange
- Increase risk of postoperative pulmonary complications
- May tire easily
- Increase in anteroposterior (AP) diameter
Difference between dyspnea , orthopnea and Paroxysmal Nocturnal Dyspnea
- *Dyspnea**
- Shortness of breath
- Caused by asthma, heart failure, COPD
- *Orthopnea**
- Discomfort when breathing while lying down flat
- Heart isn’t strong enough to pump-out
- *Paroxysmal Nocturnal Dyspnea**
- Sensation of shortness of breath that awakens
- Often after 1 or 2 hours of sleep
- Usually relieved in the upright position
Difference between Pleural friction rub, Pericardial friction rub, and Pleural effusion
- *Pleural friction rubs**
- low-pitched, grating, or creaking sound
- More often heard on inspiration than expiration
- *pericardial friction rub**
- High-pitched scratching, grating, or squeaking leathery sound
- Heard best with the diaphragm
- *Pleural effusion**
- A buildup of fluid between the tissues that line the lungs and the chest
- A very muffled sound
Difference between hypoxemia and hypoxia
Hypoxemia
-low oxygen content in the blood
Hypoxia
-low oxygen supply in bodily tissues
Differences between the anterior and posterior side of the lungs
Anterior
- Smaller lower lobes
- lager upper lobes
- Asymmetrical
- Right lung has 3 lobes
Posterior side
- Smaller lobes and larger lower lobes
- Symmetrical
- Two lobes for both lungs
Emphysema?
Abnormal permanent enlargement of bronchioles and alveoli and destruction of the lung parenchyma
Expect to find during inspection of a patient with Asthma
- Increased respiratory rates
- Tachycardia/heart rate over 100 beats a minute
- Bilateral wheezing on expiration
Expect to find during inspection of a patient with Atelectasis
- Cough
- Increased RP and HR
- Breath sounds decrease vesicular or absent over area
Expect to find during inspection of a patient with Emphysema?
- Increased AP diameter/Barrel chest
- Accessory muscles used to aid respiration
- Tripod position
- decreased breath sounds
Expected findings in the normal adult lung include the presence of?
Muffled voice sounds and symmetric tactile fremitus
Functions of Respiratory System
- Supplying oxygen for energy production
- Removing carbon dioxide as a waste product
- Maintaining homeostasis (acid-base balance) of arterial blood
- By supplying oxygen to blood and eliminating excess carbon dioxide,
- Maintains pH or acid-base balance of blood
Health history question
Cough
Do you have a cough? When did it start?
Gradual or sudden?
Shortness of breath
Have you ever had any shortness of breath or hard breathing?
What brings it on? How severe is it? How long does it last?
Chest pain with breathing
Do you have any chest pain with breathing?
Please point to the exact location.
Past history of respiratory infections
Do you have any past history of breathing trouble or lung diseases like bronchitis, emphysema, asthma, pneumonia?
Smoking history
Do you smoke cigarettes or cigars?
At what age did you start? How many packs per day do you smoke now?
For how long?
Environmental exposure
Are there any environmental conditions that may affect your breathing?
Where do you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy traffic area?
Self-care behaviors
Last tuberculosis skin test, chest x-ray study, pneumonia or influenza immunization?
Suprasternal notch
Hollow U-shaped depression above sternum
How do you determine the difference between pleural friction rub and pericardial friction rub?
-Ask the patient to hold the breath briefly
-If the rubbing sound continues, it’s a pericardial friction rub
A pleural rub stops when breathing stops
Ask the patient to hold the breath briefly
- If the rubbing sound continues, it’s a pericardial friction rub
- A pleural rub stops when breathing stops
What muscles do you use to breathe?
Diaphragm,
Intercostal muscles
Hyperventilation
Rapid, deep breathing
Ride of carbon dioxide
Hypoventilation
Slow, shallow breathing
Carbon dioxide level rises
Hypoxemia
A low level of oxygen in the blood
Increased transmission of voice sounds over the right lung.
What would this indicate to the nurse?
The lung has become airless
-increased transmission of voice sounds suggests that air-filled lung has become airless
Inhalation and Exhalation
- Inhalation Diaphragm contracts/moves down
- Exhalation Diaphragm relaxes/moves up
Initial survey of respiration and the thorax
Rate, rhythm, depth, and effort of breathing
Facial expression
Level of consciousness
Assess patient’s color
Listen to patient’s breathing
Inspect the neck
Observe shape of chest
Inspection/Anterior Chest
- Shape and configuration of the chest wall
- Facial expression
- Level of consciousness
- Skin color and condition
- Quality of respirations
- Rib interspaces
- Accessory muscles
Inspection
-Thorax is symmetric with downward sloping ribs
-About 45 degrees relative to the spine
-Scapulae are placed symmetrically in each hemithorax
-AP diameter should be < than transverse diameter.
-Assess skin color, lips, & nail beds
-Note facial expression
Assess LOC
Landmarks for Anterior Thorax and Lungs
Suprasternal notch
Sternal angle (Angle of Louis)
Costal angle
Lung condition/ aging adult related?
- Decrease in number of alveoli
- Decreased mobility of the thorax
- Increase in risk of postoperative pulmonary complications
- Development of kyphosis
Fales—Decrease in AP diameter
Manubriosternal angle is also called?
Angle of Louis
Mechanic of breathing
- *Inhalation**
- diaphragm contract
- *Exhalation**
- diaphragm relax
Normal breath sound
Moderate
Bronchovesicular at over major bronchi
I=E
Normal breath sound
High, loud, harsh, hollow
High, loud,
harsh, hollow
Bronchial/Tracheal at Tracheal
I
Normal lung sounds
Low pitched, soft
Vesicular at Peripheral fields
I>E I sound is louder
Objecgtive dagta thing to be in mind
for make pt comfort
- A warm room, a warm stethoscope, and a private
- Perform inspection, palpation, percussion, and auscultation on posterior
- Then move to face the person and anterior
Objective assessment
INSPECTION
PALPATION
PERCUSSION
ASCULTATION
Palpation
- Placing hands sideways on the a)________ with thumbs pointing together at the level of b)________
- Slide hands medially to pinch up a small fold of skin between thumbs Ask the pt to c)________
- Hands serve as mechanical amplifiers; as the pt d)________, thumbs should move apart e)________
a) posterolateral chest wall
b) T9 or T10
c) take a deep breath
d) inhales deeply
e) symmetrically
- Detection of any lumps, masses, or tenderness
- Symmetric chest expansion
Palpation
- Confirm symmetric expansion,
- Detection of any lumps, masses, tenderness
- Skin turgor, temperature, moisture, texture, edema
Pleural
Structure and function
- *Structure**
- Double-layered serous membrane
- Envelope between lungs and chest wall
- *Function**
- To cushion the lungs and reduce any friction
Pleurisy
What sound?
Inflammation of the tissues that line the lungs and chest cavity
Friction rub
Posterior chest 2 linse
Vertebral line
Scapular line
Proper patient draping during thorax and lung assessment
Male
-To sit upright and disrobe to the waist
Famel
-leave the gown on and open at the back
-Anterior chest, lift up the gown and drape it on her shoulders
(rather than removing it completely)
Ribs
12 pair
Right lower lobe/RLL (Anterior)
Left lower lobe/LLL (Anterior)
-From the 6th rib in the MCL to the 7th rib in AAL down
to the 8th rib in the AAL and back up to the 6th rib in the MCL
Right middle lobe/RML
(Anterior)
- From the 4th rib at the sternum
- To the 5th rib in the anterior axillary line
- To the 6th rib in the midclavicular line and over to the sternum
Right upper lobe/RUL (Anterior)
Left upper lobe/LRUL (Anterior)
- From 1-2 cm above the clavicle in the midclavicular line (MCL)
- To the 3rd intercostal space
Right upper lobe/RUL(Posterior)
Left upper lobe/LUL(Posterior)
-From 1-2 cm above the scapulae in the midscapular line to T3-4
Right lower lobe/RLL (Posterior)
Left lower lobe/LLL(Posterior)
-From T3-4 to T10-12
What locations of each lung lobe using landmarks on the thorax?
RUL
It extends from the apex of the lung down to the horizontal and oblique fissures
RML
Located between the horizontal and oblique fissures
RLL
It lies beneath the oblique fissure
LUL
It is above the oblique fissure
LLL
Superior, anterior, posterior, medial, and lateral bronchopulmonary segments
Sternum
Chest bone
Subjective data
- Rate, rhythm, depth, and effort of breathing
- Facial expression
- Level of consciousness
- Assess patient’s color
- Listen to patient’s breathing
- Inspect the neck
- Observe shape of chest
Tactile Fremitus
The vibration of the chest wall that results from sound vibrations created by speech or other vocal sounds
The function of the respiratory system
- Supplying oxygen for energy production
- Gas exchange (Supply O2 and remove CO2)
- Maintains pH or acid-base balance of blood
The nurse assesses shallow respirations of 28 breaths/minute in a pt with pleurisy.
This finding as indicating which of the following?
The pattern is expected with this condition
The nurse auscultates the base of the lungs to assess for what reason?
It is where fluid occurs with with pulmonary edema.
The nurse notices a coarse crackling sensation over the skin surface.
The nurse suspects?
Crepitus
Crackling or grating sound caused by bones rubbing against each other
The outer layer of lung called a)________
To locate the circumference of the chest
Thin, slippery pleurae form an envelope between b)________ and c)________ wall
a) Parietal pleura
b) Lung
c) Chest
The process of aging in Thorax and lung assessment
- Costal cartilages become calcified, which produces a less mobile thorax
- Lung is more rigid that is harder to inflate
- Less surface area is available for gas exchange
- Alveoli can lose their shape and become baggy
- The diaphragm becomes weaker
- Decreasing the ability to inhale and exhale.
The pt has loud, high-pitched respirations during expiration.
Where is the nurse auscultating?
Trachea
The pt reports a recent onset of a persistent cough.
Denies any shortness of breath, or other findings of an acute upper respiratory tract illness.
What question should the nurse have?
Are you taking any medications on a regular basis?
A persistent cough without any other respiratory symptoms could be related to new medications
especially beta-blockers or angiotensin-converting enzyme (ACE) inhibitors
The therapy can induce a)__________
Do not eat right before or within 2 hours
Inhaling deeply through the b)________ and exhaling in c)________ is effective in posttreatment coughing.
a) nausea and vomiting
b) nose
c) 3 short puffs
The __________ space is the potential space between visceral and parietal pleura
pleural
To locate the circumference of the chest
a) line that is in the middle of the sternum
b) line that is 4 inches left or right of the mid sternal line.
Close to nipple
c)Drop vertically from the anterior and posterior axillary folds
a) Midsternal
b) Midclavicular
c) Axillary lines
Tobacco use is the leading cause of preventable death True or false?
True
Types of COPD 3
Emphysema, bronchitis, asthma
Unilateral __________ suggests a large pneumothorax or possibly a large air-filled bulla in the lung
hyper resonance
Which type of breath sounds should a nurse anticipate on auscultation of the right lower lobe in a client with right lower lobe pneumonia?
Bronchial
What is asthma?
Continuum of a disease process characterized by ________ of the airway wall, which acts as a variable airflow obstruction
inflammation
not in alveolar area, typically in larger airways
What is physiotherapy?
.
Physical therapy, also known as physiotherapy
Affected by injury, illness or disability movement
Education and advice
What is the Barrel Chest?
Normal is AP> T
Barrel Chest AP=T
-Ribs are horizontal instead of the normal downward slope
-With normal aging
-Chronic emphysema and asthma
(as a result of hyper inflammation of lungs)
what is the carinatum?
- A forward protrusion of the sternum, with ribs sloping back at either side
- Vertical depressions along costochondral junctions (pigeon breast)
Difference between Asthma, COPD, Emphysema and Empyema
Asthma/wheeze sound
-Airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe
Allergies are triggered
-Breathing can return to normal between attacks
- *COPD/wheeze sound**
- long-term exposure to lung irritants that damage lung cells
- Main case is cigarette smoke
- Block airflow and make it difficult to breathe
- Gradually become more severe
- Produces more mucus and phlegm
- Chronic cough is common
- Usually occurs in those over age 40
- *Emphysemas**
- A type of COPD
- A progressive lung disease caused by over-inflation of the alveoli
- A air sacs loses their shape and become floppy
- *Empyema**
- A pyogenic inflammation following an infection of the affected site
- Pneumonia caused by a bacterial infection
What is the Kyphosis?
- A forward rounding of the back
- An exaggerated posterior curvature of the thoracic spine (humpback)
- Causes significant back pain and limited mobility
- Associated with aging
- “dowager’s hump” of postmenopausal osteoporotic women
- Related to physical fitness
What is the Pectus excavatum?
-The breastbone sinks into the chest
(also called funnel breast)
-May cause embarrassment and a negative self-concept
-Shortly birth and typically worsens during the adolescent
-More common in boys
-Associated genetic or connective tissue diseases
what is the scoliosis?
- A lateral S-shaped curvature of the thoracic and lumbar spine
- More prevalent in adolescent age groups, especially girls
What is the tripod position?
-Sits or stands leaning forward and supports the upper body with hands-on
Pregnant women will have respirations?
“Pregnant women will have respirations that are more shallow due to decreased tidal volum”
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
Bronchitis
When is the costal angle greater?
During pregnancy
When percussing the anterior chest for tone,
What tone over the majority of the lung fields?
Resonance
Where is the apex located for the thorax and lungs?
Just above clavicle
Which main bronchus are children more likely to obstruct due to choking?
Right main Bronchus
Which main bronchus is curved?
Left main bronchus
Which main bronchus is more straight?
Right main Bronchus
Which main bronchus would you be more likely to develop pneumonia?
Right main bronchus
Which subjective finding in a pt with tuberculosis should a nurse recognize as an indication of the onset of pleurisy?
Knife-like pain that worsens on inspiration
While the auscultating, presence of adventitious sounds.
What actions should the nurse do first?
Have the client cough, then listen again
__________ are musical respiratory sounds that may be audible to the patient and others
Wheezes
Wheezes
__________ is the most important examination technique for assessing air flow through the tracheobronchial tree
Auscultation
Patient with severe asthma, what sound?
Wheezes
“Wicked cough” leading to dyspnea.
When trying to differentiate between pathologic lung changes and an infection as the etiology
What interview question should the nurse ask?
“How long have you been experiencing your cough?”
Asthma
What to expect?
a) Inspection
b) Palpation
c) Percussion
d) Breath sound
a) Increased RR
use of accessory muscles
b) Tachycardia/fast heartbeat
c) hyper resonant
d) Bilateral,wheezing
Emphysema
What to expect?
a) Inspection
b) Palpation
c) Percussion
d) Breathsound
a) Increased AP diameter
Barrel chest
b) chest expansion
c) Hyperresonant
d) Decreased breath sounds
Prolonged expiration
Atelectasis
Collapsed shrunken section of alveoli or an entire lung
Atelectasis
What to expect?
a) Inspection
b) Palpation
c) Percussion
d) Breathsound
a) Cough
Possibly cyanosis
b) Tracheal shift if large collapse
c) Dull over area
e) Absent over are
