Unit 7 - Thorax and Lungs Flashcards
What is a musculotendinous septum that separates the thoracic cavity from the abdomen?
The Diaphragm
Regarding to the structure, what part makes up the Thorax (Thoracic cavity/Cage)?
Thoracic vertebrae
Ribs
Sternum
Diaphragm
How many ribs do we have?
How many are direct and indirectly connected?
12 pairs all together
1-10 ribs connected to the sternum –> 1 to 7th are directly connected, and 8 to 10th ribs are indirectly attached to the sternum.
11th and 12th pair of ribs are floating ribs.
What is the point where the ribs join their cartilages called?
Costochondral junctions
Posterior Thoracic Landmarks
How do locate vertebra prominens to find our first landmark?
Flex your head forward and at the base of your neck feel for the most prominent bony protrusion, this is the spinous process C7. If we feel 2 bumps, we use the upper one as the lower one will be T1.
Where would you find the twelfth rib?
It floats between the spine and post axillary line.
A hollow, U shaped depression above the sternum is called?
Suprasternal Notch
The sternum (breastbone) is made up of what 3 parts?
The manubrium, the body, and the xiphoid process
_________ is the articulation of the manubrium and body of the sternum.
Sternal Angle/ Angle of Louis
The __________ also marks the site of tracheal bifurcation into the right and left main bronchi.
Angle of Louis
What is a costal angle?
Left and right costal margins form an angle where they meet at the xiphoid process. Usually 90 degrees (Anteriorly) or less
True or false
The right lung is shorter then the left?
True - this is because of the underlying liver.
But left is more narrow then right due to the heart.
Where are the lungs contained?
in the pleural cavities, on either side of the mediastinum
True or false
Aspiration will occur more frequently in the left lung.
False - It will more or less happen in the right due to the straight bronchioles. The left one comes in slightly tilted due to the position of the heart.
The ______ is the highest part of the lungs, where the ______ is the lowest part of the lungs.
Apex - high
Base - low
The right lung has ____ lobes. How are they divided and what are the names of each?
3 lobes. They are divided by fissures
Horizontal fissure - RUL and RML (4th rib to 5th mid axillary line)
Oblique Fissure - RML and RLL (5th mid axillary line to 6th midclavicular)
The left lung has _____ lobes. How are they divided and what are the names of each?
2 Lobes.
Left oblique fissure - LUL and LLL (5th mid axillary line to 6th rib midclavicular line)
True or False
Posterior portion of the chest is almost entirely lower lobes.
True - Small portion of the upper lobes can be heard until around T1-T3/4. You are unable to access the RML either.
The anterior portion of the chest is almost entirely Upper and middle lobes.
Which pleural membrane lines the outside of the lungs?
Visceral Pleura
Which pleural membrane lines the inside of the chest wall and diaphragm?
Parietal pleura
The respiratory has four major functions. What are they??
1) supplying oxygen to the body for energy production
2) removing carbon dioxide as a waste product of energy reactions
3) Maintaining homeostasis (acid-balance) of arterial blood
4) maintaining heat exchange (less important in humans)
What structures make up the upper respiratory system?
Nose, mouth, pharynx
What structure is the transition between the upper and lower respiratory system?
The Larynx
What structures make up the lower respiratory system?
Trachea, Rt & Lt bronchi and Lungs
Where does the conduction portion of respiration occur?
Nose/mouth to terminal bronchioles (dead space - no gas exchange)
Where does the respiratory portion/zone occur?
Respiratory bronchioles to alveoli (acini) where gas exchange occurs.
What is hypercapnia?
Stimulus to breathe in response to high levels of C02 in the body.
Respiration occurs in 3 steps. What are the 3 steps and what happens in each?
- Ventilation = breathing
- External respiration = exchange of gases between alveoli and capillaries; blood gains 02 and loses C02
- Internal respiration = exchange of gases between cells and tissue; blood loses 02 and gains C02
What is it called when there is increased rate and depth of respiration that leads to decreased C02?
Hyperventilation
What is it called when there is decreased rate and depth (shallow) respiration that may be irregular?
Hypoventilation
What does apnea mean?
Not breathing
Chest size ________ with inspiration and ________ with exhalation.
Increases - Decreases
What is shortness of breath?
Dyspnea
What is some subjective data to collect for a lung health history?
Cough - productive, dry, how long? etc.... SOB - does it affect ADL's... Chest pain with breathing HX of resp infections Smoking history (Smoking cessation) Environmental exposure/travel Self care behaviours
Upon inspection of the posterior chest, what are we looking for?
Shape and configuration of chest wall
Anteroposterior/transverse diameter (Ratio 1:2)
Position of Patient (Relaxed, tripod?)
Skin colour and condition
Symmetrical chest expansion, you are placing your thumbs posteriorly around _________ and asking the patient to take a deep breath. A normal finding would be _________?
T9 or T10
Your hands should move apart symmetrically
What is creating the sounds for vibration in tactile fremitus?
Sounds generated from the larynx that are transmitted through patent bronchi and through the lung tissue to the chest wall where they are felt as vibrations.
Where is fremitus most prominently felt?
Between the scapulae and around the sternum. (Sites where the major bronchi are closest to the chest wall)
True or False
As you feel for fremitus down the chest, it will increase as you get to the bottom due to the more tissue creates more vibration?
False
Fremitus normally decreases lower down because more and more tissue impedes sounds transmission.
An obstruction (ie pneumothorax) of the lung will cause ____________ fremitus.
Decreased, any barrier between the sound are your palpating hand decreases fremitus.
A compression/consolidation (ie lobar pnumonia) of the lung will cause ___________ fremitus.
Increased, this occurs only when the bronchus is patent and when the consolidation extends to the lung surface.
What is a coarse crackling sensation palpable over the skin surface called?
Crepitus
When percussing the lungs, which sounds will you hear in healthy lung tissue?
Resonance - In apices, between the interspaces on either side of the cervical column (avoiding the scapulae)
Dull - over any visceral or liver borders
Flat - Ribs and scapula
How is percussion limited and not always consistent?
The depth of penetration for percussion has limits, only can get 5 to 7 cm of tissue. If a patient has heavy muscles, thick chest wall, or obese, the sounds may appear to be dull.
Which lung sound produces a short inspiration and long expiration?
Bronchial (Tracheal) - Trachea and larynx
Note* High pitch, loud amplitude, harsh/hollow/tubular quality
Which lung sound produces a long inspiration with a short expiration?
Vesicular - Peripheral lunch fields (Small bronchioles and alveoli)
Note* Low pitch, soft amplitude, rustling (like the sound of trees) quality.
Which lung sounds produce a long inspiration and a long expiration?
Bronchovesicular - Over major bronchi
Note* Moderate pitch, moderate amplitude, Mixed quality (from Vesicular and Bronchial)
What may be some causes for decreased breath sounds in the lungs?
Obstruction of the bronchial tree (by mucous, secretions, or foreign body)
Hyper-inflated lung tissue due to the loss of elasticity in the lung fibres and decreased force of inspired air (Emphysema)
Obstruction of the transmission of sound between the lung and your stethoscope (pneumothorax, plural effusion)
What may be some causes for increased breath sounds in the lungs?
Consolidation (pneumonia) or compression (fluid in the intrapleural space) increases the density in a lung area, which enhances the transmission of sound from bronchi.
Additional sounds that are not normally heard in the lungs are called _______________?
Adventitious sounds
What are some adventitious sounds that could be found in the lungs?
Crackles - fine or coarse Wheezes Stridor Atelectatic crackles (short popping) Pleural friction rub
What is pulse oximetry and what are the normal limits?
Pulse oximetry is a noninvasive method of assessing arterial oxygen saturation (SP02)
Healthy Adult = 97% -98% O2 on RA
If less then 93% on RA, Elevate HOB and instruct patient to take deep breaths.
What are some developmental considerations when it comes to the decrease function of lungs in older adults?
Mobility of thorax - barrel shaped chest
Chest expansion
Elasticity of lung tissue
Number of alveoli - may tire easily
Cough + airway reflexes (Leads to increase secretions)
What are some ways we can measure pulmonary functions status?
Spirometer
Forced expiratory time
Forced vital capacity (FVC)
Forced expiratory volume in 1 second (FEV1)
What is hypoxia?
A condition of insufficient oxygen anywhere in the body. Localized, specific area is not receiving O2 and can cause tissue damage (Ischemia or infarction)
Can lead to hypoxemia.
What is hypoxemia?
Reduced oxygen level in the blood. Systemic issue as impaired diffusion at the alveolar-capillary bed.
Can cause hypoxia.
By using just the concept of cyanosis, how could you tell the difference between hypoxia and hypoxemia?
Hypoxia - cyanosis is localized
Hypoxemia - cyanosis is generalized
What would you set the flow rate of oxygen for someone using a nasal cannula?
Up to 6L per min (Humidify if more than 4Lpm)
What would you set the flow rate of oxygen for someone using a non-rebreathing mask?
More then 10L per min
What type of mask could someone who is receive high flow O2 have?
Venturi mask, Nebulizer, Bag valve mask
What would you set the flow rate of oxygen for someone using a simple O2 mask?
5 to 10L per min (Humidify if on for more than a few hours)
What condition is caused by the destruction of pulmonary connective tissue (elastin, collagen) characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls?
Emphysema - Cigarette smoking accounts for 80-90% of cases of emphysema.
What condition is a proliferation of mucous glands in the passageways resulting in excessive mucus secretions and inflammation of the bronchi with partial obstruction of bronchi due to secretions or constrictions?
Bronchitis - may be acute or chronic with recurrent productive cough. Cigarette smoking is usually the cause of chronic bronchitis.
What condition is an allergic hypersensitivity to certain inhaled allergens, irritants, microorgansims, stress, or exercise that produces a complex response by bronchospasam and inflammation in the walls of the bronchioles?
Asthma - increased airway resistance, especially during expiration. Produce symptoms of wheezing, dyspnea, and sensation of tightness in chest.
What condition is caused by free air in pleural space that causes partial or complete lung collapse?
Pneumothorax - can be spontaneous, traumatic, or tension caused. Air in plural space neutralized the usual negative pressure present, thus lung collapses.
A functional category of abnormal respiratory conditions characterized by airflow obstruction like emphysema and chronic bronchitis is called?
Chronic obstructive pulmonary disease (COPD)
What is egophony?
The voice sound of “eeeeeee” heard through the stethoscope.
The manubriosternal angle is:
A) the articulation of the manubrium and the body of the sternum.
B) a hollow, U-shaped depression just above the sternum
C) also known as the breastbone
D) a term synonymous with costochondral juntion
A) the articulation of the manubrium and the body of the sternum.
Select the correct description of the left lung:
A) Narrower than the right lung with three lobes
B) narrower than the right with two lobes
C) wider than the right lung with two lobes
D) shorter than the right with three lobes
B) narrower than the right with two lobes
Some conditions have a cough with characteristic timing. The cough associated with chronic bronchitis is best described as:
A) continuous throughout the day.
B) productive cough for at least three months
C) occurring in the afternoon or evening because of exposure to irritants at work
D) occurring in the early morning.
D) occurring in the early morning.
The assessment of the lateral chest wall is :
A) important when assessing the left middle lobe
B) only performed when assessing adults
C) referred to as the forgotten lobe
D) only performed on the right lateral chest wall.
C) referred to as the forgotten lobe
Auscultation of breath sounds is an important component of respiratory assessment. Select the most accurate description of this part of the examination.
A) hold the bell of the stethoscope against the chest wall, listen to the entire right field, then the entire left field.
B) hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparison.
C) Listen from the apices to the bases of each lung field using the bell of the stethoscope.
D) Select the bell or diaphragm depending upon the quality of sounds heard; listen for one respiration in each location, moving from side to side.
B) hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparison.
Select the best description of bronchovesicular breath sounds.
A) High-pitched, of longer duration on inspiration than expiration
B) Moderate pitch, inspiration equal to expiration
C) Low-pitched, inspiration greater than expiration
D) rustling sound, like the wind in the trees
B) Moderate pitch, inspiration equal to expiration
After examining a patient, you make the following notation: Increase expiratory rate, chest expansion decreased on left side, dull to percussion over left lobe, breath sounds louder with fine crackles over left lower lobe. These findings are consistent with a diagnosis of: A) Bronchitis B) asthma C) pleural effusion D) lobar pneumonia
D) lobar pneumonia
Upon examining a patient’s anterior chest, you not cutaneous angiomas on the upper chest wall. These findings are consistent with:
A) Adult respiratory distress syndrome
B) Tuberculosis
C) chronic, congenital heart disease and COPD
D) Liver disease or portal hypertension
D) Liver disease or portal hypertension
Upon examination of a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient complains of pain with breathing. These findings are consistent with: A) Fine crackles B) wheezes C) atelectatic crackles D) pleural friction rub
D) pleural friction rub
In order to use the technique of egophony, ask the patient to:
A) Take several deep breaths, then hold for five seconds
B) say “eeeeeee” each time the stethoscope is moved
C) repeat the phrase “Ninety-nine” each time the stethoscope is moved.
D) whisper a phrase as auscultation is performed
B) say “eeeeeee” each time the stethoscope is moved
When examining for tactile fremitus, it is important to: A) have the patient breath quickly B) ask the patient to cough C) palpate the chest symmetrically D) use the bell of the stethoscope
C) palpate the chest symmetrically
The pulse oximeter measures: A) Arterial oxygen saturation B) venous oxygen saturation C) combined saturation of arterial and venous blood D) carboxyhemoglobin levels
A) Arterial oxygen saturation
