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NR 302

Thorax and Lung

Thoracic Cage Sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles(intercostal)& cartilage.
Mediastinum Contains Trachea, Esophagus, Heart. Located in center of thoracic cavity.
Pleural Cavity What the lungs lie in.
Lungs Apex (top of lung, extends above clavicle) & Base. Right- 3 lobes Left- 2 lobes
Thoracic Cavity Cone-shaped, elastic, suspended in the thorax.
Anterior Landmarks of Thoracic Cavity Suprasternal notch "U shaped", Sternum "breastbone", Sternal angle (angle of Louis) continuous w/ 2nd rib, Ribs & Intercostals, Costal angle (@ xiphoid) 90 degrees.
Posterior Landmarks of Thoracic Cavity Vertebra prominens C7, Spinous processes T1 is 1st rib, T3 seperates upper & lower lobes, Inferior border of the scapula 8th rib, Twelfth rib.
Parietal Pleura Lines inside of chest wall & diaphragm.
Visceral Pleura Lines outside of the lungs.
Pleural Space Pleural Cavity
Pleuralcentesis Needle/catheter placed in pleural cavity to remove fluid.
Trachea (dead air space) & Bronchi Bronchi, Bronchioles, Alveolar Sacs, Alveoli (oxygenation takes place)
External Respiration Exchange of gases between the alveoli and blood capillaries.
Inhalation Diaphragm moves down.
Exhalation Diaphragm moves up.
Subjective Data: Health History Difficulty breathing & sleeping, chest pain, cough & sputum, past history, family history, smoking, environment (asbestos, chemicals, ETS), last TB test, flu-vaccine.
Sputum Colors Rust=Tuberculosis Red, frothy=Chronic heart failure
Smoking: Calculating pack years # of cigarettes smoked per day x # yrs. smoked divided by 20.
Objective data: Inspection Nasal flaring, color, nails (clubbing, cap. refill), configuration of chest, accessory muscles, positioning.
Objective data: Palpation Tenderness, crepitus (cracking), lestions, tactile fremitus (vibrations), expansion.
Objective data: Percussion Resonance (normal), bone (flat), hyper-resonance (over-inflated alveoli), dull (fluid filled organs), diaphragmatic excursion (deep breath & hold).
Objective data: Auscultation Normal, adventitious & voice sounds.
Normal Findings Symmetric chest shape, AP diameter less than size of transverse diameter, normal chest shape w/o deformities, no muscle contractions when breathing, quiet unlabored resp., regular rythym & rate of 12-20, skin color matching rest of body.
Normal Breath Sounds Tracheal: Over trachea I<E. Bronchial: Over bronchus E>I. Bronchovesicular: Over major bronchi I=E. Vesicular: Peripheral over terminal bronchi I>E.
Voice Sounds Bronchophony: "ninety-nine". Egophony: "ee". Whispered. Pectoriloguy: "one-two-three".
Rales Crackles. Not clear with coughing. From fluid or consolidation.
Rhonchi Gurgles/rattling. Narrowing airway. Can be cleared.
Wheeze High pitched continuous.
Stridor Low high pitched/crowing. Upper. Croup.
Pleural Friction Rub Low pitched grating/rubbing. Inflammation.
Eupnea Normal Respirations
Tachypnea Rapid. >20
Bradypnea Slow. <12
Hyperventilation Fast, deep & rapid.
Hypoventilation Slow, shallow. (Immobility, narcotics)
Cheyne-Stokes Deep shallow breaths & apnea.
Biots Irregular. No cyclic pattern. Neurological problems.
Thoracic Deformities Barrel, Pectus Excavatum (funnel), Pectus Carinatum (pigeon), Scoliosis (decreased lung capacity), Kyphosis (excessive outward curve of spine).
Chronic Lung Disease (COPD) Wheezing, pursed-lip breathing, chronic cough, barrel chest, dyspnea, prolonged expirations. Don't over-oxygenate. 1st indicator: Confusion,change in mental state.
Created by: MeganZajac