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NR 302
Thorax and Lung
Question | Answer |
---|---|
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. |