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HA lung-thorax
| Question | Answer |
|---|---|
| sternum | composed of manubrium, body, xiphoid process |
| how many ribs | 12 pairs of ribs, connected to spinal column by cartilage |
| mediastinum | central area of the thoracic cavity |
| pleura | thin double layered serous membrane lining thoracic cavity |
| inspiration | enlargement of chest cavity resulting in negative pressure -> inflow of air into lungs |
| expiration | passive process relaxation of intercostal muscles/diaphragm leading to reduced thorax size/positive pressure -> air out of lungs |
| normal respiratory rate in adults | 14-20 breaths/minute |
| how does respiration happen physiologically | diaphragm contracts ribcage expand horizontally intercostal muscles lift sternum + elevate rib |
| lung anatomy (anterior) | right lung has 3 lobes able to be seen anteriorly (RUL, RML, RLL) left lung has 2 lobes anteriorly (LUL, LLL) |
| lung anatomy (posterior) | LUL/LLL RUL/RLL |
| 4 functions of respiratory system | changing chest size (volume) during respiration inspiration expiration control of respiration with main goal of adequate O2 perfusion |
| risk factors for lung cancer | toxin/occupational exposures (asbesto, radon) Hx Hodgekin's poor diet Beta-Carotene (taken to reduce risk but actually can increase risk probably) poor diet (saturated/trans fat, processed foods, refined sugar) |
| Lung CA prevalence | - 2nd most common CA for both gender (excluding skin CA) - black men higher incidence/mortality c/w white - more common in 65+ |
| SCLC vs NSCLC rates | 10-15% SCLC 80-85% NSCLC |
| modifiable risk factor for lung CA | smoking cessation asbesto/radon exposure toxins like diesel exhaust, arsenic, silica, chromium, etc beta-carotene supplement |
| nonmodifiable risk factor for lung CA | gender (men more common) racial/ethnical factor age genetic/FHx |
| Lung CA and clotting disorders | increases risk of developing blood clots --> increase risk for DVT, and subsequently PE when DVT clot travels |
| subjective data collection for lungs | COLDSPA PHx (cough, SOB/orthopnea, chest pain w/ breathing, Hx respiratory infection, smoking Hx, environmental exposure, self care) FHx lifestyle |
| orthopnea | SOB when lying down which improves in other positions |
| types of self care behavior in relation to lung CA | last TB exam, CXR, pneumonia/flu immunization |
| SOB and anxiety consideration | stress can cause anxiety, which can lead to SOB |
| true/false: orthopnea is associated with heart failure | true |
| observational considerations with lung/thorax exam | seating position level of awareness of environment/own medical status mood (relaxed/anxious/uncomfortable) obvious signs of difficulty breathing |
| ABCDEs for lungs | airway breathing circulation disability exposure for immediate assessment and tx of critically ill/injured patient |
| visual objective inspection of lung/thorax | shape/configuration symmetry AP:Transverse (normal 1:2) muscle development/accessory muscle use patient position trachea position |
| nasal flaring | seen in labored respiration, especially in small children indicative of hypoxia |
| pursed lip breathing | moving O2 in and CO2 out of lungs keeps airway open longer to slow breathing rate and relieve SOB |
| conditions associated with pursed lip breathing | asthma, emphysema, chronic heart failure (CHF) |
| ruddy to purple complexion seen in which conditions | COPD/CHF this is due to polycythemia, cyanosis may also occur if pt is cold or hypoxic |
| polycythemia | elevated HGB or HCT in the blood |
| what does pale/cyanotic nail indicate | possible hypoxia --> early/late clubbing of nails may occur d/t hypoxia |
| accessory muscles | muscles of the shoulder, neck and upper chest can lift up breastbone, upper ribs and collar bones = bigger lungs/increased inspiration |
| what does use of accessory muscle indicate | severe airway/pulmonary disease the forced expiratory volume over 1s (FEV1) is decreased to 30% of normal or less |
| which airway disease do accessory muscles facilitate | acute/chronic airway obstruction or atelectasis |
| atelectasis | partial lung collapse |
| emphysema | enlargement of alveoli/lung air spaces and reduced lung elasticity symptoms include SOB/chronic cough |
| tripod position | leaning forward and using arms to support weight/lift chest COPD and children with cardiac issues |
| crepitus | crackling sensation associated with subcutaneous emphysema, pneumothorax/chest trauma, rupture/tear in esophagus/airway, |
| fremitus | vibrations of air in bronchial tubes transmitting to chest wall increase with consolidation and blunted with pneumothorax |
| what to look for in palpation of thorax | tenderness/sensation crepitus surface characteristics palpate for fremitus assess chest expansion posteriorly |
| how to palpate for fremitus | ball surface of hand say 99 surface characteristics tenderness/masses/sensation/inflammation avoid breast tissue in females |
| how to palpate for crepitus | palpate with finger on the thorax/chest |
| subcutaneous emphysema and signs | air trapped under skin audible popping, crackling, grating, crunching sensation |
| pneumothorax | air within cavity between chest wall/lungs leading to total collapse of lungs |
| how to assess chest expansion | place hands on anterolateral wall along costal margin pointing xiphoid process should be symmetric |
| what does abnormal chest expansion indicate | unequal expansion = severe atelectasis, pneumonia, chest trauma, pleural effusion, pneumothorax decreased expansion = COPD |
| pleural effusion | fluid build up in the pleura, tx with thoracentesis |
| what does tactile fremitus indicate | lung infection (ie pneumonia), atelectasis, lung tumor has to reach lung border/chest wall to carry vibration |
| what does decreased fremitus indicate | blocked bronchus or pleural effusion excess air in lungs increased thickness of chest wall |
| type of percussion sounds | dull, flat, resonance, hyperresonance, tympany |
| dullness sound | thud like heard over solid tissue (ie. liver, spleen, heart) |
| flatness | sounds flat heard over dense tissue (muscle/bone) also pleural effusion |
| resonant | long, loud, low pitch/hollow normal tissue or possible bronchitis |
| hyperresonant | very loud, lower pitched hyperinflated lung such as emphysema/pneumothorax |
| tympanic | loud, high pitched, moderate length, musical/drum like indicative of air collection such as gastric bubble, air in intestine, or lung pneumothorax |
| diaphragmatic excursion | movement of the thoracic diaphragm during breathing, normally 3-5 cm |
| labored/noisy breathing indicative of | severe asthma or chronic bronchitis |
| types of lung sounds | bronchial, bronchiovesicular, vesicular |
| tracheal sound | over the trachea harsh high pitched sound |
| bronchial sound | B/L above the clavicles loud + high pitched |
| bronchiovesicular | B/L next to sternum anteriorly and B/L between scapulae medium loudness + pitch |
| vesicular | where the lungs are soft + low pitch |
| adventitious sounds | added/superimposed sounds over normal breath sounds |
| how should patient breathe during auscultation | breathe through mouth with complete inspiration and expiration at each site |
| types of adventitious sounds | discontinuous: crackle (fine/coarse), wheeze, atelectatic crackles continuous: pleural friction rub, wheeze (sibilant/sonorous) |
| types of voice sounds | bronchophony egophony whispered pectoriloquy |
| how to perform bronchophony and abnormal sounds | repeat 99 normal = muffled/soft/indistinct abnormal = loud/easily understood |
| how to perform egophony and abnormal sounds | say E normal = soft/muffled but sounds like E abnormal = over areas of consolidation/compression sounds like A and is louder |
| how to perform whispered pectoriloquy and abnormal sounds | whisper 123 normal = faint/muffled sound abnormal = clear/distinct sound as if whispering into stethoscope |
| what does abnormal bronchophony mean | indicative of consolidation like possible pneumonia, atelectasis, tumor |
| fine crackles | high pitched/short popping during inspiration and not cleared with coughing late inspiration crackles: pneumonia or CHF early inspiration crackles: bronchitis, asthma, emphysema |
| coarse crackles | low pitch/bubbling, moist sound (like soft velcro) during early inspiration to early expiration possible pneumonia, pulmonary edema, pulmonary fibrosis |
| velcro rales | type of coarse crackle indicative of pulmonary fibrosis commonly seen in COPD |
| pleural friction rub | low pitch/dry grating sound, occurs in both inspiration/expiration pleuritis |
| sibilant wheezes | high pitched musical sounds primarily in expiration but also inspiration acute asthma or chronic emphysema |
| sonorous wheezes | low pitched snoring/moaning sound primarily in expiration CAN clear with coughing bronchitis, sleep apnea |
| stridor | harsh honking wheeze with severe broncholaryngospasm occurs in croup |
| kyphosis | rounding of thoracic spine often seen with osteoporosis in older women |
| scoliosis | lateral deviation of spine in cervical, thoracic or lumbar |
| pectus excavatum | funnel chest |
| pectus carinatum | pigeon breast |
| chest pain related to pleuritis is always felt by older adults | false, sometimes absent in older adults due to age related alteration in pain perception |
| older adult considerations | reduced cough effectiveness difficulties with deep breathing (need to offer rest) kyphosis is common reduced thoracic expansion (should still be symmetric) sternum/ribs may be more prominent |
Created by:
sleepingbear
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