CH.19 Thorax and Lungs

Question 1

Functions of Respiratory System

Answer 1

• Supplies oxygen to the body for energy production
• Removes CO2 as waste product of energy reactions
• Maintains homeostasis (acid-base balance) in blood
• Maintains heat exchange

Question 2

Suprasternal notch

Answer 2

U shaped depression just above sternum between clavicles

Question 3

Sternum

Answer 3

“breastbone”

Manubrium, Body, Xiphoid process

Question 4

Manubriosternal Angle

Answer 4

“Angle of Louis” - marks site of tracheal bifurcation into right and left main bronchi

At articulation of manubrium and sternum, continuous with second rib

Corresponds with upper border of atria of the heart and lies above fourth thoracic vertebrae on the back

Question 5

Costal Angle

Answer 5

the right and left costal margins form an angle where they meet at xiphoid process

Question 6

Anterior Chest

Answer 6

oblique fissure crosses the 5th rib in midaxillary line and terminates at 6th rib in midclavicular line

Question 7

Posterior Chest

Answer 7

composed of almost all lower lobes

Question 8

Lateral Chest

Answer 8

lung tissue extends from apex of axilla down to 7th or 8th rib

Question 9

Left Lung

Answer 9

• no middle lobe
• anterior chest = mostly upper lobe and little lower lobe
• posterior chest = all lower lobe and some upper

Question 10

Right Lung

Answer 10

• has middle lobe
• anterior chest = mostly upper and middle lobe, very little lower lobe
• posterior chest = mostly all lower lobe and some upper lobe

Question 11

Bronchial Tree

Answer 11

protects alveoli from small particulate matter with mucus and cilia that sweep upwards for swallowing or expulsion through coughing

Question 12

Oxygen Saturation

Answer 12

measure of the amount of oxygen-carrying hemoglobin in the blood relative to the amount of hemoglobin not carrying oxygen

pulse oximeter is noninvasive method to assess SpO2

should be >95%

every result must be evaluated in context of person’s Hb level, acid-base level, and ventilatory status

Question 13

6 Minute Walk Test

Answer 13

safer, simple, inexpensive clinical measure of functional status in aging adults

Question 14

Inspection

Answer 14

thoracic cage, respirations, skin color, and condition

person’s facial expression and LOC

Question 15

Palpation

Answer 15

confirm symmetric expansion and tactile fremitus

detect any lumps, masses, or tenderness

Question 16

Percussion

Answer 16

lung fields, assess for resonance

Question 17

Auscultation posterior, lateral, and anterior chest

Answer 17

assess breath sounds (presence and quality), normal and note any abnormal breath sounds (crackles or rales, wheezes or ronchi)

Question 18

Inspection of Anterior Chest

Answer 18

note shape and configuration of chest wall

note patients facial expression

assess LOC

note skin color and condition

assess quality, volume, effort, symmetry of respirations and determine if accessory muscles are being used

Question 19

Palpation of Anterior Chest

Answer 19

palpate for symmetric chest expansion

Assess tactile fremitus - compare vibrations of one side from the other “99” - decreased fremitus with pneumothorax, emphysema, pleural effusion; increased fremitus with severe pneumonia or any conditions that increase density of the lung tissue

Palpate anterior chest wall for tenderness, lumps, skin mobility, turgor, temperature, moisture

Question 20

Barrel Chest

Answer 20

equal AP to transverse diameter
normal with aging and chronic emphysema and asthma due to hyperinflation of lungs

Question 21

Scoliosis

Answer 21

A lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation

If severe (>45 degrees) deviation is present, scoliosis may reduce lung volume, and person is at risk for impaired cardiopulmonary function.

Question 22

Pectus Carinatum

Answer 22

A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast)

Question 23

Pectus Excavatum

Answer 23

A markedly sunken sternum and adjacent cartilages (also called funnel breast). Depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticeable on inspiration.

Question 24

Kyphosis

Answer 24

An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. Severe deformities impair cardiopulmonary function. If the neck muscles are strong, compensation occurs by hyperextension of head to maintain level of vision.Kyphosis is associated with aging, especially the “dowager’s hump” of postmenopausal osteoporotic women. However, it is common well before menopause. Women with adequate exercise habits are less likely to have kyphosis.

Question 25

Emphysema

Answer 25

inner walls of lungs' alveoli are damages, causing them to rupture. this creates one larger air space instead of many smaller ones = reduce surface area available for gas exchange continuous with delayed capillary refill, clubbing, cyanosis near fingertips

Question 26

Percussion of Anterior Chest

Answer 26

- perform bilateral comparison - dont percuss directly over female breast tissue because it will sound dull; shift breast over with edge of stationary hand - in right hemithorax, upper border of liver sounds dull (5th ICS right midclavicular line) NORMAL - on left hemithorax, tympany is evident over gastric space NORMAL

Question 27

Percussion Chest - Resonance

Answer 27

normal lung sound is in all lung fields

Question 28

Hyper- resonance

Answer 28

over stomach lower pitched booming sound when too much air is present; as in with emphysema or pneumothorax

Question 29

Dullness

Answer 29

signals abnormal density as in pneumonia or atelectasis

Question 30

3 Types of Normal Breath Sounds

Answer 30

Bronchial Bronchovesicular Vesicular

Question 31

Bronchial breath sound

Answer 31

heard over trachea and larynx high pitched, loud, harsh, hollow, tubular inspiration < expiration

Question 32

Bronchovesicular breath sound

Answer 32

heard over the major bronchi where alveoli are absent moderate pitch and amplitude mixed quality sounds inspiration = expiration | heard in upper sternum and between scalpulae

Question 33

Vesicular breath sounds

Answer 33

heard over peripheral lung fields, bronchioles, and alveoli low pitched, soft, rustling quality like wind in the trees inspiration > expiration

Question 34

Crackles aka Rales: Fine

Answer 34

popping, early inspiration with obstructive disease i.e. asthma, chronic bronchitis, emphysema, NOT cleared by coughing | caused by movement of fluid through small airways or alveoli

Question 35

Crackles aka Rales: Coarse

Answer 35

like opening Velcro, early inspiration and early expiration, DECREASED by coughing. low pitched bubbling or gurgling sounds i.e. pulmonary edema, pneumonia, terminally ill with depressed cough reflex | caused by movement of fluid through small airways or alveoli

Question 36

Wheezes: high pitched sibilant

Answer 36

squeaking, musical predominantly on expiration but also with inspiration secondary from diffuse airway obstructions with acute asthma or chronic emphysema | bronchospasm

Question 37

Wheezes aka ronchi: low pitched

Answer 37

snoring sounds heard throughout cycle, may clear somewhat with coughing caused by air moving over secretions in larger airway i.e. airflow obstruction, bronchitis, bronchus obstruction | COPD; bronchospasm

Question 38

Stridor

Answer 38

crowing sound, originates in larynx or trachea i.e. upper airway obstructions or swelling, foreign body inhalation elevating head of bed can help with swelling

Question 39

Adventitious Sounds

Answer 39

Abnormal breath sounds You must auscultate from supraclavicular areas down to 6th rib from side to side to compare bilateral

Question 40

Inspect Posterior Chest

Answer 40

- note shape and configuration of chest wall - note position person takes to breath - assess skin color and condition - note any lesions and inquire about changes

Question 41

Palpation of Posterior Chest

Answer 41

symmetric expansion tactile fremitus

Question 42

Resonance

Answer 42

low pitched, clear, hollow sound that predominates in healthy adult lung tissue

Question 43

Auscultation of Voice Sounds

Answer 43

- normal voice transmission is soft, muffled, and indistinct - pathology that increases density of lung tissue enhances transmission of voice sounds

Question 44

Ask about Screening and Follow-up testing

Answer 44

When was the last time you had the following? TB skin test Chest X-ray Pneumonia or Influenza immunization

Question 45

Subjective Data

Answer 45

Cough Shortness of Breath SOB Chest Pain when Breathing History of Respiratory Infections Smoking Environmental Exposure Fatigue with ADLs

Question 46

Tachypnea

Answer 46

abnormal, rapid, shallow breathing increased respiratory rate > 24 bpm i.e. fever, exercise, pneumonia, respiratory insufficiency

Question 47

Bradypnea

Answer 47

abnormal, slow breathing decreased respiratory rate < 10 bpm i.e. drug induced depression or increased intracranial pressure, diabetic coma

Question 48

Hyperventilation

Answer 48

increased rate and depth, causes decreased CO2 levels in blood (alkalosis) i.e. extreme exertion, fear, anxiety

Question 49

Chronic Obstructive Breathing

Answer 49

normal inspiration and prolonged expiration to overcome increase airway resistance i.e. chronic obstructive lung disease

Question 50

Cheyne-Stokes Respiration

Answer 50

cycle respirations gradual wax and wane in a pattern with increasing rate and depth and then decreasing, periods of apnea i.e. severe heart failure, drug overdose, increased intracranial pressure may be normal in older adults while sleeping

Question 51

Pleural Friction Rub

Answer 51

coarse and low pitched; grating quality like two pieces of leather are rubbing together; caused when pleurae are inflamed and lose their normal lubricating fluid i.e. pleuritis

Question 52

Methods of Assessment for Thorax and Lungs

Answer 52

Inspection Palpation Percussion Auscultation