Chapter 18 Flashcards
(22 cards)
Anterior thorax surface landmarks
Posterior Surface landmarks
Describe the lobes of the lungs.
Lungs are paired but not precisely symmetric structures; right lung shorter than left because of underlying liver; left lung narrower than right because heart bulges to left; right lung has three lobes, and left lung has two lobes.
Describe the pleurae.
The pleurae is the thin and slippery; forms an envelope between lungs and chest wall. Visceral pleura lines outside of lungs, dipping down into fissures. It is continuous with parietal pleura lining inside of chest wall and diaphragm. Pleural cavity is potential space filled only with few milliliters of lubricating fluid. Exert a negative pressure that holds the lungs tightly together against the chest wall.
What are the characteristics of the trachea and bronchial tree?
The trachea and bronchi transport gases between the environment and lung parenchyma. Space that is filled with air but is not available for gaseous exchange known as dead space; this is about 150 ml in adult. Bronchial tree protects alveoli from small particulate matter in inhaled air
What are the four major functions of respiration?
- Supplying oxygen to the body
- Removing carbon dioxide
- Maintaining homeostasis (acid-base balance) of arterial blood
- Maintaining heat exchange
How is brathing controlled normally?
Normally breathing patterns change involuntarily and are mediated by respiratory center in brainstem, the medulla and the pons. The major feedback loop is humoral regulation or change in carbon dioxide and oxygen levels in blood. Normal stimulus to breathing is an increase of carbon dioxide in blood, or hypercapnia or to a lesser extent a decrease of oxygen in blood (hypoxemia).
Describe what muscles are involved in repiration.
Increasing the size of the thorax creates slightly negative pressure in relation to atmosphere; air rushes in. The major muscles responsible for this increase is the diaphragm. Intercostal muscles lift sternum and elevate ribs, making them more horizontal.
Expiration is primarily passive; positive pressure in alveoli cause air to flow out. Forced expiration, such as that after heavy exercise or pathological condition with respiratory distress, commands use of the accessory neck muscles. These neck muscles are the scalene, sternocleidomastoids, trapezium.
Describe the development of the lungs in an infant.
- During first 5 weeks of fetal life, primitive lung bud emerges
- By 16 weeks of gestation, conducting airways reach same number as in adult;
- At 32 weeks of gestation, surfactant is present in adequate amounts
- At birth lungs have 70 million primitive alveoli ready to start job of respiration
- Newborn inhales their first breath; A lusty cry than follows
Body systems all develop in utero, but the espiratory system does not function until birth.
- Umbilical cord is cut
- Blood is cut off from placenta, and flows into pulmonary circulation
What must you be aware of for pregnant women for their respiration system?
Enlarging uterus elevates diaphragm 4 cm during pregnancy; decreases vertical diameter of thoracic cage and increases in estrogen level relaxes chest cage ligaments. Total circumference of chest cage increases by 6 cm.
The diaphragm is elevated, but not fixed; it moves with breathing even more during pregnancy. The growing fetus increases oxygen demand on mother’s body, but this is met easily by increasing tidal volume. Little change occurs in respiratory rate; an increased awareness of need to breathe develops, even early in pregnancy.
What must you be aware of for the aging adult for their respiration system?
the aging adult lung bases become less ventilated as a result of closing off of a number of airways. Increased risk for dyspnea on exertion, atelectasis and infection due to decreased ability to cough. Histologic changes also increase the older person’s risk of postoperative pulmonary complications.
Costal cartilages become calcified, which produces a less mobile thorax; respiratory muscle strength declines after age 50 years and continues to decrease into 70s. Decreased elastic properties within lungs, making them less distensible and lessening their tendency to collapse and recoil.
What are the catergories of subjective data for the lungs and thorax?
- Cough
- Shortness of breath
- Chest pain with breathing
- History of respiratory infections
- Smoking history
- Environmental exposure
- Self-care behaviors
What are the factors affecting normal tactile fremitus?
- Relative location of bronchi to chest wall
- Thickness of chest wall
- Greater over thin wall than over an obese or heavily muscular one
- Pitch and intensity; loud, low-pitched voice generates more fremitus than soft, high-pitched one
What conditions can increase tactile fremitus?
Conditions that increase density of lung tissue make a better conducting medium for sound vibrations and increase tactile fremitus.
Percussion notes
Which areas should you listed to when auscultatwing the posterior chest wall?
While standing behind person, listen to following lung areas
- Posterior from apices at C7 to bases around T10
- Laterally from axilla down to seventh or eighth rib
What are the extraneous noised taht may be confused with lung pathology if not recognized?
Extraneous noises that may be confused with lung pathology if not recognized
- Examiner’s breathing on stethoscope tubing
- Stethoscope tubing bumping together
- Patient shivering
- Patient’s hairy chest;
- Rustling of paper gown or paper drapes
What are the three types of normal breath sounds and their locations?
Bronchial (tracheal)
Brochiovesicular
Vesicular
What are the characteristics of brochial breath sounds?
Pitch
- High
Amplitude
- Loud
Duration
- Inspiration < Expiration
Quality
- Harsh, hollow, tubular
Normal Location
- Trachea and Larynx
Describe the characteristics of brochovesicular breath sounds?
Pitch
- Moderate
Amplitude
- Moderate
Duration
- Inspiration = Expiration
Quality
- Mixed
Normal location
- Over major bronchi where fewer alveoli are located: posterior, between scapulae especially on the right; anterior, around upper sternum in 1st and 2nd intercostal spaces
How are vesicular breath souds characterized?
Pitch
- Low
Amplitude
- Soft
Duration
- Inspiration > Expiration
Quality
- Rustling, like the sound of the wind in the trees
Normal Location
- Over peripheral lung fields where air flows through smaller bronchioles and alveoli
What can increase breath sounds during auscultation?
Normal voice transmission is soft, muffled, and indistinct; Pathology that increases lung density enhances transmission of voice sounds.
