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NURS 307 > Chapter 18: Thorax and Lungs > Flashcards

Chapter 18: Thorax and Lungs Flashcards

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1
Q

The thoracic cage consists of

A
  1. sternum
  2. 12 ribs
  3. 12 Thoracic Vertebra
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2
Q

What ribs attach to the sternum?

A

first 7 ribs

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3
Q

What ribs attach to the costal cartilage?

A

ribs 8, 9, and 10

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4
Q

What ribs are considered floating ribs?

A

ribs 11 and 12

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5
Q

What are the anterior thoracic landmarks?

A
  1. suprasternal notch
  2. sternum
  3. costal angle
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6
Q

suprasternal notch

A

hollow, u shaped depression just above the sternum

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7
Q

What does the sternum consist of?

A
  1. manubrium
  2. body of the sternum
  3. xiphoid process
  4. manubriosternal angle
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8
Q

manubriosternal angle is aka

A

Angle of Louis

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9
Q

Manubriosternal Angle

A
  • good landmark to count ribs (2nd rib).

- corresponds with the upper border of the atria of the heart and above the 4 thoracic vertebra on the back.

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10
Q

Where is the site of tracheal bifurcation into R and L main bronchi?

A

manubriosternal angle

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11
Q

Costal Angle

A

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

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12
Q

What are the posterior thoracic landmarks?

A
  1. vertebra prominens
  2. spinous processes
  3. scapula
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13
Q

The inferior border of the scapula is located …

A

usually at the 7th or 8th rib

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14
Q

What is the most prominent bony spur at the base of the neck called?

A

vertebra prominens

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15
Q

What are the reference lines?

A
  1. midsternal
  2. midclavicular
  3. axillary line
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16
Q

The axillary line consists of

A

posterior mid and anterior axillary lines

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17
Q

Thoracic Cavity consists of

A
  1. Mediastinum
  2. Pleural Cavities
  3. Lung Borders
  4. Lung Lobes
  5. Pleurae
  6. Trachea
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18
Q

Mediastinum

A

middle section containing the esophagus, trachea, heart and great vessels

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19
Q

Pleural Cavities

A

contain the lungs

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20
Q

Lung Borders

A
  1. apex: highest point

2. base: lower border

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21
Q

Lung lobes

A

anterior posterior and lateral.

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22
Q

Pleurae

A
  • thin, slippery envelope between the lungs and chest wall.

- 2 types

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23
Q

2 Types of Pleurae

A

visceral and parietal pleura

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24
Q

visceral pleura

A

lines the outside of the lungs

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25
parietal pleura
lines the inside of the chest wall
26
Trachea
in front of the esophagus from the cricoid cartilage to sternal angle in R and L bronchi
27
Function of the trachea
transports gases between the environment and lung parenchyma
28
What are the four functions of the respiratory system?
1. Supply O2 to the body for energy production 2. Remove CO2 as a waste product of energy 3. Maintain Homeostasis (acid balance of arterial blood) 4. Maintain Heat Exchange
29
How does respiration maintain the pH or the acid/base balance of the blood?
by supplying O2 to the blood and eliminating excess CO2
30
What cultural variations should a nurse be aware of in regards to the respiratory system?
1. TB 2. Asthma 3. Size of thoracic cavity and vital lung capacity
31
Why should a nurse be aware of the cultural variations for TB?
foreign born and racial/ethnic minorities have a higher incidence of TB
32
Why should a nurse be aware of the cultural variations for asthma?
- the incidence of asthma increases every year in the US among all ethnic groups. - However, asthma is more prevalent in African Americans.
33
Why should a nurse be aware of the cultural variations for size of thoracic cavity and vital lung capacity?
- Vary by culture. | - Caucasians and African Americans have a larger chest volume than Native Americans and Asians.
34
What information should a nurse gather during a health history in regards to the respiratory system?
1. cough 2. shortness of breath, wheezing 3. chest pain with breathing 4. past hx of respiratory infections: bronchitis, pneumonia, emphysema, asthma 5. family hx of allergies, asthma or TB 6. smoking hx 7. environmental exposure 8. self care behavior
35
In a health history regarding the respiratory system, what additional information should be obtained when asking about a cough?
1. productive vs nonproductive 2. quality of cough - dry, hacking, bark, loose, wet, congested 3. production of phlegm or sputum: color, quantity 4. cough up blood? streaks or frank blood? odor? 5. does activity make it better or worse? 6. does it seem to come with anything (activity, position, fever, congestion, talking, anxiety)? 7. treatment? 8. does it bring on anything: chest pain, ear pain? tiring? concerned?
36
In a health history regarding the respiratory system, what additional information should be obtained when asking about self care behavior?
- last TB skin test - chest x ray - flu shot - pneumonia vaccine
37
What are the steps for the physical exam/assessment in regards to the thorax and lungs?
1. inspect posterior chest 2. skin color and condition 3. palpate symmetric chest expansion 4. tactile fremitus 5. palpate chest wall for tenderness, skin temperature and/or masses 6. percussion 7. diaphragmatic excursion 8. auscultate lungs 9. inspect anterior chest 10. palpate anterior chest for symmetric chest expansion 11. percuss anterior chest 12. auscultate anterior chest 13. include oxygen saturation with VS and note any oxygen therapy
38
What must you look for when inspecting posterior chest?
note symmetry
39
What must you look for when inspecting skin color and condition?
- normal or abnormal - color change ex) jaundice, cyanosis, pallor - note any lesions
40
What must you look for when palpating symmetric chest expansion?
...
41
tactile fremitus
palpable vibration ("99")
42
What must you look for when palpating the chest wall?
check for tenderness, skin temperature and/or masses
43
What must you look for when doing percussion?
note resonance or dullness over the lung fields
44
diaphragmatic excursion
not routinely done and not required
45
What must you look for when auscultating lungs in all fields?
- note whether clear or adventitious sounds, decreased or absent sounds. - not necessary to determine - bronchial, bronchiovesicular or vesicular
46
Adventitious Sounds
abnormal sounds
47
List the adventitious sounds.
1. crackles (rales) 2. wheezing 3. rhonchi 4. bronchophony 5. egophony 6. whispered pectoriloquy
48
crackles (rales)
short crackling, popping sounds
49
wheezing
high pitched squeak
50
rhonchi
low pitched, harsh sounds, snoring (sometimes clear with cough)
51
bronchophony
- pt repeats "99" while you auscultate | - should hear sound with stethoscope but can't distinguish what is actually said.
52
egophony
- pt repeats "ee-ee-ee-ee" while nurse auscultates | - should hear "ee-ee-ee-ee" through stethoscope
53
whispered pectoriloquy
- pt whispers a phrase like "1-2-3" | - should be faint, muffled and almost inaudible.
54
What must you look for when inspecting the anterior chest?
-note shape and configuration: elliptical, downward sloping ribs, AP/transverse diameter (depth
55
What must you look for when palpating the anterior chest?
- assess for symmetric chest expansion | - palpate for tenderness, masses and skin temperature
56
How does the nurse palpate the anterior chest?
- Nurse has pt do a deep inhalation while nurse uses thumbs to assess symmetric movement - tactile fremitis ("99", avoid female breast tissue)
57
What must you look for when percussing anterior chest?
resonance, dull, flat, tympany
58
List the common respiratory abnormalities
1. barrel chest 2. pectus carinatum 3. tachypnea 4. bradypnea 5. cheyne-strokes respirations 6. pleural effusion 7. pneumothorax 8. tuberculosis 9. bronchitis 10. pneumonia 11. asthma 12. atelectasis
59
The right lung has how many lobes?
3
60
The left lobe has how many lobes?
2
61
the anterior chest contains
mostly upper and middle lobes with very little lower lobe
62
the posterior chest contains
almost all lower lobe
63
anteroposterior diameter should be __________ than transverse diameter
less
64
decreased fremitus
occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema.
65
increased fremitus
occurs with compression or consolidation of lung tissue.
66
Characteristics of Normal Breath Sounds: Bronchial (tracheal)
Pitch: High Amplitude: Loud Duration: Inspiration < Expiration Quality: Harsh, hollow, tubular.
67
Normal Location for Bronchial (tracheal) Breath Sounds
trachea and larynx
68
Characteristics of Normal Breath Sounds: Bronchovesicular
Pitch: Moderate Amplitude: Moderate Duration: Inspiration = Expiration Quality: Mixed
69
Normal Location for Bronchovesicular Breath Sounds
over major bronchi where fewer alveoli are located: | posterior, between scapulae especially on right, anterior, around upper sternum in 1st and 2nd intercostal spaces.
70
Characteristics of Normal Breath Sounds: Vesicular
Pitch: Low Amplitude: Soft Duration: Inspiration > Expiration Quality: Rustling, like the sound of the wind in the trees
71
Normal Locations for Vesicular Breath Sounds
over peripheral lung fields where air flows through smaller bronchioles and alveoli

NURS 307 (29 decks)

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