Thorax & Lungs Flashcards
(111 cards)
A pneumothorax occurs when air leaks into the pleural space.
True or false?
True
A pt is experiencing hypoxia related to an ineffective airway.
Which assessment findings support the presence of hypoxia?
Cyanotic nail beds
Nasal flaring

A pt is reporting symptoms and demonstrating signs associated with dyspnea.
What is the nurse’s initial action?
Begin administering supplemental oxygen
a) Palpate/Anterior Chest
b) Percuss/Anterior
a) Symmetric chest expansion
Palpate the anterior chest wall
b) Predominant note over lung fields
Borders of cardiac dullness
a)________ is a functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli.
This bunched arrangement creates surface area for b)_______ that is as large as a tennis court.
a) Acinus
b) Gas exchange
a)________is potential space filled only with few milliliters of lubricating fluid
Pleural cavity
Abnormal findings for the lungs
Respiratory patterns,
Tactile Fremitus,
Lung sounds
Airway
Structure and Functions
- to act as a conductor of air
- to humidify and warm or cool the inspired air
- to prevent foreign materials from entering the tracheobronchial tree
Alveoli
Structure and function
Structure
Tiny air sacs at the end of the bronchioles
Covered in tiny blood vessels called capillaries
- *Function**
- Storage of air for a shorter period
- Permits absorption of oxygen into the blood
- Gas exchange(02 and CO2) When breath in and out
An elderly pt reports a feeling of dyspnea with normal activities of daily living.
What is an action by the nurse?
Observe the client’s respiratory rate and pattern
An old pt respiratory assessment.
The nurse should attribute what finding to age-related changes?
Slight kyphosis
Atelectasis
- The collapse of part or all of a lung
- Caused by a blockage of the air passages or by pressure on the lung
Auscultation
Listen to one full respiration in each location
Side-to-side comparison is most important
Note any abnormal/adventitious breath sounds.
Do not confuse background noise with lung sounds
Breathing
Anteroposterior diameter a) or b), which is accomplished by elevation or depression of ribs
a) increases
b) decreases
Breathing
Vertical diameter a) or b), which is accomplished by downward or upward movement of the diaphragm
a) lengthens
b) shortens
Common abnormal lung sounds 5
- *Wheeze**
- high-pitched whistle sound
- something is making airways narrow, blocking(COPD, asthma)
- Foreign body obstruction
- *Rhonchi**
- low-pitched,continuous sounds like snoring
- Fluid-blocked airways
- *Stridor**
- Loud,High pitched
- Obstructed upper airway
- Common in infants/larynx is soft and floppy
Crackles (rales)
Crackles-rales:small clicking, bubbling, or rattling sounds
Crackles - fine: usually high in pitch; soft
Crackles - coarse: low in pitch
- *Crepitus**
- Rubbing of parts one against the other
a) Tachypnea?
b) Bradypnea?
a) Respiratory rate that is greater than the normal for age
Asthma,pneumonia,COPD
More than 20 breaths
b) Respiratory rate that is lower than normal for age
lightheadedness,dizziness, tiredness
COPD changes the costal angle, how?
Angle increased
Cyanosis signals __________
hypoxia
Developmental Competence: Pregnancy
- Enlarging uterus elevates diaphragm 4 cm
- Respirations are deeper allowing for a 40% increase in tidal volume
- Diaphragm is elevated, it is not fixed
Developmental Competence:The Aging Adult
- Costal cartilages become calcified/which produces a less mobile thorax
- The lunge rigid that is harder to inflate.
- Histologic changes/less surface area is available for gas exchange
- Increase risk of postoperative pulmonary complications
- May tire easily
- Increase in anteroposterior (AP) diameter
Difference between dyspnea , orthopnea and Paroxysmal Nocturnal Dyspnea
- *Dyspnea**
- Shortness of breath
- Caused by asthma, heart failure, COPD
- *Orthopnea**
- Discomfort when breathing while lying down flat
- Heart isn’t strong enough to pump-out
- *Paroxysmal Nocturnal Dyspnea**
- Sensation of shortness of breath that awakens
- Often after 1 or 2 hours of sleep
- Usually relieved in the upright position
Difference between Pleural friction rub, Pericardial friction rub, and Pleural effusion
- *Pleural friction rubs**
- low-pitched, grating, or creaking sound
- More often heard on inspiration than expiration
- *pericardial friction rub**
- High-pitched scratching, grating, or squeaking leathery sound
- Heard best with the diaphragm
- *Pleural effusion**
- A buildup of fluid between the tissues that line the lungs and the chest
- A very muffled sound
Difference between hypoxemia and hypoxia
Hypoxemia
-low oxygen content in the blood
Hypoxia
-low oxygen supply in bodily tissues








