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CH. 18 Thorax and Lungs
Terms in this set (60)
Anterior thoracic landmarks
Suprasternal notch, Sternum, Mandubriosternal angle (also called Sternal angle and Angle of Louis), Costal angle
Posterior thoracic landmarks
Vertebra prominens (C7), Spinous processes, Inferior border of scapula, Twelfth rib
Thoracic cage is defined by...
the sternum, ribs, vertebrae, and diaphragm.
U-shaped depression just above the sternum, in between the clavicles
there right and left costal margins form an angle where they meet at the xiphoid process
Angle of Louis
useful place to start counting ribs, which helps localize a respirator finding
Anterior Reference lines
Anterior axillary line, Midclavicular line, Midsternal line
Lateral Reference lines
anterior axillary line, posterior axillary line, midaxillary line
Equal anteroposterior to transverse diameter and the ribs are horizontal instead of the norma downward slope. causes osteoarthritis
sunken sternum and adjacent cartilages. Depression begins at 2nd intercostal space and becoming more depressed at the junction of the xiphoid and body of the sternum. Born with, called a funnel chest, with heart and lung functions
forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions. Sometimes linked to other genetic disorders ie heart
lateral s-sape curvature of the thoracic and lumbar spine
exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. Age related due to arhtioarthritis
middle section of the thoracic cavity containing the esophagus, trachea, hear, and great vessels
shorter because of the underlying liver and has 3 lobes
narrower because of the heart and has 2-lobes
Mechanism of respiration
(1) the vertical diameter lengthens or shortens, which is accomplished by downward or upward movement of the diaphragm; and (2) the anteroposterior (A-P) diameter increases or decreases, which is accomplished by elevation or depression of the ribs.
diaphragm descends as it contracts, external intercostal elevate ribs, increase ventricle diameter, scalenus muscles elevate ribs up, sternomastoid
diaphragm rises, internal intercostals depress ribs, decrease ventricle diameter, external obliques and abdominal rectus depress lower ribs and compress viscera
normal stimulus caused by an increase of carbon dioxide in the blood caused by hyperventilation
A decrease of oxygen in the blood
Normal breath sounds
bronchial, bronchovesicular, vesicular
high pitch, loud amplitude, inspiration < expiration, located trachea and larynx
moderate pitch, moderate amplitude, inspiration = expiration, located around upper sternum in 1st and 2nd intercostal space
low pitch, soft amplitude, inspiration > expiration, located over peripheral lung
Crackles, wheeze, atelectatic crackles
Fine (rales): high pitched, short crackling, popping sounds during inspiration.
Coarse (coarse rales(: loud, low pitched, bubbling and gurgling sound that dart in early inspiration and may be present in expiration.
Sounds like fine crackles but do not last and are not pathologic; disappear after the first few breaths
sibilant: High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord);
predominate in expiration but may occur in both expiration and inspiration
Sonorous rhonchi:Low-pitched; monophonic single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration.
A very superficial sound that is coarse and low pitched; it has a grating quality as if two pieces of leather are being rubbed together
Use the flat diaphragm end-piece of the stethoscope.
Hold firmly on the person's chest wall.
Listen for at least one full respiration in each location.
Side-to-side comparison is the most important
High-pitched, monophonic, inspiratory, crowing sound, louder in neck than over chest wall
Collapsed shrunken section of alveoli or and entire lung as a (1)result of airway obstruction (2) compression on the lung (3) lack of surfactant
Infection in lungs parenchyma leaves alveolar membrane edematous and porous, (RBCs) and (WBCs) pass from blood to alveoli. Alveoli progressively fill up with bacteria, solid cellular debris, fluid, and blood cells, which replace alveolar air. This decreases surface area of the respiratory membrane, causing hypoxemia.
Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion.
Caused by destruction of pulmonary connective tissue (elastin, collagen); characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls
An allergic hypersensitivity to certain inhaled allergens (pollen), irritants (tobacco, ozone), microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus into airways.
Pleural effusion or Thickening
Collection of excess fluid in the intrapleural space, with compression of overlying lung tissue.
Pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries.
Free air in pleural space causes partial or complete lung collapse. Air in pleural space neutralizes the usual negative pressure present; thus lung collapses.
(1) spontaneous (air enters pleural space through rupture in lung wall, (2) traumatic (air enters through opening or injury in chest wall), or (3) tension (trapped air in pleural space increases, compressing lung and shifting mediastinum to the unaffected side.
Pneumocystis carinii pneumonia
This virulent form of pneumonia is a protozoal infection associated with AIDS.
Cysts containing the organism and macrophages form in alveolar spaces, alveolar walls thicken, and the disease spreads to bilateral interstitial infiltrates of foamy, protein-rich fluid.
Inhalation of tubercle bacilli into the alveolar wall starts
Undissolved materials originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels.
Acute respiratory distress syndrome (ARDS)
An acute pulmonary insult damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema.
The manubriosternal angle is
the articulation of the manubrium and the body of the sternum
Select the correct description of the left lung
narrower than the right lung with two lobes
Some conditions have a cough with characteristic timing. The cough associated with chronic bronchitis is best described as
productive cough for at least 3 months of the year for 2 years in a row
Symmetric chest expansion is best confirmed by
placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch up a small fold of skin between the thumbs.
Absence of diaphragmatic excursion occurs with
pleural effusion or atelectasis of the lower lobes
Auscultation of breath sounds is an important component of respiratory assessment. Select the most accurate description of this part of the examination
Hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons
Select the best description of bronchovesicular breath sounds
moderate pitched, inspiration equal to expiration
After examining a patient, you make the following notation: Increased respiratory rate, chest expansion decreased on left side, dull to percussion over left lower lobe, breath sounds louder with fine crackles over left lower lobe. These findings are consistent with a diagnosis of
Upon examining a patient's nails, you note that the angle of the nail base is >160 degrees and that the nail base feels spongy to palpation. These findings are consistent with
chronic congenital heart disease and COPD
Upon examination of a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient complains of pain with breathing. These findings are consistent with
pleural friction rub.
In order to use the technique of egophony, ask the patient to
say "eeeeee" each time the stethoscope is moved
When examining for tactile fremitus, it is important to:
palpate the chest symmetrically
The pulse oximeter measures
arterial oxygen saturation
A pleural friction rub is best detected by
A barrel-shaped chest is characterized by
equal anteroposterior-to-transverse diameter and ribs being horizontal
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