THORAX & LUNGS

• upper airway structures

  • Nasopharynx

  • Oropharynx

  • Larynx

  - warms, filter and humidify

  - helps to make sound

  - sends air to lower airways
• Trachea 


  divides into the right and left mainstem bronchi and continues to divide into smaller passages
• Bronchioles 


  terminate into the alveolar ducts and alveoli
• Alveoli 


  is the gas exchanging units in the lungs
• THORAX

  • How many?

  2 clavicles

  2 scapula

  1 Sternum (breast bone)

  12 pair of ribs – allow chest to contract and expand during each breath

  12 thoracic vertebrae
• Dead Space 


  portion of respiratory system which is external to the bronchioles and througn which air must pass to reach the bronchioles and alveoli.
• DIAPHRAGM - the primary muscle of respiration

  ACCESSORY MUSCLES (ANTERIOR AND POSTERIOR) - the secondary muscles

  PLEURA - maintains negative lung pressure that is needed for breathing
• Mechanical Process

  1. inspiration / inhalation- during inhalation the diaphragm presses the abdominal organs downward and forward
  2. expiration / exhalation- during exhalation the diaphragm rises and recoils to the resting position
• PHYSIOLOGICAL PROCESS

  1. external respiration

  ▪ the exchange of gases (oxygen and carbon dioxide) between the alveoli and the blood through the alveolar-capillary membrane

  2. internal

  ▪ the exchange of gases between the systemic capillaries and the tissue at the cellular level

  3. cellular

  ▪ exchange of gases within the cell
• RESPIRATIONS in newborn and children

  ▪ obligatory nose breathers

  ▪ primarily abdominal, breath

  ▪ sounds are louder, harsher, and more bronchial
• - Right lung has three lobes

  - Left has two these lobes are divided by fissures
• • In Front - when approached anteriorly, the apices of the lungs extend about 2 cm (3⁄4 to 1

  inch) above the inner aspect of the clavicles

  - they then continue downward to the sixth intercostal space at the midclavicular line

  (MCL)

  • At the side - laterally, the lower border of the lung is at the eighth rib at the midaxillary line

  • At the back - posteriorly, the apices of the lungs start at T1 and extend to T10 and T12 on deep inspiration
• Deviations from normal

  ▪ Pale diaphoretic

  - sympathetic response to respiratory distress and hypoxia

  ▪ Central cyanosis

  - dusky or blue buccal mucosa and tongue

  ▪ Peripheral cyanosis

  - Blue dusky-red, purple color; lips, nail beds, tips of nose and ears; sometimes face and cheeks

  ▪ Ruddy, reddish color

  - associated with polycythemia
• ▪ Clubbing - long-standing lung disease

  ▪ Peripheral edema - frequently seen in people with chronic lung disease secondary to right-side CHF

  ▪ Cyanotic or dusky nails - reflect peripheral cyanosis seen in vasoconstriction and slowing of peripheral blood flow

  ▪ Yellow-brown stains on nails and fingers - nicotine stains from long history of smoking

  ▪ Purple / dusky lower extremities - venous stasis, especially if PO2 is low
• • PEEP (“physiological positive end expiratory pressure”)

  - a compensatory mechanism

  • used by people with COPD

  - to prolong expiration

  - help expel trapped air

  - keep alveoli open longer for maximum oxygenation of pulmonary blood
• NASAL FLARING occurs in infant and small children and indicates acute respiratory distress or cyanotic heart disease
• Normal / Eupnea


  - normal breathing pattern

  - 16–20 breaths/min and regular

  
• Tachypnea


  - may be a normal response to fever, anxiety, or exercise

  - can occur with respiratory insufficiency, alkalosis, pneumonia, or pleurisy

  - more than 24 breaths / min and shallow

  
• Bradypnea


  - may be normal in well – conditioned athletes

  - can occur with medication – induced depression of the respiratory center, diabetic coma, neurologic damage

  - less than 10 breaths / min and regular

  
•  Hyperventilation


  - usually occurs with extreme exercise, fear, or anxiety

  - causes of hyperventilation include

  - disorders of the central

  - nervous system

  - overdose of the drug salicylate

  - or severe anxiety

  - increased rate

  - increased depth

  
•  Kussmaul


  - a type of hyperventilation associated with diabetic ketoacidosis

  - rapid, deep, labored

  
•  Hypoventilation


  - Usually associated with overdose of narcotics or anesthetics

  - Decreased rate, decreased depth, irregular pattern

  
• Cheyne-Stokes Respiration


  - May result from severe congestive heart failure, drug overdose,

  - increased Intracranial pressure,

  - or renal failure

  - May be noted in elderly persons during sleep, not related to any disease process

  - Regular pattern characterized by alternating periods of deep, rapid breathing

  followed by periods of apnea

  
•  Biot’s Respiration

  - May be seen with meningitis or severe brain damage

  - Irregular pattern characterized by varying depth and rate of respirations followed by periods of apnea

  
• Ataxic


  - A more extreme expression of Biot’s respirations indicating respiratory compromise

  - Significant disorganization with irregular and varying depths of respiration

  
• Air Trapping


  - In chronic obstructive pulmonary disease, air is trapped in the lungs during forced expiration

  - Increasing difficulty in getting breath out

  
• - Barrel Chest

  ▪ Most often associated with emphysema, asthma

   

  - Pectus Excavatum

  ▪ Congenital chest wall deformity – ribs and sternum grows abnormally producing cave-in (concave) shape

   

  - Pectus Carinatum

  ▪ Deformed human chest – projecting breastbone

  ▪ Defect in the connective tissue
• BRONCHIAL (B)

  • exhales – just above the clavicles on each side of the sternum
• BRONCHOVESICULAR (BV)

  • inhales and exhales – continous – next to the sternum between the scapula
• VESICULAR (V)

  • prolonged during inhalation shortened during exhalation –remainder of the lungs
• TRACHEAL

  • inhales or exhales above supraclavicular notch
• BRONCHOPHONY

  • ask the client to repeat the phrase “99” or Blue Moon while auscultating the chest wall
• EGOPHONY

  • ask the client to repeat the letter “E” while you listen over the chest

  wall
• WHISPERED PECTORILOQUY

  • ask the client to whisper the word “one-two-three” while you auscultate the chest wall
• Common Signs and Symptoms : COUGH

  1. ATELECTASIS

  2. LUNG CANCER

  3. PLEURAL EFFUSION                        
• Common Signs and Symptoms :

  1. DYSPNEA
  2. ARDS
  3. EMPHYSEMA
  4. PULMONARY EMBOLISM
• Common Signs and Symptoms :

  1. HEMOPTYSIS
  2. PNEUMONIA
  3. PULMONARY EDEMA
  4. PTB
• Common Signs and Symptoms :

  1. WHEEZING
  2. ASPIRATION OF FOREIGN BODY
  3. ASTHMA
  4. CHRONIC BRONCHITIS
• The term thorax identifies the portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly.
• The lungs, distal portion of the trachea, and the bronchi are located in the thorax and constitute the lower respiratory system.