thorax and peripheral

• The scapulae are symmetric and non- protruding. Shoulders and scapulae are equal horizontal positions. The ratio on anteroposterior diameter is 1:2.
• Kyphosis


  an increased curve of the thoracic spine is common in older clients, results from a loss of skeletal muscles. It may be a normal finding
• SCOLIOSIS


  Spinal process that deviates laterally in the thoracic area
• BARREL CHEST


  Ribs appearing horizontal at an angle greater than 45 degrees

  with the spinal column are frequently the result of an increased ratio

  between the anteroposterior transverse diameter. This condition is commonly the result of emphysema due to hyperinflation of the lungs.
• ACCESSORY MUSCLES

  • Trapezius

  • Scalene

  • Sternomastoid

  • Pectoralis major and minor (not shown)

  • Abdominal muscles (not shown)
• Tender or painful areas at posterior thorax may indicate inflamed fibrous connective tissue.
• Crepitus, also called subcutaneous emphysema, is a crackling sensation (like bones or hairs rubbing against each other) that occurs when air passes through fluid or exudate.
• Wheezes are high-pitched whistle like sounds heard during expiration caused by narrowed bronchial tubes.
• Bronchovesicular breath sounds

  are heard over major bronchi. Moderate pitch and loudness. The upper sternum area is where major bronchi are located.
• Vesicular breath sounds


  are heard over the peripheral lung fields. It is low pitched soft sound.
• Bronchial (tracheal) breath sounds


  are heard over the trachea and larynx. It is high pitched loud and harsh.
• Adventitious lung sounds:

  Crackles – Discrete and discontinuous sounds

  Wheezes- musical and continuous are evident.
• PECTUS EXCAVATUM


  is a markedly sunken sternum and adjacent cartilages- often referred as funnel chest.
• PECTUS CARINATUM


  is a forward protrusion of the sternum causing the adjacent ribs to slope backward.
• HYPERRESONANCE - in cases of trapped air such as emphysema, pneumothorax.
• Epitrochlear nodes are located approximately 3 cm above the

  elbow on the inner (medial) aspect of the arm.
• ALLEN’S TEST 


  is a test used to assess the blood supply of the hand through the radial and ulnar arteries. The test is performed before procedures that require intravascular access to the radial artery or that may affect the blood flow to the hand.
• What are the possible causes of nail clubbing?

  • symptom of disease, like heart or lung disease which cause chronically low blood levels of oxygen.
  • Digestive conditions: Crohn’s disease (inflammation of digestive tract), Celiac disease (problem in the small intestine)
  • Liver disease: Liver cirrhosis
  • Cancers
  • Thyroid conditions: Hyperthyroidism and Grave’s disease
• PULSE AMPLITUDE CLASSIFICATION

  0 = ABSENT

  1+ = DIMINISHED

  2+ = NORMAL

  3+ = FULL

  4+ = BOUNDING
• pallor - when elevated

  Rubor - when dependent (arterial insufficiency)

  Cyanosis - when dependent (venous insufficiency)

  Rusty or brownish pigmentation - (venous insufficiency)
• Thrombophlebitis


  is a swollen or inflamed vein due to a blood clot (surface of the skin).
• Thrombosis


  blood clot within blood vessels that limits the flow of blood
• Phlebitis


  inflammation of a vein near the surface of the skin
• Pain behind the knee = positive homan sign
• Deep vein thrombosis or DVT


  the vein is deep within a muscle. May cause serious health problems when dislodged
• Unequal chest expansion can occur with severe atelectasis (collapse / incomplete expansion), pneumonia, chest trauma or pneumothorax (air in the pleural space).
• Decreased chest excursion at the base of the lungs is characteristic of COPD. This is due to decreased diaphragmatic function.
• possible causes for limited descent can be pain, or abdominal changes such as extreme ascites, tumors or pregnancy.