thorax

• nasal flaring


  labored respirations (especially in small children) is indictive of hypoxia
• pursed lip breathing


  not normal, usually an exercise or technique
• pursed lip breathing


  may be seen in asthma, emphysema, or CHF as a physiologic response to help slow down expiration and keep alveoli open longer
• Ruddy to purple complexion may be seen in clients with?

  COPD or CHF as a result of polycythemia
• Polycythemia

  excess of red blood cells
• cyanosis


  may be seen if client is cold or hypoxic
• cyanosis

  in white skin, this appear BLUE-TINGED, especially in the perioral, nailbed, and conjunctival area
• cyanosis


  in dark skin, this appears blue, dull, and lifeless in same areas
• anemia


  in dark skin, this may be yellowish
• capillary refill


  the return (refill) of blood into the capillaries of the skin; normal capillary refill time is two seconds or less
• pale or cyanotic nails


  this occur from hypoxia, no perfusion of nail beds within 3 secs
• early clubbing


  180-degree angle, usual in smokers
• late clubbing


  Greater than 180 degree angle can occur from hypoxia
• clubbing of nail


  if there is no diamond shape formed by pointing two fingernails in front of each other
• scoliosis

  lateral deviation of the spine in the thoracic area
• respiratory implications

  spinal configurations may have ____
• kyphosis


  excessive outward curvature of the spine, causing hunching of the back, common in older clients
• Lordosis


  sway or lean backwards, usual in pregnancy
• A barrel chest should make you think of what diagnosis?

  emphysema, due to hyperinflation of the lungs
• barrel chest


  a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.
• barrel chest


  ribs appearing horizontal at an angle greater than 45 degrees, result of an increased ratio between the antero-posterior transverse diameter
• trapesiuz, diaphragm, intercostal, or shoulder muscles


  muscles that are used to facilitate inspiration in cases of acute and chronic airway obstruction
• tripod position


  when the client lean forward and uses arms to support weight and lift chest to increase breathing capacity
• tripod position


  this is seen in COPD, where clients have comfortable breathing in this position
• tender or painful areas

  inflamed fibrous connective tissue
• pain over the intercostal spaces

  inflamed pleurae
• pain over the ribs(costal chondral junctions)

  symptom of fractured ribs
• flail chest


  paradoxical, not equal expansion of lungs due to fracture in ribs
• muscle soreness


  from exercise or excessive work of breathing (as in COPD) may be palpated as tenderness
• increased warmth in some area

  it may be related to local infection or inflammation
• crepitus


  this can be palpated if air escapes from the lungs or other airways into the subcutaneous tissue as occurs after an open thoracic injury, around a chest tube or tracheostomy
• crepitus

  it may also be palpated in areas of extreme congestion or consolidation
• mark margins and monitor

  in such situations of crepitus, it is important to _____ and _____ to note any decrease or increase in the crepitant area
• crepitus

  a.k.a subcutaneous emphysema
• crepitus


  a crackling sensation (like bones or hairs rubbing against each other) that occurs when air passes through fluid or exudate
• trachial deviation


  a shifting of the trachea to either side of the midline of the neck caused by the buildup of pressure inside the chest (tension pneumothorax)
• unequal fremitus


  it is usually the result of consolidation(increases fremitus) or bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax(which all decreases fremitus)
• consolidation


  this increases fremitus
• bronchial obstruction, air trapping in emphysema, pleural effusion, or pneumothorax

  these all decreases fremitus
• fremitus


  a palpable vibration from the spoken voice felt over the chest wall, it must be equal