HE LEC - THORAX AND LUNGS

    Cards (56)

    • Respiratory system
      • The structures (airways, lungs, bony thorax, respiratory muscles, central nervous system) work together to deliver oxygen to the bloodstream and remove excess carbon dioxide from the body
    • Subdivision of Airway
      • Upper airways
      • Lower Airways
    • Larynx
      Houses the vocal cords, transition point between upper and lower airways, epiglottis protects from aspiration
    • Thorax
      Portion of the body extending from the base of the neck superiorly to the diaphragm inferiorly
    • Lungs
      • Distal portion of the trachea and bronchi, located in the thorax and constitute the lower respiratory system
    • Thoracic cage

      The outer structure of the thorax, contains the respiratory components
    • Parts of the thoracic cage
      • Sternum
      • 12 pairs of ribs
      • 12 thoracic vertebrae
      • Muscles
      • Cartilage
    • Sternum
      Breastbone, divided into manubrium, body, and xiphoid process, connects to clavicles and first two pairs of ribs
    • Clavicles
      Extend from the manubrium to the acromion of the scapula
    • Ribs
      • 12 pairs, numbered superiorly to inferiorly, each pair has a corresponding intercostal space
    • Vertical reference lines on the anterior chest
      • Midsternal line
      • Right and left midclavicular lines
    • Vertical reference lines on the posterior thorax
      • Vertebral (or spinal) line
      • Right and left scapular lines
    • Vertical reference lines on the lateral aspect
      • Midaxillary line
      • Anterior axillary line
      • Posterior axillary line
    • Mediastinum
      Central area in the thoracic cavity that contains the trachea, esophagus, heart, and great vessels
    • Lungs
      • Cone-shaped, elastic structures, right lung has 3 lobes, left lung has 2 lobes, space between lungs is the mediastinum
    • In healthy adults, during deep inspiration the lungs extend down to about the 8th intercostal space anteriorly and 12th intercostal space posteriorly. During expiration, the lungs rise to the 5th or 6th intercostal space anteriorly and 10th posteriorly
    • Pleural membranes
      Thin, double-layered serous membrane lining the thoracic cavity and covering the external surfaces of the lungs, with the pleural space in between
    • Trachea
      • Flexible structure anterior to the esophagus, begins at the cricoid cartilage, composed of C-shaped rings of hyaline cartilage
    • Airflow through the respiratory system
      Air travels through trachea into main bronchi, repeatedly bifurcates into smaller bronchioles, terminates at alveolar ducts and sacs containing alveoli for gas exchange
    • Respiratory muscles
      • Diaphragm and external intercostal muscles are primary, accessory inspiratory muscles include trapezius, sternocleidomastoid, and scalenes
    • Mechanics of breathing
      External respiration (ventilation) is the mechanical act of breathing, accomplished by expansion of the chest vertically and horizontally, inspiration is the inflow of air, expiration is mostly passive
    • Health assessment
      Observe general appearance, then use inspection, palpation, percussion, and auscultation to examine the chest
    • Respiratory rate
      Adults 12-20 breaths per minute, infants 40 breaths per minute, respiratory pattern should be even, coordinated, and regular with occasional sighs
    • Accessory muscle use
      Frequent use may indicate a respiratory problem, particularly when patient purses lips and flares nostrils
    • Inspecting related structures
      Skin, tongue, mouth, fingers, and nail beds, cyanosis and finger clubbing may be observed
    • Palpating the chest
      Should feel smooth, warm, and dry, pain can indicate costochondritis, fractures, or muscle soreness, crepitus indicates air leakage, tactile fremitus is palpable vibrations from air transmission
    • Breathing
      • Purses lips
      • Flares nostrils
    • Inspecting related structures
      1. Inspect skin, tongue, mouth, fingers, nail beds
      2. Check for cyanosis
      3. Check for finger clubbing
    • Palpating the chest
      • Should feel smooth, warm, and dry
      • Pain can be caused by costochondritis, rib or vertebral fractures, or sore muscles from coughing
      • Crepitus indicates air leaking from airways or lungs
      • Tactile fremitus are palpable vibrations from air transmission through bronchopulmonary system
    • Evaluating chest-wall symmetry and expansion
      1. Place hands on chest wall, watch thumbs separate during deep inhale
      2. Repeat at different intercostal spaces
      3. Asymmetric expansion may indicate pleural effusion, atelectasis, pneumonia, or pneumothorax
    • Percussion sounds
      • Flat
      • Dull
      • Resonant
      • Hyperresonant
      • Tympanic
    • Diaphragmatic excursion

      Movement of thoracic diaphragm during breathing, normally 3-5 cm
    • Auscultating the chest
      1. Listen to breath sounds as air moves through bronchi
      2. Have patient breathe through mouth
      3. Mat down chest hair with damp cloth
    • Vocal fremitus
      • Voice sounds from chest vibrations as patient speaks
      • Abnormal transmission may indicate consolidation
    • Paradoxical (uneven) chest wall movement is abnormal, can occur with chest wall injury
    • Abnormal respiratory patterns
      • Kussmaul
      • Cheyne-Stokes
      • Biot
      • Apneustic
      • Ataxic
    • Grading dyspnea

      • 0 - No dyspnea
      • 1 - Dyspnea on strenuous exertion
      • 2 - Dyspnea on moderate exertion
      • 3 - Dyspnea on mild exertion
      • 4 - Dyspnea at rest
    • Abnormal breath sounds
      • Crackles
      • Wheezes
      • Rhonchi
      • Stridor
    • Disorders
      • Asbestosis
      • Asthma
      • Atelectasis
      • Bronchiectasis
      • COPD
      • Pleural effusion
      • Pneumonia
      • Airway obstruction
    • Trachea
      A flexible tube that extends downward from the larynx, located anterior to the esophagus, and composed of C-shaped rings of hyaline cartilage. Begins at the cricoid cartilage.