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61 Cards in this Set
- Front
- Back
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The phrenic nerve innervates what? |
diaphragm C3,C4,C5 |
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Perforating structures at T8 |
Inferior vena cava |
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Perforating structures at T10 |
esophagus and vagus |
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Perforating structures at T12 |
Aorta Thoracic Duct Azygous vein |
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Right lung |
3 lobes (upper, middle, lower) 3 main bronchi tricuspid valve major oblique and horizontal fissures
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Left lung |
2 lobes (upper, lower) and a lingula major/oblique fissure |
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What do lobes of lung contain? |
blood vessels lympahtics nerves alveolar ducts connecting alveoli alveoli |
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What is the relationship to the bronchus at each lung hilus? |
RALS Right is anterior Left is superior |
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Right main bronchus and aspiration |
while upright- lower portion of right inferior lobe
while supine- superior portion of right inferior lobe |
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Why is the right bronchus at an increased risk for aspiration? |
it is more wide, short, and more vertical than the left |
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Tracheobronchial tree |
-trachea lies anterior to the esophagus and posterior to the isthmus -divide right and left main bronchi at T4 and just below the manubriosternal junction - main bronchi are divided into three branches and two on the left |
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What is the function of the tracheobronchial tree? |
filters humidifies warms |
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Main muscle in inspiration |
diaphragm |
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Expiration is |
passive |
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Excercise/ Respiratory distress |
InSpiration- scalene sternocleidomastoid Trapezius Expiration-internal intercostal muscles |
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Nipples |
T4 |
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Red/crust |
pneumonia cancer TB |
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White clear yellow green |
bacterial infection |
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red currant jelly sputum |
klebsiella |
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pink, forthy |
pulmonary edema |
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Pack years |
packs per day * number of years smoked |
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What would the pack years for a pt who has smoked a pack and half for 17 years? |
25.5 1.5*17 |
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Inspection |
-increased respiratoty rate/labored breathing -retractions: chest appears to sink in just below the neck w/ eat breath -cyanosis -accessory muscle use -nasal flaring -lip pursing -tripoding -shape -symmetry -deformities -edema -erythema -lesions -chest wall movement -superficial venous pattterns -pectus carinatum -pectus excavatum -AP vs transverse diameter -Prominence of ribs |
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Pectus Carinatum |
sternum protrudes outward |
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Pectus excavatum |
lower sternum indents -respiratory compromise |
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Barrel chest |
thoracic ratio close to 1 COPD |
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Tracheal deviation |
toward side of decreased breath sounds Pneumothorax |
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Crepitus |
crackly or crinckly sensation palpated and heard air or infection (indicates subcutaneous tissue)
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TActile femitus |
palpable vibration of the chest |
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Viscerosomatic levels |
T2-T7 Vagus |
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OA/AA |
parasympathetics |
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Normal breath sounds |
vesicular- low pitched. low intensity sounds heard over lung tissue Bronchovesicular- heard over the major bronchi and are typically moderate in pitch and intensity Bronchial-high in pitch and intensity ordinaryily heard only over ttreachea
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Crackles (rales) |
coarse cracking sound, high pitched inspiration
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Rhonchi |
coarse low pitched, may clear with cough improve if they cough Asthma, copd |
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Wheezes (aka silibant wheeze) |
whistling high pitched sounds louder on expiration but can be heard on inspiration too |
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Mediastinal Crunch (hamman sign) |
mediastinal emphysema synchronous with heartbeat |
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Inspiratory |
most likely upper airway |
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Expiratory |
central airway |
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Hyperresonance on percussion |
hyperinflation -emphysema pneumothorax
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dullness on percussion |
diminished air exchange or fluid |
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Parainfluenza virus |
croup-(seal like bark cough and steeple sign) May cause stridor |
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Diptheria |
pseudomembraneous pharyngitis |
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Acute epiglotitis |
thumb sign -H influenza not as common since Hib V vaccine |
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Respiratory grunting |
baby tires to expel trapped air or fetal lung fluid to maintain oxygen levels |
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Infants special considerations |
Paradoxic breathing: chest wall collapses as abdomen distends on inspiration Nasal breathers and respiratory rate is more rapid and less consistent Respiratiry grunting |
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Pregnant women special considerations |
*enlarged uterus causing diphragm to rise and lower ribs to flare * minute ventilation increases due to tidal volume * resp rate remains unchanged *dyspnea common |
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Elderly special considerations |
unexpected weight changes * barrel chest- loss of muscle strength in thorax and diaphragm and loss of lung resiliency * hyperthoracic kyphosis and hypolumbar lordosis *alveoli less elastic * decreased vital capacitance/increased residual volume *mucous membranes drier |
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Friction rub |
dry cracking grating, low pitched sound and is heard both on expiration and inspiration Machine like quality |
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Neumonic for perforating structures |
I (IVC) ate (8) ten (10) eggs (espohagous) at (aorta) twelve (12) |
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Virshows node |
lymph node commonly associated with abdominal and breast cancer -where the thoracic duct drains |
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Normal ventilation rate is |
12-20 |
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Tachypnea is |
greater than 20 |
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Bradypnea |
less that 12 |
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hyperventilation |
deep fast breaths <20 per min |
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sighing |
frequently interspersed deeper breath |
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Air trapping |
increased difficulty getting breath out |
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Cheyene stokes |
varying periods of increasing depth with interspersed apnea |
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Kussmaul |
rapid, deep, labored
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Biot |
irregular interspersed periods of apnea in a disorganized sequence of breaths |
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ataxic |
significant disorganization with irregular and varying depths of respiration |
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What do kussmaul breaths indicate |
metabolic acidosis |
