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37 Cards in this Set
- Front
- Back
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What is the name of the cavity that holds the lungs?
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Thoracic cavity
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How many lobes does the right lung have? left lung?
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Right- 3
Left- 2 |
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What 3 parts compose the lungs?
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Trachea
Bronchioles Alveoli |
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What are the anterior anatomical landmarks you should know for the lungs?
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Anteriorly:
Apex of lung 3/4-1 and 1/2' (2-4cm) above clavicle Anteriorly: Base to 6th rib midclavicular, 8th rib midaxillary |
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What are the posterior anatomical landmarks you should know for the lungs?
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Posterior:
Apex- first thoracic vertebrae Posterior: Base T-10 expiration and t-12 inspiration |
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What are the 6 topics to discuss when collecting subjective data?
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Cough
Sputum Shortness of Breath (SOB) Smoking Past history of respiratory disorders Environmental factors |
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What environmental factors would effect the thorax and lungs?
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pollution
smoke being near a waste disposal plant use of a wood burning stove for heat rural vs urban |
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What are some important past history respiratory disorders to make note of?
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asthma & copd
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Instead of admonishing someone for smoking, what should you do as the RN?
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Assess smoking behaviors and ways to support quitting. Studies show that patients should be told to quit smoking with each office visit.
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What should you look for when inspecting the thorax and lungs?
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Look for how the chest rises and falls
Look for barrel chest Barrel chest is abnormal but it is a sign of emphysema Note both posterior and anterior views Observe for lesions, chest symmetry, ventilatory pattern, depth, rate and rhythm, muscles used and skin color Anteroposterior diameter should always be less than transverse (ideally 1/2 the size) Posture should be relaxed with arms at sides or in lap Skin should be free of cyanosis, lesions, & pallor |
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When palpating chest wall, what should you be paying attention for?
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tenderness
alingment any bulging or retractions masses crepitus |
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What is crepitus?
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Coarse, crackling sensation palpable over skin surface in subcutaneous emphysema. May follow thoracic injury or surgery.
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What is tactile fremitus?
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palpable vibrations in the neck felt when you say "ahhh"
palpate the pts back to right and left of spine as the pt says "99" and examiner palpates with palm of hand, compare bilaterally |
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What causes decreased fremitus?
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Anything obstructing the transmission of vibrations
ie obstructed bronchus, pneumothorax, emphysema It is decreased when space is filled with air or fluid |
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Palpating chest to show expansior/excursion
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Posterior-
Place hands along outer edge of costal margin with thumbs toward middle of spine Have pt take a deep breath Should observe your hands moving equally far apart Unequal expansion could be due to marked atelectasis, pneumonia, trauma to thorax, or pneumothorax |
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Percussion of the Thorax
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Apices to bases
Posterior-have pt fold arms across chest Hear resonance and dullness alternately with lung or ribs Dullness on ribs, resonance on lungs Percussion will not penetrate deeper than 5-7 cm |
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What does it signify if you hear hyperresonance over the lungs?
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Too much air is present (emphysema, pneumothorax)
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What does it signify if you hear dullness over the lungs?
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Abnormal density existing- pneumonia, atelectasis, tumor
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What is diaphragmatic excursion?
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The distance between deep inspiration and full expiration
Exhale and hold, percuss and mark location of diaphragm: change dull-resonance Deep inspiration and hold it, percuss & mark change again Normally renges from 3-6 cm These exams have predominately been replaced with pulmonary function tests, cxray, and ct scans |
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Auscultation of lungs
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Begin at apices to base, compare bilaterally
Listen for full cycle, note quality and intensity Instruct patient to breath through mouth, a little deeper (but not faster) than usual Use stethoscope diaphragm firmly vs chest wall |
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What are the three normal breath sounds to listen for?
What is the duration of inspiration and expiration for each sound? What is the pitch for each sound? Where should each sound be heard? |
Bronchial-- heard over trachea and larynx, high pitch, loud, harsh
inspiration < expiration Bronchovesicular--heard over major bronchi, moderate pitch and loudness inspiration = expiration Vesicular-- heard over lung fields, low pitch, soft sounds inspiration > expiration |
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What are abnormal lung sounds called?
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Adventitious
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What are crackles?
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(rales) rub hair between fingers adventitious lung sound in which crackling/popping sound
secondary to fluid in airway or to opening of collapsed alveoli in atelectasis |
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What are wheezes?
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adventitious lung sound in which continuous musical and high pitched, due to constricted bronchi
ex: asthma, allergens,etc |
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What are rhonchi?
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adventitious lung sound in which lower pitched, coarse, snoring, due to thick secretions
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Can you grow out of asthma? why?
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Yes because the rib cage, trachea, & bronchioles expand
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What does it mean if the chest is silent?
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no air is moving in or out
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What is the normal respiratory rate for an adult?
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12-20 breaths per minute
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What adventitious lung sound do you hear if pt has pneumonia?
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rhonchi
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What is aspiration?
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When food goes down the wrong pipe and ends up in the lungs instead of esophagus
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What causes the barrel chest found in patients with emphysema?
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Decreased elasticity
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Assess Lungs
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Note: decreased or absent breath sounds
Bronchial tree obstructed at some point by secretions, mucus plug or foreign body Emphysema Anything that obstructs sound transmission: pleurisy, pleural thickening, air (pneumothorax), fluid (pleural effusion), in pleural space |
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Increased Breath Sounds
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Sounds are louder than they should be
ex: bronchial sounds heard over peripheral lung fields They occur when consolidation (pneumonia or compression) creates a denser lung area that enhances sound transmission |
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What is an area of consolidation?
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When there are clear and distinct noises heard over lung tissue when it normally should be muffled
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What is bronchophony?
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say "99", if heard loud and distinct, it is abnormal
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What is whispered pectoriloquy?
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whisper "1,2,3" should be muffled. Abnormal = loud & distinct, means there is consolidation
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What is Egophony?
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say "E", the E changes to an "A" sound over area of consolidation, pleural effusion or abscess
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