THORAX AND LUNGS

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THORAX AND LUNGS
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A P

• ANTERIOR THORACIC LANDMARKS -DIAPHRAGM
• -SUPRASTERNAL NOTCH
• -STERNUM
• -MANUBRIOSTERNAL ANGLE
• ANGLE OF LOUIS
• -COSTAL ANGLE

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POSTERIOR THORACIC LANDMARKS

• VERTEBRA PROMINENS
• SPINOUS PROCESSES

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REFERENCE LINES

• MIDSTERNAL
• MIDCLAVICULAR
• VERTEBRAL

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THORACIC CAVITY

• LUNG LOBES- RIGHT- 3, LEFT- 2
• ANTERIOR VS POSTERIOR
• PLEURAE- forms an envelope between the lungs and
  the chest wall
• PLEURAL CAVITY has a vacuum or negative pressure
• TRACHEA/ BRONCHIAL TREE- gas transport
• PURPOSE- protects alveoli, bronchi goblet cells
  secrete mucus to catch particles
• ACINUS-functional respiratory unit

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RESPIRATION MECHANICS

• FOUR FUNCTIONS OF RESP. SYSTEM
• - SUPPLY O2 TO BODY FOR ENERGY
• - REMOVE CO2
• - MAINTAIN HOMEOSTASIS
• - MAINTAIN HEAT EXCHANGE
• MAINTAINS BALANCE by adjusting CO2 levels through
  respirations

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AGING ADULT

• LESS MOBILE THORAX
• RESP. MUSCLE STRENGTH DEC.
• DEC. IN ELASTICITY WITHIN LUNGS
• HARDER TO INFLATE LEADS TO DEC. VITAL CAPACITY
  AND INC. RESIDUAL VOLUME
• LESS SURFACE AREA- LUNG BASES ARE LESS VENTILATED
  ? DYSPNEA
• RISK FOR POST OP COMPLICATIONS

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CULTURAL CONSIDERATIONS

• TB
• THORACIC CAVITY SIZE

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SUBJECTIVE DATA

• COUGH- ? TIME OF DAY
• SOB- ORTHOPNEA, WITH ADLS?
• CHEST PAIN WITH BREATHING
• PAST HX OF RESP. INFECTIONS
• SMOKING HX
• ENVIRONMENTAL
• SELF- CARE BEHAVIORS

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OBJECTIVE DATA

• PREPARATION
• INSPECTION-
• - shape/ configuration of chest
• - A/P diameter
• - Neck muscles
• - Breathing positions
• - Skin color

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Obj. data cont.

• PALPATION- POSTERIOR CHEST
• - SYMMETRY- most imp.
• - TACTILE FREMITUS- SAY 99 OR
• BLUE MOON
• - Dec. with obstructions
• - Inc. with compression or consolidation
• - CREPITUS

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OBJ. DATA CONT.

• PERCUSSION- POSTERIOR CHEST
• - LUNG FIELDS- predominant note
• -RESONANCE
• - DIAPHRAGMATIC EXCURSION
• - EXHALE AND HOLD IT
• - SCAPULA LINE DOWN- sound
• changes from resonance to dull
• - EST. LEVEL OF DIAPHRAGM
• SEPARATING LUNGS FROM ABD
• WALL.

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OBJ. DATA CONT

• DIAPH. EXCURSION CONT
• TAKE DEEP BREATH AND HOLD IT
• PERCUSS DOWN FROM 1ST MARK AND MARK THE LEVEL
  WHERE SOUND CHANGES TO DULL WITH DEEP INSPIRATION
• SHOULD BE EQUAL
• HOLD YOUR BREATH AT SAME TIME AS PT.

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OBJ. DATA CONT

• AUSCULTATION
• BREATH SOUNDS
• ELIMINATE EXTRANEOUS NOISES- P. 454
• BRONCHIAL
• BRONCHOVESICULAR
• VESICULAR
• DEC. OR ABSENT WITH OBSTRUCTION, LOSS OF
  ELASTICITY IN LUNG FIBERS OR DEC. FORCE OF
  INSPIRED AIR (EMPHYSEMA)
• INC. WITH CONSOLIDATION OR COMPRESSION

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AUSCULTATION CONT.

• ADVENTITIOUS SOUNDS
• - CRACKLES (RALES)
• - WHEEZES (RHONCHI)
• VOICE SOUNDS
• BRONCHOPHONY
• EGOPHONY
• WHISPERED PECTORILOQUY

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INSPECTION- ANTERIOR CHEST

• SHAPE/ CONFIGURATION
• FACIAL EXPRESSION
• LOC
• SKIN COLOR/ CONDITION
• QUALITY OF RESP.
• RETRACTION/ ACCESSORY MUSCLE USE- ABNORMAL
• RESP. RATE

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• PALPATE ANTERIOR CHEST
• - SYMMETRY
• - TACTILE FREMITUS
• - CHECK FOR TENDERNESS
• PERCUSSION
• - SYMMETRY
• - NOTE BORDERS- P. 461
• AUSCULTATE
• FORCED EXPIRATORY TIME
• PULSE OXIMETER