Chapter 18 Thorax and Lungs Chapter 18 Elsevier
- Slides: 35
Chapter 18: Thorax and Lungs Chapter 18 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 18: Thorax and Lungs Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Slide 18 -2
Chapter 18: Thorax and Lungs Anterior thoracic landmarks Suprasternal notch Sternum Manubriosternal angle Costal angle Slide 18 -3
Chapter 18: Thorax and Lungs Structure and Function Position and Surface Landmarks Posterior thoracic landmarks Vertebra prominens Spinous processes Inferior border of scapula Twelfth rib Slide 18 -4
Chapter 18: Thorax and Lungs Reference lines-Anterior Midsternal line Midclavicular line Scapular line Vertebral line Anterior, posterior, midaxillary lines Slide 18 -5
Chapter 18: Thorax and Lungs Reference Lines (Posterior) Vertebral Line Scapular Line Slide 18 -6
Chapter 18: Thorax and Lungs Reference Lines (Lateral) Anterior Axillary Midaxillary Posterior Axillary Slide 18 -7
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Chapter 18: Thorax and Lungs Structures of the Respiratory System Slide 18 -10
Chapter 18: Thorax and Lungs Mechanics of respiration Four functions of respiratory system Changing chest size during respiration Inspiration Expiration Control of respiration Slide 18 -11
Chapter 18: Thorax and Lungs Mechanics of Respiration (cont. ) © Pat Thomas, 2006. Slide 18 -12
Chapter 18: Thorax and Lungs Infants & Children Infants and children During first 5 weeks of fetal life, primitive lung bud emerges By 16 weeks of gestation, conducting airways reach same number as in adult; at 32 weeks, surfactant, complex lipid substance needed for sustained inflation of air sacs, is present in adequate amounts At birth lungs have 70 million primitive alveoli ready to start job of respiration Breath is life; when newborn inhales first breath, the lusty cry that follows reassures straining parents that their infant is all right Slide 18 -13
Chapter 18: Thorax and Lungs Pregnant Women Pregnant woman Enlarging uterus elevates diaphragm 4 cm during pregnancy This decreases vertical diameter of thoracic cage, but this decrease is compensated for by an increase in horizontal diameter Increase in estrogen level relaxes chest cage ligaments This allows an increase in transverse diameter of chest cage by 2 cm, and costal angle widens Total circumference of chest cage increases by 6 cm Slide 18 -14
Chapter 18: Thorax and Lungs Elderly Aging adult Costal cartilages become calcified, which produces a less mobile thorax Respiratory muscle strength declines after age 50 years and continues to decrease into 70 s More significant change is decrease in elastic properties within lungs, making them less distensible and lessening their tendency to collapse and recoil Aging lung is more rigid structure that is harder to inflate Slide 18 -15
Chapter 18: Thorax and Lungs Asthma occurs in about 5% to 12% of the U. S. population and is the most common chronic disease in childhood Groups at increased risk include African Americans who reside in inner cities and premature or low birth weight infants Asthma prevalence is highest among African American and native American adults; lowest among Asian and Hispanic adults Slide 18 -16
Chapter 18: Thorax and Lungs Cultural Differences Biocultural differences in size of thoracic cavity significantly influence pulmonary functioning as determined by vital capacity and forced expiratory volume In descending order, the largest chest volumes are found in whites, African Americans, Asians, and American Indians Even when shorter height of Asians is considered, their chest volume remains significantly lower than that of whites and African Americans Slide 18 -17
Subjective Data— Health History Questions Chapter 18: Thorax and Lungs Cough Shortness of breath Chest pain with breathing History of respiratory infections Smoking history Environmental exposure Self-care behaviors Slide 18 -18
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam Preparation Position- sitting up, leaning forward. Draping Timing during a complete examination Cleaning stethoscope endpiece Equipment needed Stethoscope Small ruler marked in centimeters Marking pen Alcohol swab Slide 18 -19
Chapter 18: Thorax and Lungs Objective Assessment Anterior and Posterior chest Inspection Palpation Percussion Auscultation Slide 18 -20
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam INSPECT Anterior and Posterior Chest Position of person, Facial expression, Level of consciousness Skin color and condition Quality of respirations Thoracic cage Shape and configuration of chest wall, rib interspaces Anteroposterior/transverse diameter Use of Accessory muscles Slide 18 -21
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam PALPATE Anterior and Posterior Chest Palpate the entire chest wall (crepitus, masses) Symmetric expansion Tactile (or vocal) fremitus Pt says “ 99” while examiner palpates chest Slide 18 -22
Chapter 18: Thorax and Lungs PERCUSSAnterior, Posterio r and Lateral Chest Predominant note= RESONANCE Diagphragmatic Excursion 3 -6 cm R side higher than L Slide 18 -23
Chapter 18: Thorax and Lungs Objective Data—The Physical Exam Auscultate- Anterior, Posterior and lateral Chest Breath sounds- Technique Listen with diaphragm of stethoscope. Listen systematically, top to bottom, compare side to side Listen to complete inhalation/exhalation at all sites Slide 18 -24
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Chapter 18: Thorax and Lungs Breath Sounds Bronchial (Tracheal) breath sounds location/characteristics Bronchovesicular breath sounds location/characteristics Vesicular breath sounds location/characteristics You. Tube- Breath Sounds Slide 18 -26
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Chapter 18: Thorax and Lungs Bronchial/Tracheal Broncho-vesicular Vesicular Slide 18 -28
Chapter 18: Thorax and Lungs Adventitious Breath Sounds Cracklesdiscontinous, early or late inspiration Fine Crackles Fine or coarse Crackles Wheeze- continuous, musical, inspiration or expiration, high/low pitched Atelectatic crackles. Early inspiration, High-pitched Low-pitched Slide 18 -29
Chapter 18: Thorax and Lungs Voice Sounds Used to help determine if lung consolidation is present. Perform if abnormal lung sounds detected Bronchophony- “ 99” Egophony- “eeee” Whispered pectoriloquy “ 1, 2, 3” Slide 18 -30
Chapter 18: Thorax and Lungs Abnormal Findings Configurations of the Thorax Barrel chest Pectus excavatum Pectus carinatum Scoliosis Kyphosis Slide 18 -31
Chapter 18: Thorax and Lungs Abnormal Findings Respiration Patterns Sigh Tachypnea Bradypnea Hyperventilation Hypoventilation Cheyne-Stokes respiration Biot’s respiration Chronic obstructive breathing Slide 18 -32
Chapter 18: Thorax and Lungs Abnormal Findings Abnormal Tactile Fremitus Increased tactile fremitus Decreased tactile fremitus Rhonchial fremitus Pleural friction fremitus Slide 18 -33
Chapter 18: Thorax and Lungs Abnormal Findings Adventitious Lung Sounds Discontinuous sounds Crackles—fine Crackles—course Atelectatic crackles Pleural friction rub Continuous sounds Wheeze—sibilant Wheeze—sonorous rhonchi Stridor Slide 18 -34
Chapter 18: Thorax and Lungs Abnormal Findings Common Respiratory Conditions Atelectasis Lobar pneumonia Bronchitis Emphysema Asthma (reactive airway disease) Pleural effusion thickening Congestive heart failure Pneumothorax Pneumocystis carinii pneumonia Tuberculosis Pulmonary embolism Acute respiratory distress syndrome (ARDS) Slide 18 -35