Term
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Definition
mediastinum-middle section-esophagus, trachea, heart, and great vessels
posterior- c7 to t12
inferior border of the scapula- t7-8 |
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Term
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Definition
Left and right pleural cavities on either side of the mediastinum contain the lungs.
Left lung has 2 lobes, right has 3 separated by fissures, oblique on both and horizontal on right
Borders:
-anterior-
apex- 3-4cm above inner third of clavicles
base-rests on diaphragm at about the 6th rib midclavicular
Laterally-apex of axilla to 7-8th rib
posteriorly-c7 apex, t10 base, base lowers to t12 |
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Term
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Definition
Pleurae-form an envelope around the lungs
trachea- begins at cicoid cartilage and lies anterior to the exophagus.
bronchial bifurcation: t4-5
inspiration: flattens diaphragm
expiration: relaxes diaphragm
accessory muscles:
sternomastoid
scaleni
trapezii
intercostal |
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Term
Physiology
four functions of the respiratory system |
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Definition
-supplying oxygen to the body for energy production
-removing carbon dioxide as a waste product of energy reactions
-maintaining homeostasis (acid-base balance) of arterial blood
-maintaining hear exchange |
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Term
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Definition
involuntary- brain stem-medulla and pons
humeral regulation
-hypoxemia: decreased o2 level
-hypercapnia: increase co2 level |
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Term
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Definition
dyspnea
-tachypnea: >24 breaths per min, fever, fear, exercise, pneumonia, lesions in the pons, alkalosis
-bradypnea: <10/min, drug induced respiratory depression in medulla, increased intracranial pressure, diabetic coma
-hyperventilation: increase in rate and depth (blows of co2)diabetic ketoacidosis (kussamauls respiration), hepatic coma, overdose of salicylate, lesion in midbrain
-hypoventilation: irregular and shallow, overdoes of narcotics, anesthetics, prolonged bed rest, splinting
-cheyne-stokes respiration: 30 sec of breathing and 20 sec of apnea, severe heart failure, renal failure, meningitis, drug overdose, increased cranial pressure, normal in infants and aging persons during sleep
-biots respiration: like cheyne-stokes but irregular (cycle can last from 10 sec-1 min), head trauma, brain abscess, heat stroke, spinal meningitis, encephalitis
-chronic obstructive breathing: prolonged expiration, COPD |
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Term
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Definition
cough:productive, dry, blood, odor, severity
-description(hacking, congested, dry, barking, what makes it better/worse
shortness of breath: with chest pain(stabbing, burning, constant), time of day, better/worse, accompanying side effects
orthopnea: difficulty breathing when supine (pillows)
paroxysmal nocturnal dyspnea
history of pulmonary disease
history of respiratory infections
smoking history
environmental factors
self care behaviors |
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Term
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Definition
respiratory infections-continuous throughout the day-acute illness
irritants- afternoon/evening
postnasal drip- night
chronic bronchial inflammation of smokers- early morning
chronic bronchitis- productive cough for 3 months of the year for 2 years in a row |
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Term
objective data
inspection |
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Definition
anterior chest
-inspect:
skin color and condition: cyanosis, pallor of lips and nails
symmetry
facial expression: relaxed, unconscious breathing effort
level of consciousness: alert and cooperative
quality of respirations
position
rib interspaces: retractions, bulges
accessory muscles (scalene, sternomastoid, trapezius)
shape and configuration of chest wall
posterior
-inspect:
skin
symmetry
anteroposterior:transverse diameter 1:2 |
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Term
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Definition
anterior
-symmetric chest expansion
-lumps and tenderness
-tactile fremitus
posterior
-symmetric expansion
-spinous processes
-tactile fremitus
-tenderness, moisture, temperature, masses, lesions and crepitus |
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Term
symmetric chest expansion |
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Definition
place hands on chest:
posterior t9-10
anterior costal margins
slide hands medially to pinch up small fold of skin
unequal occurs with marked atelectasis or pneumonia, thoracic trauma or with pneumothorax |
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Term
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Definition
a palpable vibration- using palmar base or ulnar edge of one hand touch persons chest while they repeat the words "99
decreased fremitus-anything obstructs transmission of vibrations. obstructed bronchus, pleural effusion or thickening, pneumothorax or emphysema
increased fremitus- compression or consolidation of lung tissue. lobar pneumonia.
rhonchal fremitus- palpable with thick bronchial secretions
pleural friction fremitus- palpable with inflammation of the pleura |
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Term
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Definition
resonance- the low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult
hyperresonance-lower-pitched, booming sound found when too much air is present, as in emphysema or pneumothorax
dull-soft, muffled thud, signals abnormal lung density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor
percussion sets into motion the outer 5-7 cm of tissue and abnormality needs to be 2-3 cm wide
Anterior
-predominant note over lung fields
-borders of cardiac dullness
posterior
-predominant note over lung fields; shoulders, interspaces, 5cm intervals
-diaphragmatic excursion- |
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Term
Auscultation
normal breath sounds |
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Definition
bronchial (tracheal)-high, loud, inspration < expiration, harsh, hollow tubular...trachea and larynx
bronchovesicular- moderate, inspiration = expiration, mixed quality, over major bronchi
vesicular- low, soft, inspiration > expiration, rustling, over peripheral lung fields where air flows through smaller bronchioles |
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Term
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Definition
compare bilaterally
-anterior 4
-lateral 5
-posterior 6
decreased or absent breath sounds-obstruction
increased breath sounds |
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Term
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Definition
-crackles fine(rales)-high pitched short crackling, popping, deflated airways, inspiratory, pneumonia, heart failure, fibrosis, chronic bronchitis, asthma, emphysea
-crackles course- loud, low-pitch, bubbling gurgling-like opening velcro, pneumonia, pulmonary edema, fibrosis, depressed cough reflex
-pleural friction rub- a very superficial sound, coarse and low pitched, as if two pieces of leather rubbed together, both inspiratory and expiratory, when pleurae become inflamed and lose their normal lubricating fluid, pleuritis |
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Term
continuous sounds
connected musical sounds
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Definition
-wheeze- sibilant: high pitched, musical squeaking, polyphonic (narrowed passageways), predominant in expiration, acute asthma, chronic emphysema
-wheeze- sonorous rhonchi: low pitched, musical snoring, predominant in expiration, may clear with coughing, bronchitis, single bronchus obstruction-tumor
-stridor- high-pitched, crowing sound, monophonic, (upper airway swelling obstruction, foreign body), inspiratory, originates in larynx and trachea (louder in neck than chest, croup, acute epiglottitis |
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Term
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Definition
bronchophony: "99" normal: muffled, density: clear
egophony: normal "eeee" consolidation "aaaa"
whispered pectoriloquy: "one-two-three" normal-faint or muffled, consolidation- clear |
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Term
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Definition
free air in pleural space
-spontanious, trauma, or tension
inspection
-deviated trachea
-unequal chest expansion
-cyanosis
palpatation
-tactile fremitus-decreased or absent
percussion
-hyperressonant
auscultation
-absent breath sounds |
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Term
measurement of pulmonary function status
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Definition
-forced expiratory time-number of seconds it takes for the person to exhale from total lung capacity to residual volume, 6 sec or more occurs with obstructive lung disease
-pulse oximeter- 97-98% normal |
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Term
summary checklist:
thorax and lung exam |
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Definition
-inspection
thoracic cage
respirations
skin color and condition
person's position
facial expression
level of consciousness
-palpation
confirm symmetric expansion
tactile fremitus
detect any lumps, masses, tenderness
-percussion
percuss over lung fields
estimate diaphragmatic excursion
-auscultation
assess normal breath sounds
note any abnormal breath sounds
if so, perform bronchophony, whispered pectoriloquy, egophony
note any adventitious sounds |
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Term
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Definition
| markedly sunken sternum and adjacent cartilages |
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Term
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Definition
| a forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions |
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