Chapter 18: Thorax and Lungs – Flashcards

-Cough -Shortness of breath -Chest pain with breathing -History or respiratory infections -Smoking history -Environmental exposure -Self-care behaviours

- Thin, slippery pleura form an envelope between the lungs and chest wall - Outside layer visceral; inside layer parietal - Function: form cushion for lungs - Pleural cavity has negative pressure or vacuum which holds the lungs tightly against chest wall - Helps lungs slide smoothly

Trachea & Bronchi

Normally, our breathing pattern changes without our awareness in response to cellular demands. This involuntary control is mediated by the respiratory centre in the brainstem (pons and medulla). The major feedback loop is humoral regulation, or the change in carbon dioxide and oxygen levels in the blood, and less, importantly, the hydrogen ion level. Normal stimulus to breathe for most of us is an increase of carbon dioxide in the blood, or hypercapnia.

Posterior and lateral thorax; anterior chest

Barrel chest has horizontal ribs and costal angle >90 degrees. Note equal anteroposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.

- Barrel chest: Note equal anteroposterior-to-transverse diameter and that ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs. - Pectus excavatum: markedly sunken sternum and adjacent cartilages (also called funnel breast). Depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticeable on inspiration. Congenital, usually not symptomatic

Bronchial (Tracheal) High pitch; Loud Amplitude; Duration- inspiration expiration; Quality - rustling, like the sound of the wind in the trees; Normal Loc - Over peripheral lung fields, where air flows through smaller bronchioles and alveoli

Crackle- Discontinuous, brief, popping sounds Wheezes-Continous musical sounds, high or low pitched, more noticeable on expiration

... angle of Louis. Because it is continuous with the second rib

90 degrees

1:2 or 5:7 Role in breathing cycle; inspire and exhale fully

Leaning forward with arms braced against their knees, chair, or bed. This gives them leverage so that their rectus abdominis, intercostal, and accessory neck muscles all can aid in expiration.

1. Relative location of bronchi to the chest wall 2. Thickness of the chest wall 3. Pitch and intensity

Resonance

3 to 5 cm... or 7 to 8 cm in well-conditioned people; it may be somewhat higher on the right side (1-2 cm) because of the presence of the liver.

- Examiner's breathing on stethoscope tubing - Stethoscope tubing bumping together - Patient shivering - Patient's hairy chest; movement of hairs under stethoscope sounds like crackles (rales) - Rustling of paper gown or paper drapes