Thorax and Lungs PDF

The Thorax and Respiratory System Mediastinum  Apices https://www.youtube.com/watch?v=sU_8juD3YzQ  Anatomy and Physiology Pleural Membranes Visceral Membrane Lines the outer surface of each lung Parietal Membrane...

The Thorax and Respiratory System Mediastinum  Apices https://www.youtube.com/watch?v=sU_8juD3YzQ  Anatomy and Physiology Pleural Membranes Visceral Membrane Lines the outer surface of each lung Parietal Membrane Lines the thoracic wall and upper surface of the diaphragm  Landmarks l Landmarks l Help provide exact locations for assessment findings l Help envision underlying structures l Bony structures l Sternum, vertebrae l Clavicles, ribs l Imaginary horizontal and vertical lines  Landmarks Position and Surface Landmarks l Anterior l Sternum l Suprasternal notch/jugular notch l Between clavicles/top of sternum l Manubrium l Sternal angle or angle of Louis l Second rib l Bifurcation of trachea/Upper border of atria l Body l Xyphoid process l Costal angle should be slightly less than 90 degrees l Increased angle with overinflation  Landmarks l Midsternal l Midclavicular l Anterior axillary  Landmarks l Anterior axillary l Midaxillary l Posterior axillary  Landmarks l Posterior Thorax l Use vertebrae and scapulae as locators l C7/TI are prominent with flexed neck l Lower border of scapula is usually at the 7th or 8th rib l 12th rib bottom of cage Landmarks l Trachea and Bronchi l Trachea bifurcates l Sternal Angle l T4  Respiratory System/With Age l Decreased efficiency l Lungs lose elasticity l Skeletal muscles weaken l Costal cartilage becomes calcified l Decreases depth of respirations l Diameters of thoracic cavity change l Barrel chest l AP=T  Respiratory System/With Age l Kyphosis l Curved thoracic spine l Decreased ability to inflate lungs l Less O2 for body l Increased retention of CO2 l Increased risk for: l DOE l postoperative complications l pneumonia  Respiratory System/Cultural Considerations l Increased incidence of respiratory disease in poor, rural, urban, and recent immigrant groups l asthma l TB l Increased incidence l Travel, immunosupression l Patients should be fully disrobed l cultural prohibition of removing clothing l same sex examiner Respiratory System/Cultural Considerations Environmental concerns--Occupational Asbestos Asbestosis Air conditioning/Heating systems Increased respiratory infections Environmental concerns--Home Secondhand smoke Pet dander Dust Molds  Subjective Examination/Health History Questions l “Are you having any problems with your respiratory system?” l “Compare your respiratory system to the past?” l Breathing with l Exercise l Lying down l orthopnea l History of respiratory illness or infection l Treatment  Subjective Examination/Health History Questions l Cough l Description l Mucous l How much l Color l Consistency l Blood l Odor l Chest Pain  Subjective Examination/Health History Questions l Shortness of breath (Dyspnea) l Compared with the patientʼs norm l What brings it on l Related to position l Time of day l Wheezing l Musical respiratory sound l Weight loss  Subjective Exam/Health History Questions History of Respiratory Disorders Infections Covid Bronchitis Pneumonia TB Chronic Disorders Emphysema Asthma Colds Frequency  Subjective Examination/Health History Questions l Environmental exposure l Dust/allergens l Workplace l Self care behaviors l Pneumococcal Vaccine l 65 or older l Covid l Influenza Immunization l Protective Wear  Subjective Examination/Health History Questions Tobacco is the leading cause of preventable death in the United States (Center for Disease Control and Prevention) Do you smoke cigarettes or cigars How many packs/day for how many years Exposure to 2nd hand smoke  Inspection l Inspect for any signs of respiratory difficulty l Assess the patientʼs color (lips and nail beds) l Listen to the patientʼs breathing l Inspect the patientʼs neck l Facial expression l Level of Consciousness 35 35  Inspection of the Posterior Chest Shape and Configuration AP:T Diameter 1:2 Muscles Skin Palpation of the Posterior Chest Symmetric Chest Expansion  Inspection of the Anterior Chest Shape and Configuration Costal Angle Ribs Deformity Symmetry Respirations and chest Observe the rate, rhythm, depth, and effort of breathing Palpation of the Anterior Chest l Usually supine l Palpate l Sternum, ribs, intercostal areas l Count ribs and intercostals l Tenderness l Inflammation l Masses l Crepitus l Air in SQ tissues 37  Palpation of Anterior Chest l Palpate for chest expansion l Symmetry of chest movement l Asymmetry/or decreased expansion l Pain l Pneumothorax l Fibrotic changes Palpation of Anterior Chest l Tactile Fremitus l Palpable vibrations with speaking l Diminished vibrations with obstruction l Increased vibrations with increased density l pneumonia l “99” Percussion of Anterior Chest Begin with in supraclavicular area Continue to move across and down Percuss over interspaces  Percussion of Anterior Resonance Chest Hyperressonance Over inflated lungs/COPD Dullness Organs Heart ,Liver Tympany Stomach Flat Bones, muscles  Auscultation of Anterior Chest lApices of lungs down to 6th intercostal space lListen with the diaphragm of a stethoscope/Patient should breathe deeply with mouth open lListen to at least one full breath in each location lTrachea and 1st & 2nd intercostal space next to sternum in addition to percussion locations  Normal Breath Sounds Bronchial (Tracheal) louder and higher in pitch Vesicular lover the trachea and larynx l soft sound and low pitch lInspiration < Expiration l over smaller bronchioles and alveoli, peripheral lung fields Bronchovesicular l Inspiration > Expiration lmoderate sound and pitch lover major bronchi, adjacent to manubrium, between scapulae lInspiration = Expiration Auscultating Anterior Thorax  Voice Sounds l Auscultated over anterior and posterior chest wall in same areas as tactile fremitus. l Bronchophony l 99 l Egophony l eeeeee l Whispered Pectoriloquy l 1,2,3 47 48  Palpation of Posterior Chest l Palpate for tenderness, masses, abnormalities l Palpate ribs and intercostal spaces l Respiratory Expansion l Fremitus 49 50 Tactile Fremitus Percussion of Posterior Chest Begin at apices Percuss over interspaces Progress side-to-side Avoid scapulae and ribs Expected Percussion Notes Auscultation of Posterior Chest Normal Breath Sounds  Abnormal Findings Barrel Chest AP = T Horizontal Ribs Normal Aging COPD Abnormal Findings Adventitious Lung Sounds Fine Crackles High pitched short, crackling, popping Inspiration (mostly) Do not clear with cough Collapsed or fluid filled alveoli pop open Abnormal Findings Adventitious Breath Sounds Course Crackles Loud, moist low pitched bubbling Inspiration and/or Expiration Clears with cough or suctioning Air collides with secretions Collapsed or fluid filled alveoli open Abnormal Findings Adventitious Breath Sounds Pleural Friction Rub Low pitched grating Inspiration and expiration Pleural surfaces rubbing together Abnormal Findings Adventitious Breath Sounds Wheeze (sibilant) High-pitched, musical Mostly expiration Air passing through very narrow passageways  Abnormal Findings l Respiratory patterns l Tachypnea l Rapid respirations l >24 breaths/min l Fever, exercise, pleuritic pain, pneumonia l Bradypnea l Slow, regular l