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Thorax and Lungs Chapter 18.

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Presentation on theme: "Thorax and Lungs Chapter 18."— Presentation transcript:

1 Thorax and Lungs Chapter 18

2 Structure and Function
Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings

3 Anterior thoracic landmarks
Suprasternal notch Sternum Manubriosternal angle Costal angle

4 Structure and Function Position and Surface Landmarks
Posterior thoracic landmarks Vertebra prominens Spinous processes Inferior border of scapula Twelfth rib

5 Reference lines-Anterior
Midsternal line Midclavicular line Scapular line Vertebral line Anterior, posterior, midaxillary lines

6 Reference Lines (Posterior)
Vertebral Line Scapular Line

7 Reference Lines (Lateral)
Anterior Axillary Midaxillary Posterior Axillary

8

9

10 Structures of the Respiratory System

11 Mechanics of respiration
Four functions of respiratory system Changing chest size during respiration Inspiration Expiration Control of respiration

12 Mechanics of Respiration (cont.)
© Pat Thomas, 2006.

13 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

14 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

15 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 70s 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

16 Asthma 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

17 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

18 Subjective Data— Health History Questions
Cough Shortness of breath Chest pain with breathing History of respiratory infections Smoking history Environmental exposure Self-care behaviors Cough. Do you have a cough? When did it start? Gradual or sudden? Shortness of breath. Have you ever had any shortness of breath or hard-breathing spells? What brings it on? How severe is it? How long does it last? Chest pain with breathing. Do you have any chest pain with breathing? Please point to the exact location. Past history of respiratory infections. Do you have any past history of breathing trouble or lung diseases like bronchitis, emphysema, asthma, pneumonia? Smoking history. Do you smoke cigarettes or cigars? At what age did you start? How many packs per day do you smoke now? For how long? Environmental exposure. Are there any environmental conditions that may affect your breathing? Where do you work? At a factory, chemical plant, coal mine, farming, outdoors in a heavy traffic area? Self-care behaviors. Last tuberculosis skin test, chest x-ray study, pneumonia or influenza immunization?

19 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

20 Objective Assessment Anterior and Posterior chest Inspection Palpation
Percussion Auscultation

21 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

22 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

23 PERCUSSAnterior,Posterior and Lateral Chest
Predominant note= RESONANCE Diagphragmatic Excursion 3-6cm R side higher than L

24 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

25

26 Breath Sounds Bronchial (Tracheal) breath sounds
location/characteristics Bronchovesicular breath sounds Vesicular breath sounds YouTube- Breath Sounds

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28 Bronchial/Tracheal Broncho-vesicular Vesicular

29 Adventitious Breath Sounds
Crackles- discontinous, early or late inspiration Fine or coarse Wheeze- continuous, musical, inspiration or expiration, high/low pitched Atelectatic crackles- Early inspiration, clears with coughing Fine Crackles Coarse Crackles High-pitched Low-pitched

30 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”

31 Abnormal Findings Configurations of the Thorax
Barrel chest Pectus excavatum Pectus carinatum Scoliosis Kyphosis

32 Abnormal Findings Respiration Patterns
Sigh Tachypnea Bradypnea Hyperventilation Hypoventilation Cheyne-Stokes respiration Biot’s respiration Chronic obstructive breathing

33 Abnormal Findings Abnormal Tactile Fremitus
Increased tactile fremitus Decreased tactile fremitus Rhonchial fremitus Pleural friction fremitus

34 Abnormal Findings Adventitious Lung Sounds
Discontinuous sounds Crackles—fine Crackles—course Atelectatic crackles Pleural friction rub Continuous sounds Wheeze—sibilant Wheeze—sonorous rhonchi Stridor

35 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)


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