NSG 211 Quiz 3 - Thorax and Lungs
The thoracic cage consists of what four structures?
Which ribs are attached to the sternum via their costal cartilages?
Which ribs are attached to the costal cartilage above?
Which ribs are "free floaters"?
The 11th and 12th ribs. And they have palpable tips.
On the anterior thorax, what surface landmarks do you look for?
Where is the Suprasternal Notch and how can you identify it?
It feels like a hollow U-shaped depression just above the sternum, between the clavicles.
Where is the Sternum and how can you identify it?
Where is the Sternal Angle, what else is it called, and how can you identify it?
What does the Angle of Louis mark for the respiratory system and the cardiac system?
Where is the Costal Angle and why is it important?
What are the four surface landmarks on the posterior thorax?
What are the references lines on the anterior chest?
Describe the position of the midclavicular line.
This line bisects the center of each clavicle at a point halfway between the palpated sternoclavicular and acromioclavicular joints.
What are the references lines on the posterior chest?
Describe the position of the scapular line.
This line extents through the inferior angle of the scapula when the arms are at the side of the body.
Lift up the person's arm at 90 degrees, and the lateral chest can be divided in three reference lines. What are they?
Describe the anterior axillary line.
This line extends down from the anterior axillary fold where the pectoralis major muscle inserts.
Describe the posterior axillary line.
This line continues down from the posterior axillary fold where the latissimus dorsi muscle inserts.
Describe the mid axillary line.
This line runs down from the apex of the axilla and lies between and parallel to the other two.
The mediastinum is the middle section of the thoracic cavity and contains, what?
What do the right and left pleural cavities on either side of the mediastinum contain?
Anteriorly, where does the apex (highest point) of the lungs lie?
They lie 3 or 4 centimeters above the inner third of the clavicles
Where does the base (lower border) of the lungs rest?
They rest on the diaphragm at about the fifth intercostal space in the right midclavicular line and at the 6th rib in the left midclavicular line.
Laterally, the lungs extend from the apex of the axilla to what?
Extends to the 7th or 8th rib.
Posteriorly, C7 marks the 1. and T10 usually corresponds to the 2. On deep inspiration, the base descends to 3.
The right lung is shorter than the left lung, and has how many lobes?
It has three lobes.
The left lung is narrower than the right lung, and has how many lobes?
It has two lobes.
Why is the right lung shorter than the left lung?
Because the liver lies underneath it.
Why left lung narrower than the right lung?
Because the heart bulges to the left.
On the anterior chest, where does the oblique (major or diagonal) fissure lie and terminate?
This fissure crosses the 5th rib in the midaxillary line and terminates at the 6th rib in the midclavicular line.
Anteriorly, the right lung also contains the horizontal (minor) fissure, which divides the right upper and middle lobes. Describe where it lies.
This fissure extends from the 5th rib in the right midaxillary line to the third intercostal space (ICS), or the 4th rib at the right sternal border.
Posteriorly, what is the most remarkable thing about the lungs?
It's almost all lower lobe of the lungs on both sides.
Posteriorly, the upper lobes' apices lies where?
They begin at T1 and reach down to T3 or T4.
At what level do the lower lobes begin posteriorly and where do they end?
They begin at T3 or T4 and reach down to level of T10 (or T12).
When would the posterior lungs reach T10? And T12?
Laterally, the lungs extend from where to where?
The lung tissue extends from the apex of the axilla down to the 7th or 8th rib.
Laterally, the right upper lobe extends from where to where?
It extends from the apex of the axilla down to the horizontal fissure at the 5th rib.
Laterally, the right middle lobe extends from where to where?
It extends from the horizontal fissure down and forward to the 6th rib at the midclavicular line.
Laterally, the right lower lobe extends from where to where?
It continues from the 5th rib to the 8th rib in the midaxillary line.
Laterally, the left upper lobe extends from where to where?
It extends from the apex of the axilla down to the 5th rib at the midaxillary line.
Laterally, the left lower lobe extends from where to where?
It continues down to the 8th rib in the midaxillary line.
The anterior chest contains mostly...?
Upper and middle lobe with very little lower lobe.
The posterior chest contains...?
Almost all lower lobe.
What are the four major functions of the respiratory system?
Hypoventilation (slow, shallow breathing) causes what to build up in the blood?
Carbon dioxide (CO2)
Hyperventilation (rapid, deep breathing) causes what to be blown off?
Carbon dioxide (CO2)
What mediates the involuntary control mechanism of respiration?
The Pons and Medulla in the brainstem.
What is the normal stimulus that causes us to breathe?
Hypercapnia: an increase of CO2 in the blood.
What also causes an increase of respiration, but is less effective than hypercapnia?
Hypoxemia: a decrease of O2 in the blood.
In inspiration, increasing the size of the thoracic container creates 1. what kind of pressure in relation to the atmosphere and 2. what occurs because of it?
What major muscle(s) is responsible for the lengthening of the vertical diameter?
What major muscle(s) is responsible for the lengthening of the horizontal diameter?
Intercostal muscles lift the sternum and elevates the ribs.
Together, the diaphragm and the intercostal muscles increase what?
The anteroposterior (A-P) diameter of the thoracic cavity.
Expiration is primarily passive. As the diaphragm relaxes, elastic forces within the lung, chest cage, and abdomen cause it to dome up. All this squeezing creates what kind of pressure and what occurs?
Relatively positive pressure within the alveoli, and air flows out.
To obtain subjective data, what kind of questions should be asked?
When can shortness of breath (SOB) be related to heart failure?
Difficulty breathing while supine (laying down).
Define the meaning of "Two pillow orthopnea."
Needs 2+ pillows supporting them in order to be comfortable.
Define Paroxysmal Nocturnal Dyspnea.
Awakening from sleep with SOB (caused by an unknown source) and needs to be upright to achieve comfort.
Some conditions of cough have characteristic sputum production. What could white or clear mucoid indicate?
Some conditions of cough have characteristic sputum production. What could yellow or green mucoid indicate?
Some conditions of cough have characteristic sputum production. What could rust-colored mucoid indicate?
Some conditions of cough have characteristic sputum production. What could pink, frothy mucoid indicate?
Some conditions have a characteristic cough. What could a hacking cough indicate?
Some conditions have a characteristic cough. What could a dry cough indicate?
Some conditions have a characteristic cough. What could a barking cough indicate?
Some conditions have a characteristic cough. What could a congested cough indicate?
To obtain objective data, inspect the posterior and anterior chest.
The anteroposterior (AP) ratio should be...1. than the transverse (TV) diameter. The ratio of AP to TV diameter is from...2.
Describe the characteristics of Barrel Chest.
Define symptoms of Chronic Obstructive Pulmonary Disease (COPD).
The neck muscles and trapezius muscles should be normally developed for age and occupation. What is an abnormal finding?
Neck muscles are hypertrophied in COPD from aiding in forced respiration.
Note the position the person takes to breathe.
Why do people with COPD assume a tripod position to breathe?
This gives them leverage so that their rectus abdominis, intercostal, and accessory neck muscles can all aid in expiration.
Why is it extremely important to monitor a person with COPD closely when they receive O2?
They can stop breathing when they get enough O2. This occurs because we normally breathe to get rid of CO2; but they breathe to get O2. Once they have enough O2, they stop breathing.
Palpate the thorax and lungs, assessing the entire chest wall, posterior and anterior. What are the three main things that need to be checked?
Define (Tactile/Vocal) Fremitus.
A palpale vibration because sounds generated from the larynx are transmitted through patent bronchi and through the lung parenchyma to the chest wall, where the vibrations are felt.
Fremitus varies among persons, but it should be?
Symmetrical; felt in the same corresponding areas on each side.
What are some normals that could affect the normal intensity of tactile fremitus?
What are some abnormals that could cause decreased fremitus?
What are some abnormals that could cause increase fremitus?
Define Rhonchal fremitus.
Palpable with thick bronchial secretions.
Define Pleural friction fremitus.
Palpable with inflammation of the pleura.
A coarse, crackling sensation palpable over the skin surface. It occurs in subcutaneous emphysema when air escapes from the lungs and enters the subcutaneous tissue (as after open thoracic injury or surgery).
Percuss the posterior and anterior chest; over the 1. to determine the 2. Also percuss to map out the lower lung border and measure 3.
What is the predominate sound heard in percussion over the lungs?
A partial or complete collapsed lung.
When you auscultate the lobes of the lungs, what are two questions you should be asking yourself as you go?
What are the three types of normal breath sounds heard in an adult and older child during auscultation?
What are the characteristics of normal Bronchial (Tracheal) breathing sounds? List the pitch, amplitude, duration, quality, and normal location.
What are the characteristics of normal Bronchovesicular breathing sounds? List the pitch, amplitude, duration, quality, and normal location.
What are the characteristics of normal Vesicular breathing sounds? List the pitch, amplitude, duration, quality, and normal location.
What are three reasons that would decreased or absent breath sounds?
A silent chest means no air is moving in or out, which is an ominous sign.
What are some reasons for increased breath sounds?
Define Adventitious sounds.
What are discontinuous sounds?
Discrete, crackling sounds.
What are continuous sounds?
Connected, musical sounds.
Describe Fine Crackles (or Rales).
Describe Coarse Crackles (Coarse Rales)
Describe Atelectatic Crackles (Atelectatic Rales).
Describe Pleural Friction Rub.
Describe Wheeze (Sibilant).
Describe Wheeze (Sonorous Rhonchi).
Are atelectatic crackles an adventitious sound? Why or why not?
Normally there should be no retraction or bulging of the interspaces during inspiration. What could be indicated if the abnormal findings of retraction and bulging are seen?
Describe the characteristics of Scoliosis.
Describe the respiratory pattern of a Normal Adult.
Describe the respiratory pattern of a Sigh.
Describe the respiratory pattern of a Tachypnea.
Describe the respiratory pattern of a Bradypnea .
Describe the respiratory pattern of a Hyperventilation.
Describe the respiratory pattern of a Hypoventilation.
Describe the respiratory pattern of a Cheyne-Stokes Respiration.
Describe the respiratory pattern of a Chronic Obstructive Breathing.
Describe the Assessment of the Common Respiratory Conditions of Lobar Pneumonia.
What is some subjective data for Lobar Pneumonia?
What is some objective data for Lobar Pneumonia?
Describe the Assessment of the Common Respiratory Conditions of Bronchitis.
What is some subjective data for Acute Bronchitis?
What is some objective data for Acute Bronchitis?
Describe the Assessment of the Common Respiratory Conditions of Emphysema.
What is some subjective data for Emphysema?
What is some objective data for Emphysema?
Describe the Assessment of the Common Respiratory Conditions of Asthma (aka Reactive Airway Disease) .
What is some subjective data for Asthma?
What is some objective data for Asthma?