- Also called Angle of Louis
- Location where trachae bifurcates. Located directly posterior to the sternum @ rib 2 (or 4th thoracic vertebra).
Which lung is smaller and why?
The right is smaller because its area is compromised by the liver.
Where are the spinal landmarks on the posterior thorax?
- Vertebra prominence (C7)
- Spinous process (T3)
Which lung has three lobes?
How should you auscultate the lungs?
- Start at rt just below supraclavicular level, then left.
- As pt to take deep breaths each time he feels the ss move.
Which broncial tree is more clinically significant and why?
Rt. Because it is wider, shorter, and more vertical, it is more likely to collect bacteria (pneumonia) and swallowed foreign objects.
What are the four functions of the respiratory system?
- 1) O2 supply
- 2)Remove CO2. Inspiration response triggered by elevated CO2 levels.
- 3)Maintain homeostasis of acid/base balance
- 4)Maintain heat exchange.
What are some things to think about in aged patients when it comes to the respiratory system?
- 1) Decreased vital capacity and decreased elasticity/mobility.
- 2) Increased DOE and increased risk of nfxn.
- 3) Thorax becomes more rounded (1:1)
- 4) When assessing lungs, pt is more likely to become dizzy and faint.
How do you assess a cough?
- +/- hemoptysis
- +/- sputum
- ragged, dry, wet, etc.
What is the formula for pack-years?
Number of Pack Years = (Packs smoked per day) × (years as a smoker)
Number of pack years = (number of cigarettes smoked per day × number of years smoked)/20 (1 pack has 20 cigarettes).
Subjective thorax assessment for aging adult...
Any SOB with ADL?
How much daily activity?
- (For those with Hx of COPD, lung cancer, TB)
- How are you getting along each day? Any weight change
- in last 3 months? How much?
- Energy levels? Do you tire easily? How does your illness
- affect you at home/work?
Any chest pain with breathing?
Any chest pain after coughing or after a fall?
How do you prepare for a thorax exam?
- Start at the back
- Proper draping (gown for pt should open in back)
- Examine just after neck, thyroid, lymph.
- Posterior first, then anterior
- Cleath ss and end piece
Assessment of posterior chest...
Shape and configuration of chest wall
Anteroposterior:Transverse diameter (normal = 1:2)
What position does the pt favor? ie orthopneic vs. relaxed sitting upright vs. tripod. (Orthopneic: laying down with pillows stacked under back/neck to be able to breath. Tripod: standing or sitting, leaning forward, bracing for balance and trying to catch breath.)
Skin color and condition
How do you check for symmetric expansion?
- Place warmed hands on posterolateral chest wall with thumbs at level of T9 or T10. Slide hands medially to pinch up a small fold of skin b/w thumbs. Ask person to take deep breath. Hands serve as mechanical amplifiers; as the person inhales deeply, thumbs should move apart symmetrically. Note any lag in expansion.
- Novices tend to go to low.
- Pneumothorax (collapsed lung): Only one hand will move. With ausculation will have diminished or no sounds on side with stationary hand.
- Unequal expansion = atelectasis/pneumonia/fx ribs/pneumothorax
- Pain accompanies deep breathing when the pleurae are inflamed.
Posterior Chest assessment palpation
Posterior Chest Assessment (percussion)
- Sound over bone=flat.
- Start at apices and percuss the band of normally resonant tissue across tops of both shoulders. Percuss at 5 cm intervals, avoid scapulae and ribs.
- Resonance- low-pitched, clear, hollow sound that predominates in health lung tissue in adult.
- Hyperresonance- lower-pitched booming sound found when too much air is present, as in emphysema or pneumothorax
- Dull note- soft, muffled thud- abnormal density in lungs- pneumonia, pleural effusion, atelectasis, tumor
Posterior Chest Assessment Auscultation
- Person sitting, leaning forward slightly, arms resting comfortably across lab
- Instruct to breath through mouth, deeper than usual, stop if feels dizzy.
- Use diaphragm of steth.
- Extraneous noises- examiner’s breathing on steth. steth tubing bumping together, pt shivering, pt’s hairy chest, rustling of paper gown or paper drapes
- Stand behind person listen to posterior from apices at C7 to bases around T10 and lateraly from axilla down to 7th or 8th rib.
- A- Inspiration< expiration
- B- Inspiration= expiration
- C- expiration < Inspiration
What can cause abnormal breathing sounds?
- Decreased: COPD, mucous, pleurisy, pneumothorax
- bronchial tree is obstructed; loss of elasticity; obstruction
- between stethescope and lung (pleurisy, pneumothorax,
- pleural effusion)
- Increased: pneumonia
- consolidation (pneumonia) yield a dense lung area that
- enhances the transmission of sound from the bronchi
What are Adventitious sounds?
Wheeze:airway obstruction from asthma or emphysema or bronchitis
Rhonchi: Same as wheezes, just an older term.
Increased lung density due to pathology will increase transmission of sound. Pt. stating "99" will be heard clearly.
Person saying eeeeee will augment to aaaaaa, like a bleating goat. Again, over an area of consolidation.
With only small amount of consolidation, whispered voice sounds like it's being whispered directly into ss.
What is Kyphosis?
- Kinking of the neck to compensate for poor posture resulting from barrel chest.
- Occurs mostly in the elderly.
(sunken sternum=funnel chest);
- (forward protrusion of chest=pigeon breast)
What is Stridor?
- Very, VERY high pitched wheezing.
- Always indicates emergency because airway is closing.
- croup or epiglottitis; foreign inhalation; may be life-threatening
Pleural Friction Rub?
Sounds like dry leather rubbing together. Only heard for about 24 hours and accompanied by severe pain.