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Sternum
- -3 parts: manubrium, body, xiphoid process
- -Suprasternal notch (ridged top of manubrium)
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Manubriosternal Angle
- *aka angle of Louis, sternal angle
- -Bony ridge (articulation of manubrium & body of sternum)
- -Continuous w/ 2nd rib (count ribs & ICS from this pt)
- -Site or tracheal bifurcation into R & L main bronchi
- -Corresponds w/ upper border of atria
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Ribs
- -12 pairs
- -Costochondral junction (joint where rib attaches to cartilage)
- -Intercostal spaces (below each rib)
- -Floating ribs (11-12): attached to spinal column only; 12th rib tip palpable midway b/t spine & side
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Costal Angle
- -Normal <90°
- -Abnormal if angle inc (flattens) w/ hyperinflation--maybe w/ chronic emphysema
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Vertebral prominens
- -C7-palpable w/ head flexed
- -If 2 bumps then C7 & T1
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Thoracic vertebrae
- -12
- -Spinous process (knobs on vertebrae)
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Scapula
-lower tip (inferior border) at 7th-8th rib
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Reference Lines:
-ant, post, lat
- *vertical lines used to document physical findings
- -Anterior: midsternal, midclavicular (MCL)
- -Posterior: verterbal (midspinal), scapular
- -Lateral: anterior axillary line (AAL) at ant axillary fold; midaxillary line (MAL) midway b/t AAL & PAL; post axillary line (PAL) at post axillary fold
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Other Landmarks
- -Supraclavicular (above clavicle)
- -Infraclavicular (below clavicle)
- -Infrascapular (below tip of scapula)
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TC
- -Mediastinum: heart, great vessels, esophagus, trachea
- -Pleural cavities: contain lungs
- -Diaphragm: floor of thorax, mjr muscle of respiration
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*TC
-Lung Borders
- -Anterior: APEX (3-4cm above 1st rib); BASE rests on diaphragm (R at 5th ICS MCL, L at 6th ICS MCL)
- -Lateral: from apex of axilla to 7th-8th ribs
- -Posterior: C7 to T10 or T12 w/ inspiration
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*TC
-Lobes of lungs
- -R: 3 lobes-upper/middle/lower, shorter due to liver
- -L: 2 lobes-upper/lower, narrower due to heart border
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*TC
-Fissures
- -Horizontal fissure: R side only. 4th rib R sternal border to 5th rib MAL; separates upper/middle lobe
- -Anterior Oblique fissures: Bilateral. 5th rib MAL to 6th rib MCL; R separates middle/lower, L separates upper/lower
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*TC
-Posterior thorax
- -No RML
- -Upper lobes T1-T3/T4
- -Lower lobes T3-T10 (expiration) or T12 (inspiration)
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*TC
-Lateral thorax
- -Right: RML listen ant/laterally
- -Left: no middle lobe
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*TC
-Pleura
- -Visceral: lines lungs surface
- -Parietal: lines chest wall & diaphragm
- -Pleural cavity: negative pressure to hold lungs against chest wall; collapse if pressure is disturbed
- -Costodiaphragmatic recess: pleura extend 3cm below level of lung; potential space for fluid/air which may compress lung
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*TC
-Post/Ant chest
- -Post: mostly lower lobes
- -Ant: mostly upper and middle lobes
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-Trachea
- -Anterior to esophagus
- -Starts at cricoid (10-11 cm long)
- -Bifurcates at manubriosternal angle (anteriorly)
- -Bifurcates at T4 (posteriorly)
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-Bronchial Tree
- -R main stem bronchus shorter/straighter
- -Dead space: trachea & bronchii, filled w/ air, but not gas exchange takes place
- -Bronchial tree lined w/ goblet cells (that secret mucus & entrap particles), & cilia (that sweep particles upward)
- -Acinus: functional respiratory unit; bronchioles, alveolar ducts, alveolar sacs, alveoli
- -Alveoli: where gas exchange takes place
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Mechanism of respiration
- -Supplies O2, eliminates CO2
- -Helps maintain acid-base balance
- **respiratory center (brain stem-pons/medulla): inc CO2 is normal stimulus to breathe
- -chronic hypoxia desensitizes CO2 receptors in brain--> Low O2 levels become stimulus to breathe (delivery of high O2 concentrations may result in apnea--COPD)
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Respiratory acidosis/alkalosis
- Acidosis: retained CO2
- Alkalosis: excessive excretion of CO2 thru respirations
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Respiratory conditions may effect...
- -Ventilation (air in & out)
- -Perfusion (diffusion of gases)
- **person w/ pulmonary artery stenosis may have normal ventilation, but abnormal perfusion
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*Subjective data
- -Cough timing, character
- -Sputum amount, color, odor
- -SOB, dyspnea
- -Hx of: past, family, smoking
- -Misc symptoms
- -Environmental exposure
- - Health promotion
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*Subjective data
-Sputum: (1)clear/white, (2)translucent white/gray, (3)green/yellow, (4)rust
- (1) viral bronchitis/pneumonia
- (2) non-infectious, chronic bronchitis, smoker
- (3) bacterial bronchitis/pneumonia
- (4) pneumococcal pneumonia (blood mixed w/ yellow sputum)
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*Subjective data
-Sputum: (1)pink/frothy, (2)blood, (3) foul odor
- (1) pulmonary edema (excess fluid in alveoli)
- (2) hemoptysis-cancer TB
- (3) bacterial
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*Subjective data
-Cough timing
- -continuous (respiratory infection is present 24/7)
- -nighttime, when recumbent (post nasal drip, sinusitis-drips into throat causes coughing; GERD)
- -morning, upon wakening (chronic bronchitis; smokers cough-pools when sleeping, move when get up)
- -specific settings (allergies)
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*Subjective data
-Cough character
- -hacking (mycoplasm pneumonia)
- -dry, nonproductive (early CHF, allergies, meds-ACE1)
- -barking (kroup of whooping cough)
- -congested (bronchitis, pneumonia)
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Paroxysmal nocturnal dyspnea (PND)
- -Awakens from sleep w/ SOB
- -Starts, stops suddenly
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