1. Sternum
    • -3 parts: manubrium, body, xiphoid process
    • -Suprasternal notch (ridged top of manubrium)
  2. 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
  3. 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
  4. Costal Angle
    • -Normal <90°
    • -Abnormal if angle inc (flattens) w/ hyperinflation--maybe w/ chronic emphysema
  5. Vertebral prominens
    • -C7-palpable w/ head flexed
    • -If 2 bumps then C7 & T1
  6. Thoracic vertebrae
    • -12
    • -Spinous process (knobs on vertebrae)
  7. Scapula
    -lower tip (inferior border) at 7th-8th rib
  8. 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
  9. Other Landmarks
    • -Supraclavicular (above clavicle)
    • -Infraclavicular (below clavicle)
    • -Infrascapular (below tip of scapula)
  10. TC
    • -Mediastinum: heart, great vessels, esophagus, trachea
    • -Pleural cavities: contain lungs
    • -Diaphragm: floor of thorax, mjr muscle of respiration
  11. *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
  12. *TC
    -Lobes of lungs
    • -R: 3 lobes-upper/middle/lower, shorter due to liver
    • -L: 2 lobes-upper/lower, narrower due to heart border
  13. *TC
    • -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
  14. *TC
    -Posterior thorax
    • -No RML
    • -Upper lobes T1-T3/T4
    • -Lower lobes T3-T10 (expiration) or T12 (inspiration)
  15. *TC
    -Lateral thorax
    • -Right: RML listen ant/laterally
    • -Left: no middle lobe
  16. *TC
    • -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
  17. *TC
    -Post/Ant chest
    • -Post: mostly lower lobes
    • -Ant: mostly upper and middle lobes
  18. -Trachea
    • -Anterior to esophagus
    • -Starts at cricoid (10-11 cm long)
    • -Bifurcates at manubriosternal angle (anteriorly)
    • -Bifurcates at T4 (posteriorly)
  19. -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
  20. 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)
  21. Respiratory acidosis/alkalosis
    • Acidosis: retained CO2
    • Alkalosis: excessive excretion of CO2 thru respirations
  22. Respiratory conditions may effect...
    • -Ventilation (air in & out)
    • -Perfusion (diffusion of gases)
    • **person w/ pulmonary artery stenosis may have normal ventilation, but abnormal perfusion
  23. *Subjective data
    • -Cough timing, character
    • -Sputum amount, color, odor
    • -SOB, dyspnea
    • -Hx of: past, family, smoking
    • -Misc symptoms
    • -Environmental exposure
    • - Health promotion
  24. *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)
  25. *Subjective data
    -Sputum: (1)pink/frothy, (2)blood, (3) foul odor
    • (1) pulmonary edema (excess fluid in alveoli)
    • (2) hemoptysis-cancer TB
    • (3) bacterial
  26. *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)
  27. *Subjective data
    -Cough character
    • -hacking (mycoplasm pneumonia)
    • -dry, nonproductive (early CHF, allergies, meds-ACE1)
    • -barking (kroup of whooping cough)
    • -congested (bronchitis, pneumonia)
  28. Paroxysmal nocturnal dyspnea (PND)
    • -Awakens from sleep w/ SOB
    • -Starts, stops suddenly
Card Set
202: Lungs & Thorax