The Lorax and Lungs
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What FOUR structures define the thoracic cage?
- Thoroacic vertebrae
How is the left lung different than the right lung?
- The left lung is narrower than the right lung because the heart buleges to the left.
- The left lung has two lobes.
What are three special points about the lungs?
- 1. The left lung has no middle lobe.
- 2. The anterior chest contains mostly upper and middle lobe with very little lower lobe.
- 3. The posterior chest contains almost all lower lobe.
Why is it bad news bears when the costodiaphragmatic recess fills with air of fluid?
It is potential space and when it abnormally fills with air or fluid, it compromises lung expansion.
What purpose do the trachea and bronchi serve?
Tehy transport gases between the environment and the lung parenchyma,.
What is dead space?
Space between trachea and bronchi that is filled with air but not available for gaseous exchange (150mL).
What is an acinus?
Functional respiratory unit that consists of the bronchioles, avlveolar ducts, alveolar sacs and alveoli.
What are the four major functions of the repiratory system?
- 1. supplying oxygen to the body for energy production
- 2. Removing carbon dioxide as a waste produce of energy reactions
- 3. maintaining homeostasis (acid-base balance) of arterial balood
- 4. maintaining heat exchange
What is the normal stimulus for us to breathe?
Increase of CO2 in the blood or hypercapnia
What are the major muscles responsible for the increase in the size of the thoracic container?
Diaphragm and intercostal muscles
What are THREE major changes to the thorax and the aging adult?
- 1. Costal cartilages become calcified->produces less mobile thorax
- 2. Repiratory muscle strength declines
- 3. Decrease in elastic properties in lungs->less distensible and lessen their tendency to collapse and recoil.
- ***Aging lung is more rigid structure and harder to inflate
What are the results of changes in the lungs and thorax in the aging adult?
- 1. Increase in sm airway closure that yields decreased vital capacity (max amt of air that a person can expel from the lungs after 1st filling the lungs to max)
- 2. Increased residual volume (amt of air remaining in the lungs even after most foreceful expiration)
What happens with the aging adult wiht gradual loss of intraalveolar sept and decreased number of alveoli?
- Less surface area available for gas exchange.
- Lung bases become less ventilated as reult of closing off of number of airways.
What are complications for older persons for postoperative pulmonary complications?
- greater risk for postoperative atelactasis
- infection from decreased ability to cough
- loss of protective airway refelxes
- increased secretions
What is orthopnea?
Difficulty breathing when supine. Need more pillows to achieve comfort.
What is paroxysmal nocturnal dyspnea?
Awkaening from sleep with SOB and needing to be upright to acheive comfort
What is the correct ration of anteroposterior to transverse diameter?
1:2 or 5:7
Why do we test symmetric chest expansion?
- Unequal expansion occurs with marked:
- lobar pneumonia
- pleural effusion
- thoracis trauma
Where is fremitus most prominent?
Between scapulae and around the sternum, sites where the major bronchi are closest to the chest wall.
What would cause decreased fremitus?
- obstructed bronchus
- pleural effusion or thickening
What would cause increased fremitus?
Compression or consolidation of lung tissue: lobar pneumonia
When percussing, what is a healthy sound over healthy lung tissue?
What is hyperrosonance
Lower-pitched, booming sounds when too much air is present, such as in empysema or pneumothorax
What does a dull note signal when percussing the lungs?
Abnormal desnity in the lungas, as with pneumonia, pleural effusion, atelectasis, or tumor
What are the THREE types of normal breath sounds in the adult and older child?
- 1. bronchial (Trachea and larynx)
- 2. Bronchovesicular (over major bronchi where fewer alveoli are located posterior, between scapulae, especially on rt, anterior, around upper sternum in 1st and 2nd intercostal spaces)
- 3. Vesicular (over peripheral lung fields where air flows through smaller bronchioles and alveoli)
When might you hear decreased or absent breath sounds?
- 1. Bronchial tree is obstruced by secretions, mucus plug or foreign body
- 2. Emphysema ->los of elasticity in lung fibers and decreased forced of inspired air; also, lungs are already hyperinfalted so inhaled air doesn't make much noise
- 3. When anything obstructs transmission of sound between lung and steth, i.e. pleurisy or pleural thickening or air or fluid in the pleural space
When might you hear increased breath sounds?
- consolidation (pneumonia)
- compression (fluid in the intrapleural space) yeilds dense lung area that enhances transmisison of sound from the bronchi
- when the inspired air reaches the alveoli, hits solid lung tissue that doncuts sound more efficently to the surface
What are adventitious sounds?
sounds not normally heard in the lungs
What are atelactic crackles?
- Not pathologic
- Short, popping, crackling sounds that sounds like fine crackles but don't last beyond a few breaths.
What is normal voice transmission sounds like?
- Soft, muffled, indistinct
- Can hear sounds through steth but can't distinguish what is being said.
What will make the voice sounds more distinct?
Consolidation or compression of lung tissue
If I have hypertrphy of abonimal muscles, what might I be showing symptoms of?
If I purse my lips in the whistling position, what might I be showing symptoms of?
If I have excessive drowsiness of by anxsiety, restlessness, and irritability, what might I be showing symptoms of?
What is forced expiratory time?
- Number of seconds it takes for a person to exhale from total lung capcity to residual volume
- Screening measure of airflow obstruction
When do we hear fine crackels?
- heart disease
- insterstitial fibrosis
- chronic bronchitis
- posturally induced: supine to supine with legs elevated
When do we hear course crackles?
- pulmonary edema
- pulmonary fibrosis
- terminally ill with depressed cough reflex
When do we hear atelectatic crackles?
- Aging adults
- Bedridden persons
- Persons just aroused from sleep
When do we hear pleural friction rub?
What do we hear a high-pitched wheeze?
Diffuse airwary obstruction from acute asthma or chronic emphysema
When do we hear a low-pitched wheeze?
- Single bronchus obstruction from airway tumor
When do we hear stridor?
- Acut epiglottis in children
- Foreign inhalation
- Obstructed airway
What is bronchophony?
- Should hear soft, muffled and instinct voice transmission
- Abnormal finding: increased lung density enhance transmission of voice sounds->clear "ninety-nine"
- Words sounds close to your ear (abnormal)
What is egophony?
- Should hear "eeeeee"
- Abnormal: area of consolidation or compression: eeee->aaaa
What is whispered pectoriloquy?
- Ask person to whisper a phrase as you auscultate. Normal response is faint, muffled, almost inaudible.
- Abnormal: small amts of consoidation, whispered voice is transmitted clearly as if whispering into steth
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