Chpt 15 Thorax, lungs

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Chpt 15 Thorax, lungs
2011-02-16 16:11:27
Chpt Thorax lungs

Chpt 15 Thorax, lungs
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  1. Upper Respiratory
    • Nasal Cavity: nose, warms, humidifies, filters the air we breath
    • Pharynx: back of throat. Connects nose and larynx. and Mouth and esophagus
    • Larynx: under chin, just a passage way includes the voice box
    • Bronchi and Pleura: upper trachea, anterior to esophagus
  2. Lower Respiratory
    • Lower trachea: anterior to esophagus
    • Carina: 2 main branches that turn intothe two seperate bronchi
    • Bronchi: 2 main stems. 5 twigs/segments
    • Brochioles: the tree limbs
    • Alveolar duct
    • alveolar sac

  3. Apex of lung
    Base of Lung
    • Apex is top of lung
    • Base is bottom of lung is concave where it meets the diaphram
  4. levels of Respiration: External, Internal, Cellular
    External: gas exchange between lungs and blood. O2 moves from the alveoli-blood and CO2 moves from blood-alveoli

    Internal: gas exchange between blood & body tissues. O2 goes-lungs-blood-tissue. CO2 moves from tissue to blood-r heart for reoxygenation

    Cellular: gas exchange with cells
  5. Lungs are spongelike, elastic have lots of alveoli also has
    blood vessels, nerves and lymphatics in each lung. Blood flow is brochial and pulmonary arteries
  6. Trachea
    provides airway between the larynx and bronchi
  7. Bronchi
    airway is between the primary, secondary and tertiary branches. transportation of gases. Mucous is aroung to carry stuff out
  8. Left Lung has 2 lobes but also
    a "cardiac notch" spot for the heart to sit
  9. Right lung has 3 lobes
    it is a little shorter due to liver
  10. Bronchioles
    no gas exchange
  11. Alveolar Sacs is where gas exchange
    TAKES PLACE! If no surfactant=atelectaisis with is difficult breathing.
  12. Diaphram located 6th-8th rib
    Increase volume/inspiration=contraction/squishing of diaphram. Expiration=expansion of diaphram
  13. PONS/Medulla control sensation to
    breath. CO2 build up forces us to breath
  14. Function of Pleura of lungs
    it is a serous, protective lining of the lungs. It reduces friction and maintains NEGATIVE PRESSURE!
  15. Anterior Throacic Landmarks:
    Sternum, clavicles, Nipples,
    • Suprasternal Notch: hole between clavicles. right above the manubrium
    • Angle of Louis: triangle formed between the clavicles and point at top of sternum
    • Costal Angle: formed by bottom of sternum and ribs
  16. Posterior Thoracic Landmarks:
    • Inferior angle of scapula: find bottom then follow in to spine=at 10th rib
    • Vertebra prominens
    • twelth rib
  17. Midsternal line: (anterior) verticle line
    straight down sternum.
  18. Midaxillary Line: verticle line straight
    down middle of armpit.
  19. Age related lung risks
    Children: bronchiectasis: dilation of bronchial tree. d/t weakening of muscles, cystic fibrosis: sticky, thick mucous buildup in lungs

    Adults: lung cx, pneumonia, chronic bronchitis, emphysema

    Elderly: pulmonary fibrosis
  20. Midclavicular Line (left or right)
    vertical line. Starts in middle of either the left or right clavical and goes
  21. Race Risk for lung issues: AA and caucasians
    • AA: Sarcoidosis: inflammation and makes little lumps of cells
    • Caucasians: cystic fibrosis: thick mucous
  22. Dyspnea
  23. Breathing patterns
    • Children: nose breath, fast and use abdomen
    • Elderly: alveoli and cillia stiffens, overall volume decreases. Have weaker intercostal muscles d/t no longer deep breathing no longer really active so dont use the muscles.
    • Pregnant: intercostal angle widens, increase O2 consumption/needs
  24. Cultural Variations or risks for lung issues
    • AA: increase risk d/t urban/city living
    • Asians: smaller chests
    • Native Americans: tight living quarters
    • Irish: mining/occupational risks
  25. Midspinal Line: (posterior) verticle
    line straight down spine
  26. Chest Configurations: normal, barrel, protusion, depression
    • Normal: chest transverse is 2x the size of the AP, costal angle <90, rib angle 45
    • Barrel: ratio 1:1, equal, costal angle >90, rib angle >45. COPD, emphysema. Cant get air out. Air trapped inside.
    • Pectus Carinatum: protrusion in chest, rickets causes this. Weakness and give/poke out under the weight
    • Pectus Excavatum: depression in chest (Michelle's Son)
  27. Physical Assessment/Approach
    work anterior, posterior, lateral. Work from apex to base. Compare side to side.
  28. Nailbed clubbing, Nailbed capillary refill
    • Clubbing: longterm O2 status
    • Capillary refill issues: current/present O2 status
  29. Severe long term Scoliosis can cause
    decreased lung capacity. catch it while young to wear a "brace" to move it back
  30. Intercostal Space (ICS): retraction or bulging
    • Retraction: occur during inspiration d/t obstruction of freely inflowing air. EX. tracheal/laryngeal obstruction or Foreign body
    • Bulging: occurs during expiration d/t an obstruction of freely outflowing air. Ex. enlarged heart, aortic aneyrism, pleural effusion (fluid buildup) sharp pain when cough, pneumothorax
  31. Tachypnea-fast
    • Tachy-20-24
    • Brady->12
    • Apnea-no respiration for 10+secs
    • Eupnea-12-20
  32. Orthopnea-SOB when
    laying flat
  33. Pursed lip breathing. COPD pt do this as a mechanism to their disease. It expends less
    energy with each breath cuz the alveoli dont completely collaspe. Like blowing out a candle. The expiration is controlled.
  34. Pulmonary edema sputum color and consistency
    thin and frothy
  35. Pneumonia: productive cough, Left abdominal pain and
    prululent sputum