Flashcards in Thorax and Lungs Deck (41)
3) chest pain
4) Hx respiratory infections
5) Smoking hx
6) environmental exposures
7) self-care behaviors
Cough - subjective
Do you have a cough? When did it start? Gradual or sudden? How long have you had it?
Phlegm or sputum? Streaks or odor in sputum? Time of day? Wake you up at night? Come with anything e.g. anxiety, fever, congestion, activity, position? Activity make it better or worse? Does the cough bring on anything e.g. chest pain, ear pain? Tiring? Are you concerned about it?
SOB - subjective
Ever had SOB or hard-breathing spells? How severe? How long did it last?
Position? Time of day? Associated with acitivity? Night sweats? Cough chest pain, bluish color around lips? Related to food, pollen dust animals season or emotion?
What do you do when you have a hard-breathing attack? Oxygen, inhalers? Does it help? How does it affect your ADLs?
Chest pain with breathing - subjective
Any chest pain with breathing? Please point to exactly where? When? Constant or fleeting? Describe the pain: burning, stabbing? Brought on by infection, coughing or trauma? Anything help, medications or heat application?
Hx of respiratory infections - subjective
Any past hx of breathing trouble or lung dz such as bronchitis, emphysema, asthma, pneumonia? Unusual or frequent colds? Any family hx of allergies TB or asthma?
Smoking hx - subjective
Do you smoke? What age did you start? How many packs per day? What activities do associate with smoking? Live with someone who smokes?
Environmental exposures - subjective
Any environmental conditions that may affect your breathing? Where do you work? Factory, chemical plant. coal mine, farming, outdoors? Live
Self-care behaviors - subjective
Last TB skin test, CXR, pneumonia vaccine or influenza vaccine?
Hx for aging adults - subjective
1) Have you noticed, any shortness of breath or fatigue with your ADLs?
2) Tell me about your usual amount of physical activity
3) With hx of COPD, lung CA, or TB: how are you getting along? Any weight change in past 3 mos? How much? How about energy level? Do you tire more easily? How does you illness affect you at home?
4) Any chest pain w breathing? After coughing?
Thorax and lung preparation and order
Begin just after palpating the thyroid gland when standing behind the person.
1) perform inspection, palpation, percussion and auscultation on posterior and lateral thorax
2) move to face person and repeat procedures on anterior thorax
12 pairs of ribs (1st seven attach directly to sternum; 8-10 attach to costal cartilage above)
12 thoracic vertebrae
point at which ribs join their cartilage
What are the anterior thoracic landmarks?
1) Suprasternal notch
3) Sternal angle
4) Costal angle
Three parts of the sternum
aka angle of louis
continuous with second rib
marks site of tracheal bifurcation into the right and left main bronchi
lies above T4 on back
Right and left costal margins form an angle at the xyphoid process
usually 90 degrees
angle is increased in dz where lungs are chronically inflated e.g. emphysema
What are the posterior thoracic landmarks?
Inferior border of the scapula
spinous process of C7, felt when flexing neck
correlate with ribs until T4 only
Inferior border of scapulae
lower tip at 7th or 8th rib
What are the anterior reference lines?
Midclavicular - palpated between the sternoclavicular and acromioclavicular joints
What are the posterior reference lines?
What are the lateral reference lines?
Anterior axillary - extends down from where the pectoralis major inserts
Posterior axillary - extends down from where the latissimus dorsi inserts
midaxillary - runs between and parallel
What organs and tissues does the mediastinum contain?
Located on either side of the mediastinum
Contain the lungs
What are the anterior borders of the lungs?
Apex is approx. 3-4cm above inner third of clavicle
Base rests on diaphragm at about the 6th rib midclavicular line
What are the posterior borders of the lungs?
Apex at C7
T10 base, T12 base on deep inspiration
Location of oblique fissure, anterior chest
Divides lower lobes
5th rib midaxillary to 6th rib midclavicular
Location of horizontal (minor) fissure, right lung, anterior chest
divides upper right lobe and middle lobe
5th rib midaxillary line to 3rd intercostal space at right sternal border