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Flashcards in Thorax and Lungs Deck (41)
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1

Subjective Data

1) cough
2) SOB
3) chest pain
4) Hx respiratory infections
5) Smoking hx
6) environmental exposures
7) self-care behaviors

2

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?

3

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?

4

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?

5

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?

6

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?

7

Environmental exposures - subjective

Any environmental conditions that may affect your breathing? Where do you work? Factory, chemical plant. coal mine, farming, outdoors? Live

8

Self-care behaviors - subjective

Last TB skin test, CXR, pneumonia vaccine or influenza vaccine?

9

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?

10

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

11

thoracic cage

Defined by:
sternum
12 pairs of ribs (1st seven attach directly to sternum; 8-10 attach to costal cartilage above)
12 thoracic vertebrae
diaphragm

12

costochondral junctions

point at which ribs join their cartilage

13

What are the anterior thoracic landmarks?

1) Suprasternal notch
2) Sternum
3) Sternal angle
4) Costal angle

14

Three parts of the sternum

Manubrium
Body
Xyphoid process

15

Sternal angle

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

16

Costal angle

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

17

What are the posterior thoracic landmarks?

Vertebra Prominens
Spinous processes
Inferior border of the scapula
Twelfth rib

18

Vertebra prominens

spinous process of C7, felt when flexing neck

19

Spinous process

correlate with ribs until T4 only

20

Inferior border of scapulae

lower tip at 7th or 8th rib

21

What are the anterior reference lines?

Midsternal
Midclavicular - palpated between the sternoclavicular and acromioclavicular joints

22

What are the posterior reference lines?

Vertebral line
Scapular line

23

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

24

What organs and tissues does the mediastinum contain?

Esophagus
Trachea
Heart
Great vessels

25

Pleural cavities

Located on either side of the mediastinum
Contain the lungs

26

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

27

What are the posterior borders of the lungs?

Apex at C7
T10 base, T12 base on deep inspiration

28

Location of oblique fissure, anterior chest

Divides lower lobes
5th rib midaxillary to 6th rib midclavicular

29

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

30

Location of lobes, posterior thorax

Apex at C7/T1 down to T3 or T4
Inferior border of lower lobe extends to T10, T12 on inspiration