B244 Comprehensive Health Assessment Exam 3

what are the three main structures within the thorax/chest?

1. mediastinum

2. right pleural cavity

3. left pleural cavity

mediastinum

area between the lungs containing the heart, aorta, venae cavae, esophagus, and trachea

pleural cavities

contain the lungs

what are the two types of serous membranes that line the cavities?

1. parietal pleurae

2. visceral pleurae

how many lobes does the right lung have?

3 lobes

how many lobes does the left lung have?

2 lobes

what are the three parts of the sternum?

1. manubrium

2. sternum

3. xiphoid process

intercostal space

the space between two ribs

midsternal line

a vertical line down the middle of the sternum

midclavicular line

imaginary vertical line bisecting the middle of the clavicle in each hemithorax

anterior axillary line

a line that is parallel to the mid-axillary line and passes through the anterior axillary skinfold

midaxillary line

An imaginary vertical line that starts at the middle of the axilla (armpit) and extends down the side of the chest.

posterior axillary line

a line that is parallel to the mid-axillary line and passes through the posterior axillary skinfold

scapular line

extends through the inferior angle of the scapula when the arms are at the sides of the body

vertebral line

A line running vertically down through the spinous processes of the spine

diaphragm

Large, flat muscle at the bottom of the chest cavity that helps with breathing

external intercostal muscles

A muscle that raises the rib cage, decreasing pressure inside the chest cavity

interior intercostal muscles

Decrease the transverse chest diameter during expiration

the use of what muscles indicate respiratory distress?

sternocleidomastoid and trapezius

the ____ is at the top of the lungs, whereas the _____ is at the bottom of the lungs.

apex; base

1 multiple choice option

what do the lobes of the lungs contain?

1. blood vessels

2. lymphatics

3. alveolar ducts connecting with alveoli

4. alveoli

how many alveoli are in an adult?

300 million

in the tracheobronchial tree, air is... (3)

filtered, humidified, and warmed

tracheobronchial tree

branching structures of the respiratory system that resemble an upside-down tree trunk and its branches; includes trachea, bronchi, and bronchioles.

right bronchus

larger and more vertical than the left, foreign bodies and pathogens can enter is more easily

what is the arterial supply of blood for the bronchi, lung, and pleura?

bronchial artery

the alveoli receive _________ blood from the branches of the pulmonary arteries

deoxygenated

1 multiple choice option

which of the following are INSPECTED during a lung examination?

1. appearance

2. posture

3. breathing effort

4. nails

5. skin

6. lips

7. posterior thorax

8. anterior thorax

which of the following are PALPATED during a lung examination?

1. thoracic muscles

2. thoracic wall

3. trachea

which of the following are AUSCULTATED during a lung examination?

1. posterior thorax

2. anterior thorax

3. lateral thorax

true or false: fetal lungs contain air

false

1 multiple choice option

what shape is an infant's chest?

round

diaphragmatic breathing

breathing with the use of the diaphragm to achieve maximum inhalation and slow respiratory rate.

what are common characteristics of infant breathing patterns?

1. diaphragmatic

2. abdominal

3. irregular

in infants, chest circumference is same as head circumference until about ____ years of age

2

3 multiple choice options

what are respiratory changes that occur during pregnancy?

1. lower rib flare

2. diaphragm rises above usual position

3. diaphragm movement increases

4. minute ventilation increases

5. respiratory rate remains unchanged

barrel chest

a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse; common with COPD and in older adults

what respiratory changes occur in older adulthood?

1. barrel chest

2. dorsal curve in the thoracic spine

3. alveoli less elastic

4. decrease in vital capacity

5. increase in residual volume

6. mucous membranes drier

what factors should be questioned about during history of presenting illness?

1. coughing

2. shortness of breath

3. chest pain

what factors should be questioned about during past medical history?

1. thoracic trauma or surgery

2. use of oxygen and ventilation-assistive devices

3. COPD

sputum

mucous secretion from the lungs, bronchi, and trachea expelled through the mouth

average respiratory rate of infants

40-60

periodic breathing

Cessation of breathing lasting 5 to 10 seconds followed by 10 to 15 seconds of rapid respirations without changes in color or heart rate; common in infants

in infants, ______ is rare, but _______ is frequent

coughing; sneezing

1 multiple choice option

paradoxical breathing

the chest wall collapses as the abdomen distends on inspiration; common in infants especially during sleep

what are respiratory abnormalities in infants?

1. stridor

2. respiratory grunting

3. nasal flaring

children use the thoracic (intercostal) musculature for respiration by the age of ___ or ___ years

6; 7

3 multiple choice options

resonance

low-pitched, clear, hollow sound that predominates in healthy lung tissue in the adult

hyperresonance

lower-pitched, booming sound found when too much air is present such as in emphysema or pneumothorax

overall, the pregnant women increases her ventilation by breathing more ______, not more _________.

deeply; frequently

1 multiple choice option

kyphosis

hunchback

bronchophony

abnormal lung sound characterized by greater clarity and increased loudness of spoken words when increased lung consolidation; 99- 1-2-3 while auscultation

pectoriloquy

extreme bronchophony where even a whisper can be heard through stethoscope with consolidation or compression of lung

egophony

the voice sound of "eeeeee" heard through the stethoscope; intensity of spoken voice is increased and there is a nasal quality

asthma

small airways obstruction due to inflammation and hyperreactive airways; familial and allergen-induced

atelectasis

collapsed lung; incomplete expansion of alveoli

bronchitis

inflammation of the bronchi

pleurisy

inflammatory process involving the visceral and parietal pleura, which becomes edematous and fibrinous

pleural effusion

accumulation of serous fluid in the pleural space between the visceral and parietal pleurae

empyema

purulent exudative fluid in the pleural space

lung abscess

well-defined, circumscribed mass defined by inflammation, suppuration, and subsequent central necrosis

pneumonia

inflammatory response of the bronchioles and alveoli to an infective agent (bacterial, fungal, or viral)

tuberculosis

chronic infectious disease that most often begins in the lung but may then have widespread manifestations

pneumothorax

presence of air or gas in the pleural cavity

hemothorax

presence of blood in the pleural cavity

lung cancer

generally refers to bronchogenic cancer, a malignant tumor that evolves from bronchial epithelial structures

cor pulmonale

acute or chronic condition involving right-sided heart failure

pulmonary embolism

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow.

chronic obstructive pulmonary disease (COPD)

permanent, destructive pulmonary disorder that is a combination of chronic bronchitis and emphysema

crackles

fine, high-pitched crackling and popping noises (discontinuous sounds) heard during inspiration and sometimes during expiration; not cleared by cough or altered by changes in body position.

rhonchi

Low-pitched, coarse, loud, low snoring or moaning tone; heard primarily during expiration but may also be heard during inspiration; coughing may clear

pleural friction rub

Superficial, low-pitched, coarse rubbing or grating sound; sounds like two surfaces rubbing together; heard throughout inspiration and expiration; loudest over the lower anterolateral surface; not cleared by cough

stridor

a harsh, high-pitched sound associated with breathing that is often caused by laryngeal or tracheal obstruction.

fremitus

vibration felt of the chest wall produced by vocalization.

wheezing

High-pitched, musical sound similar to a squeak; heard more commonly during expiration but may also be heard during inspiration; occurs in small airways

signs of poor oxygenation

Cyanosis (late stage)

Clubbing (chronic low O2)

if there is ever a question of adequate oxygenation, measure the patient's...

oxygen saturation

the anteroposterior diameter of the chest is approximately _____ the lateral diameter

one half

3 multiple choice options

costal angle

the right and left costal margins form an angle where they meet at the xiphoid process; should be less than 90 degrees

bell of the stethoscope

low pitched sounds

diaphragm of the stethoscope

high pitched sounds

bronchial breath sounds

those heard over the larynx and trachea are high-pitched, harsh "blowing" sounds, with sound on expiration being longer than inspiration

bronchovesicular breath sounds

normal breath sounds heard over the mainstem bronchus; they are moderate blowing sounds, with inspiration equal to expiration

vesicular breath sounds

normal sound of respirations heard on auscultation over peripheral lung areas; they are low in pitch and soft in intensity, with inspiration greater than expiration

lung consolidation

Firming of the lungs as a result of fluid accumulation.

what characteristics of sputum should be inquired about?

1. color

2. consistency

3. odor

4. how often it is coughed up

what abnormal breath sounds can be auscultated in a patient with pneumonia?

crackles or rhonchi

croup

an acute respiratory syndrome in children and infants characterized by obstruction of the larynx, hoarseness, and a barking cough

how should posterior chest movement be assessed?

With thumbs together on either side of patient's spinal process, extend fingers and ask patient to take deep breaths through the mouth

how should anterior chest movement be assessed?

hands placed on bare lower chest of a patient with thumbs placed on sternum and fingers extended on lateral side over the floating ribs.

how should fremitus feel?

bilaterally equal over posterior and anterior chest walls, although the quality of the vibrations may vary from person to person because of chest wall density and relative location of the bronchi to the chest wall.

hemoptysis

coughing up blood

how does a pleural friction rub differ from a cardiac friction rub?

asking the patient to hold his or her breath. If the rub is not heard, the source is lung pleura rubbing together. If the sound persists, it is caused by pericardial pleura rubbing together.6

thrombus

blood clot

pericardium

thin sac composed of a fibro serous material that surrounds the heart

what are the layers of the pericardium

fibrous and serous (parietal and visceral)

the _____ is at the top of the heart, and the ______ is at the bottom of the heart

base; apex

1 multiple choice option

where is the apical impulse located?

5th intercostal space, midclavicular line (point of maximum impulse)

what are the three layers of the heart wall?

epicardium, myocardium, endocardium

epicardium

visceral layer of serous pericardium; outer layer of the heart