CH 19: Thorax and Lungs

Right lung has how many lobes?

3 lobes

There is no gas exchange in = dead space

Main bronchi and trachea

Gas exchange takes place in

Acinus; bronchioles, alveoli, alveolar sacs,

What controls breathing rhythm and depth

Medulla and pons

Most powerful drive to breath

Hypercapnia

In chronic CO2 retention (COPD), hypercapnia or hypoxemia is the primary respiratory drive?

Hypoxemia

Increased anteroposterior diameter in COPD patients due to chronic hyperinflation

Barrel chest

COPD patients lean forward with arms supported to maximize breathing efficiency

Tripod position

Lateral curvature of spine 

Scoliosis 

Exaggerated thoracic curvature affecting lung capacity

Spinal deformities

Hearing tactile fremitus

Use palmar surface or ulnar edge of hand.

What causes decreased fremitus?

Obstructed bronchus, pleural effusion, pneumothorax, or emphysema blocking transmission

Increased fremitus 

lung compression or consolidation where solid material enhances vibration transmission

Pain with deep breathing indicates

Pleural inflammation (pleuritis) or chest wall injuryy

Unequal chest expansion indicates

Atelectasis, pleural effusion, pneumothorax, or fractured ribs

Asymmetric findings are more significant than bilateral change. True or false?

True

What does bronchial sound like

High-pitched, loud sounds over trachea and manubrium

What does Bronchovesicular sound like

Medium-pitched sounds over main bronchi

What does vesicular sound like

Soft, low-pitched sounds over peripheral lung fields

How can pulse oximeter be limited?

Limitations in dark skin pigmentation, nail polish, or poor perfusion

Normal O2 sat values

97-99%

6-minute walk test

Safe, simple, inexpensive functional assessment. Patients walking >300 meters typically maintain independence in activities of daily living

Collapsed alveoli or entire lung segments. Results from airway obstruction, external lung compression, or inadequate surfactant production. 

Atelectasis

Inspection findings for atelectasis

Increased respiratory rate and pulse as compensation mechanism.

Palpation results for atelectasis

Markedly decreased chest expansion on affected side due to reduced lung volume

Percussion & Auscultation

Percussion: Dull sound over collapsed area

Auscultation: Decreased or absent breath sounds

Early recognition and treatment prevent progression to complete lung collapse and respiratory failure.

Make patients take deep breaths and ambulate

Damage to alveolar-capillary membrane increases permeability, causing non-cardiogenic pulmonary edema

ARDS

Subjective data for thorax & lungs assessment

1. Cough

2. Shortness of breath

3. Chest pain with breathing

4. History of respiratory infections

5. Smoking history

6. Environmental exposure

7. Patient-centered care