THORAX AND LUNGS

Thorax

Portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly.

Lungs

distal portion of the trachea

Thoracic Cage

Constructed of the sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles, and cartilage

Sternum

the breastbone that lies in the center of the chest anteriorly divided into three parts.

Manubrium

connects laterally with clavicles and first 2 pairs of ribs 

Suprasternal notch

an important landmark, U-shaped indentation on the superior border of manubrium

Sternal angle

known as Angle of Louis location of 2nd pair of ribs and reference point for counting ribs and intercostal spaces.

12 pairs of ribs

This constitute the main structure of the thoracic cage.

11th and 12th pairs of ribs

the “floating” ribs because they do not connect to either the sternum or another pair of ribs anteriorly.

Vertical Reference Lines

Examiner uses this imaginary lines, running vertically on the chest wall

Anterior Vertical lines

Right midclavicular, midsternal, left midclavicular lines

Posterior Vertical Lines

Left scapular, Midspinal, right scapular lines which extends through the inferior angle of the scapulae when the arms are at the client’s side 

Bronchi

constitute the lower respiratory system

Midaxillary line

This runs from the apex of axillae to the level of 12th rib 

Anterior axillary line

This extend from the anterior axillary fold along anterolateral aspect of the thorax 

Posterior axillary line

This runs from the posterior axillary fold down the posterolateral aspect of the chest wall.

Lateral Vertical Lines

anterior axillary, midaxillary, posterior axillary lines

Mediastinum

division of thoracic cavity central area in the chest between the lungs that contains the trachea, bronchi, esophagus, thymus gland heart and great vessels. 

Plueral cavity

right and left, spaces between the parietal and visceral

Lungs

pair of spongy, air-filled organs located on either side of the chest (thorax). not completely symmetric.

Right lung

has 3 lobes

Left lung

has only 2 lobes

Pleura

thin, double-layered serous membrane that protects and cushion the lungs 

Parietal Pleura

lines the chest cavity or covers the inside of thoracic wall

Visceral Pleura

much thinner, covers the external surfaces of the lungs

Pleural Space

fluid-filled space lies between the two pleural layers. The fluid allows the layers to glide over each other as the lungs inflate and deflate during respiration.

Trachea

“windpipe”, Connecting larynx to the bronchi. allow passage for air, moistens and warms it while it passes into the lungs, and protects the respiratory surface from an accumulation of foreign particles.

Bronchi

the two large tubes that carry air from your windpipe (Trachea) to your lungs. 

Right main bronchus

shorter and more vertical making aspirated objects more likely to enter the right lung than the left lung. 

Left main bronchus

narrow, long passageway into your left lung

Respiration

The purpose of this is to maintain an adequate oxygen level in the blood to support cellular life.

Inspiration

inhalation diaphragm contracts and pulls downward, enlargement of chest cavity

Expiration

exhalation, passive in nature and occurs with relaxation of the intercostal muscles and diaphragm.

Common colds, viral infections and bronchitis

This has white or mucoid sputum

Bacterial infections

This has yellow or green sputum

Tuberculosis or pneumococcal pneumonia

this has rust colored sputum

Pulmonary edema

pink, frothy sputum

Second-hand smoke

this puts clients at risk for COPD or lung cancer later in life.

Nasal flaring

This should not be present

1:2

The ratio of anteroposterior to transverse diameter is?

COPD

Tripod position is seen in patients with

Fremitus

symmetric and easily identified in the upper regions of the lungs.

Tactile fremitus

vibration of the chest wall that results from sound vibrations created by speech

T9 or T10

In assessing the chest expansion, the hands should be on the posterior chest wall with thumbs at the level of

5-10 cm

When assessing chest expansion the examiner’s thumb should move ____ apart symmetrically when client takes a deep breath

T7

Percussing the beginning of the scapular line which is

3-5 cm

Excursion should be equal bilaterally and measure of

Resonance

What is the percussion tone elicited over normal lung tissue

Bronchial, Bronchovesicular, and Vesicular

These are the three types of breath sounds may be auscultated. These are also the normal breath sounds.

Bronchial

tubular and hollow sound loud and high-pitched with a short pause between inspiration and expiration 

Bronchovesicular

softer than bronchial sounds equal during inspiration and expiration.

Vesicular

soft, blowing or rustling sounds normally heard throughout most of the lung fields

Adventitious sounds

These are also sounds added or superimposed over normal breath sounds and heard during auscultation such as crackles and wheezes.

Crackles

discrete and discontinuous, clicking or rattling sounds

Wheezes

musical and continuous, high-pitched whistling sound

Bronchophony, Egophony, Whispered Pectoriloquy

These are the Voice sounds

Bronchophony

Ask the client to repeat the phrase “ninety-nine” while auscultating.

Bronchophony

Soft, muffled, and indistinct. Voice can be heard but actual phrase cannot be distinguished. 

Egophony

 Ask the client to repeat the letter “E” while auscultating. 

Egophony

 soft and muffled but letter “E” should be distinguishable.

Whispered Pectoriloquy

Ask a client to whisper the phrase “one-two-three” while auscultating.

Whispered Pectoriloquy

very faint and muffled and may be inaudible.

90 degrees

Costal angle is within?

Tympany

detected over the stomach, and flatness is detected over the muscles and bones.

Bronchial

present over large airways in anterior chest near 2nd and 3rd intercostal spaces. Loud and high-pitched with a short pause between inspiration and expiration 

Bronchovesicular

sounds heard in posterior chest between scapula and in the center part of anterior chest. Softer than bronchial sounds, equal during inspiration and expiration

Vesicular

soft, blowing or rustling sounds normally heard throughout most of the lung fields.

Barrel Chest

refers to a broad, deep chest found on a patient

Pectus excavatum (funnel chest)

a deformity that can cause a child's ribs and breastbone to grow inward giving the chest wall a sunken appearance.

Scoliosis

a sideways curvature of the spine

Kyphosis

exaggerated, forward rounding of the back. KUBA

Lordosis

inward curve of the lumbar spine. LIYAD

Dullness

Is a percussion elicits dullness over breast tissue, heart, and the liver

Sternum and ribs

may be more prominent in the older client because of loss of subcutaneous fat.