thorax and lungs

respiratory system

support cellular life

provide oxygen and eliminate carbon dioxide

inspiration

contraction of diaphragm

expansion of chest

create negative pressure within lungs

expiration

passive

relaxation of diaphragm and intercostal muscle

major function of respiratory system

supply O2 to body (energy production)

remove carbon dioxide as waste product

maintain homeostasis (acid-base)

maintain heat exchange

pleura

• Visceral pleura → covers lungs

• Parietal pleura → lines thoracic cage

• Pleural space → lubricating fluid → smooth lung movement

thoracic cage protect

• Lungs

• Trachea

• Bronchi

• Heart

• Liver

• Spleen

• Kidneys

newborn lungs

fluid filled—-cleared with first few breaths

alveoli open after 32 weeks

more vulnerable to viruses and second hand smoke

pregnant women lungs

deeper breathing

diaphragm pushed forward

estrogen relaxes thoracic ligament

lungs expand horizontal

aging adults lungs

thoracic cage become calcified, less mobile

muscles decrease in strength

decrease number alveoli for gas exchange

culture, environmental risk

genetics

TB risk

asthma

chronic disease childhood

subjective data collection (you ask patient)

• Cough

• Shortness of breath (dyspnea)

• Chest pain with breathing

• Respiratory illness history

• Smoking history

• Environmental exposure

• TB test history

• Chest X-ray

• Pneumonia & flu vaccines

objective data collection

1. inspect

2. palpate

3. percussion

4. auscultate

inspect thorax

pallor, cyanosis

symmetry, shape thoracic cage

respiratory rate, pattern

use of accessory muscles

barrel chest

1:2 ratio

rounded, broad, deep shape

chronic asthma, emphysema, older adults

tripod position

severe difficulty breathing

sit or stand, lean forward, support upper body to breath

palpate thorax

• Symmetric chest expansion

• Tactile fremitus

• Lumps, masses, tenderness

palpate symmetric chest expansion

hands below shoulder blade

hands should more evenly

palpate for tactile fremitus

99 phrase

percussion of thorax, lung

tone over lung- resonant

tone over bone-flat

tone over organ-dull

tone over stomach-tympany

auscultation of lung

use stethoscope

listen to full breaths

bronchial

sound over trachea

high pitch, harsh

bronchovesicular

sound over major bronchi

moderate in pitch

vesicular

sound over peripheral lung

auscultate lungs directions

bronchial (neck)

bronchovesicular (sternum)

vesicular (side)

stridor

emergency lung sound

blockage airway

normal respiratory pattern

10-20 BPM

tachypnea

more than 25 bpm

shallow

bradypnea

less than 10 bpm

hyperventilation

increase rate, depth

hypoventilation

irregular

shallow

cheyne-stoke

unusual pattern

shallow, then stop

end of life

measure pulmonary

pulse oximeter: SPO2 95% or higher

forced expiratory time: no longer than 4 sec to exhale completely

6 min walk text: patient walk far as possible in 6 min, 300 meters