nursing 344 - thorax and lungs

ventilation

movement of air between atmosphere and respiratory portion of lungs

perfusion

• flow of blood through lungs

• delivers oxygen and nutrients

diffusion

• transfer of gases between air-filled spaces in lungs and blood

• high pressure → low pressure

older adult considerations

• dyspnea

• thoracic expansion and coughing effectiveness decreased

• kyphosis

history of present health concern

• dyspnea, chest pain, coughing, wheezing

• sputum (color, odor, amount)

• gi symptoms (heartburn + hiccups)

personal history and family history

• thoracic surgery, biopsy, trauma?

• recent travel?

• meds affecting breathing?

lifestyle and health practices

• smoking? work with people that smoke?

• difficulty performing adls?

inspection

• rate, rhythm, depth

• color of face, lips, chest, nails

palpation - crepitus

crackling sensation felt when air is trapped from emphysema

palpation - fremitus

• + consolidation from fluid

• - copd air trapping, pneumothorax, bronchial obstruction

normal breath sounds

• bronchial/tracheal

• bronchovesicular

• vesicular

bronchial/tracheal

• location: trachea and thorax

• loudest and harshest

• short during inspiration, long during expiration

bronchovesicular

• location: upper chest and between scapulae

• slightly loud and more coarse than vesicular

• same during inspiration + expiration

vesicular

• location: over most lungs

• softest sound

• short in expiration + long in inspiration

adventitious breath sounds

• crackles

• pleural friction rub

• stridor

• sibilant wheezes

• sonorous wheezes (rhonchi)

crackles - fine

• high-pitched

• short

• popping sounds during inspiration

crackles - coarse

• low-pitched

• gurgling

• moist sounds

crackles - coarse (diseases)

• pneumonia

• pulmonary edema

• pulmonary fibrosis

• chf

what does crackles in early inspiration mean?

• bronchitis

• asthma

• emphysema

pleural friction rub

• loud, rubbing sound by inflamed pleuras

• disease: pleuritis

stridor

caused by upper airway obstruction

• croup

• epiglottis

• foreign body aspiration

sibilant wheezes

• high-pitched

• obstructive lung disorders causing bronchoconstriction

• ex. acute or chronic emphysema

sonorous wheezes (rhonchi)

• low-pitched snoring during expiration

• bronchitis where mucus production is increased

• copd

barrel chest

round thorax with 1:1 AP diameter to lateral diameter ratio

who has barrel chest?

• aging adults

• copd

• chronic asthma

pectus excavatum

• sternum and ribs inward = funnel appearance

• congenital conditions - murmurs or compress heart

pectus carinatum

pigeon chest where sternum is pushed outward

copd examples

• emphysema

• chronic bronchitis

copd facts

• 4th leading death - not fully reversible

• airflow limitation is usually progressive and associated with inflammatory responses

copd risk assessment

• asthma

• smoking exposure

• exposure to dust + chemicals + fumes

• 35-40 years+

• rarely, genetic

copd client education

• avoid smoking

• teach them: pursed lip breathing, tripod positioning, energy-conserving methods

lung cancer types

• small cell lung cancer

• non-small cell lung cancer

• 2nd leading cause of death

lung cancer screening

annual screening in adults with smoking history

lung cancer risk factors

• smoke + radiation + chemical (asbestos) exposure

• air pollution

• diet + fam history

lung cancer client education

• avoid smoke (and second hand) or stop

• check home for asbestos + radon

• use protective gear

obstructive atelectasis

• complete collapse of alveoli → reduce oxygenation

• dullness, decreased breath + lung size

emphysema lungs

• increased thoracic volume

• hyperresonance

• prolonged breath sounds