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Thorax And Lungs.330.Ss.09

Thorax And Lungs.330.Ss.09






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    Thorax And Lungs.330.Ss.09 Thorax And Lungs.330.Ss.09 Presentation Transcript

    • Thorax and Lungs Nursing 330 Governors State University Shirley Comer
    • Posterior Chest
      • Inspect- observe shape and configuration
        • Spinous process in straight line
          • Scoliosis= s shaped curve
          • Kyphosis= outward curvature
        • Thorax symmetrical
        • Ribs slope downward
        • Scapulae placed symmetrically
    • Chest Diameter
        • Anteroposterior diameter less than transverse diameter
        • Barrel Chest - diameter equal to transverse diameter /c horizontal ribs and costal angles greater then 90 degrees.
          • Occurs in chronic emphysema r/t lung hyperinflation
      • Neck and Trapezius muscles- normal development
        • Hypertrophy /c COPD
    • Chest diameter image
    • Observe
      • Body position
        • Tripod position /c COPD so ancillary muscles can aid breathing
        • Orthopnea- inability to lie flat r/t SOB- rib cage cannot expand fully while lying-Some pt may report using several pillows in bed or sleeping sitting up
      • Skin color and condition
      • Resp rate and character
    • Palpate the Posterior Chest
      • Symmetric chest expansion- place hands at T9-chest should expand evenly during inspiration.
        • Unequal may be present in:
          • Atelectasis
          • Pnuemonia
          • Trauma/fractured ribs
          • Pnuemothorax
    • Chest expansion image
    • Tactile Fremitus
      • Is a palpable vibration
        • Use palms
        • Pt repeats phrase “99 or blue moon”
          • Palpate over apices to bases
          • Vibrations should be equal bilaterally
          • Decreased fremitus = pleural effusion, thickened chest wall, Pnuemothorax, emphysema
          • Increased fremitus= consolidation of lung tissue, pneumonia, tumor, fibrosis
          • Crepitus = crackling sensation over skin surface = SQ emphysema
    • Tactile Fremitus image
    • Palpate
      • Palpate the entire chest wall
        • Note
          • Tenderness
          • Change in skin temp
          • Moisture
          • Lumps
          • Masses
          • Skin lesions
    • Percuss
      • Percuss from apices to bases
      • Percuss at 5cm intervals
      • Avoid the ribs, clavicle and scapulae
        • Resonance is heard over healthy lung tissue
          • Heavily muscled or obese pt may sound duller
        • Dullness is heard over bone or abnormal lung = pneumonia, pleural effusion Atelectasis or tumor
        • Lungs are hyper inflated /c COPD=hyper resonance
    • Percussion/Auscultation pattern
    • Diaphragmatic Excursion
      • Percuss the position of the diaphragm during inspiration and expiration and mark.
      • Measure the difference
      • should be equal
      • Normal is 3 to 5 cm but may be as high as 8 in athletes
      • Excursion will be decreased in COPD, pleural effusion and Atelectasis
    • Diaphragmatic Excursion
    • Auscultate the Posterior chest
      • Normal breath sounds
        • Bronchial aka tracheal or tubular-
          • heard close to larger airways (trachea, main bronchi)
        • Bronchovesicular -
          • heard over medium sized airways
        • Vesicular -
          • heard over lung periphery
    • Decreased/ Diminished Breath Sounds
      • Occur when
        • Bronchial tree is obstructed by secretions, mucous plug or foreign body
        • Emphysema r/t loss of elasticity in lung and decreased force of inspired air
        • Sound transmission is obstructed- pleurisy, pleural thickening, Pnuemothorax, pleural effusion
        • Absent breathing
    • Adventitious Sounds
      • Crackles AKA fine rales
        • Short popping sounds at the end of inspiration
        • Caused by fluid collapsing the alveoli during expiration
        • Common /c pneumonia, CHF, Atelectasis
      • Coarse Rales
        • Similar to crackles but more bubbling sounds earlier in inspiration
        • Caused by more fluid than crackles
    • Adventitious Sounds cont
      • Rhonchi
        • Snoring sound heard during expiration
        • Caused by secretion in bronchial tree
      • Wheezes
        • Musical whistling sounds heard mainly on expiration but can be through our cycle
        • Present in asthma, emphysema, bronchitis or bronchospasm
    • Anterior Chest
      • Observe shape and configuration of chest
      • Costal angle less than 90 degrees
      • Position of ribs
      • Observe
        • Facial expression- COPD may have tense or tired faces
        • LOC- Cerebral hypoxia = drowsiness, irritability confusion
        • Skin color and condition
        • Quality of respirations-noisy, use of ancillary muscles
    • Auscultate the Anterior chest
      • Listen for 1 full respiratory cycle over the entire anterior chest.
      • Will hear vesicular lung sounds over most of anterior chest.
      • Pt should take deep breath in and out through mouth.
    • Vocal Fremitus
      • Egophony
        • Pt says “E”
      • Bronchophony
        • Pt says “99 or blue moon”
      • Whispered Pectoriloquy
        • Pt says “1-2-3”
    • Age Specific Considerations
      • Infants and Children
        • Resp rate will be irreg during feeding or sleeping in neonate.
        • Broncho vesicular sounds heard over entire lung field r/t thin chest wall
        • Crackles heard in upper fields /c cystic fibrosis.
        • Stidor is a high pitched inspiratory sound heard audibly /c croup epiglottis or foreign body aspiration
    • Age Specific Continued
      • Pregnant women
        • Thoracic cage widens
        • Apical pulse displaced laterally
        • Orthopnea may be present
        • Change in resp character
      • Elderly
        • Kyphosis-Barrel chest
        • Marked bony prominences r/t decreased subcutaneous fat.
        • May fatigue during exam or hyperventilate
        • More likely to have disease present-pneumonia,` Atelectasis ect
    • Practice Exam Question
      • Your client has a 20 year history of cigarette smoking and a productive cough. What adventitious breath sound are you most likely to hear during your assessment?
        • A. Stridor
        • B. Rhonchi
        • C. Coarse Rales
        • D. Vesicular
    • Rationale
      • B is the correct answer. A productive cough and history of cigarette smoking indicate the possible presence of secretions in the bronchial tree.
      • A is a condition seen in children
      • C is caused by fluid
      • D is not an adventitious breath sound