Structure and Function of the Lungs
reference lines
Midsternal line is down the middle of the body
Anterior axillary line is between the nipple and armpit
Midclavicular line is between the middle of the clavicle
Vertebral line is down the middle of the back down the spine
Scapular line is down the middle of the scapula
Measuring the AP diameter
the AP diameter should be less than the transverse diameter
Crepitus
course or crackling sensation palpable over the skin surface
Tachypnea/ bradypnea
Tachypnea – fast breathing, greater than 20 breaths per min
Bradypnea – slow breathing, less than 10 breaths per min
inspection
thoracic cage, respirations, skin color, condition, persons facial expression, LOC
Sternum
“breast bone” has 3 parts, the manubrium, the body, and the xiphoid process
Hyperventilation/ Hypoventilation
Hyperventilation- too much oxygen ventilation, increase both rate and depth
Hypoventilation – not enough oxygen ventilation, irregular shallow pattern
Tactile Fremitus
palpable vibration of the chest wall
accessory muscle use
the pt should not be using accessory muscles in order to breathe
confirm symmetric expansion and tactile fremitus, detection of any lumps, masses or tenderness
Sternal angle (angle of Louis)
articulation of the manubrium and body of the sternum and is continuous with the 2nd rib
Hypercapnia/ Hypoxemia
Hypercapnia – excessive carbon dioxide in the blood steam caused by inadequate respiration
Hypoxemia – too low of oxygen
Paroxysmal nocturnal dyspnea
awakening from sleep with SOB and needing to be upright to achieve comfort
Stridor/ Retractions
Stridor – harsh grating/ vibrating sound when breathing
Retractions – chest appears to be sunken in below the neck or under breastbone with each breath, respiratory support
Gender and Cultural Diseases
People of racial or ethic minorities have a larger chance of TB disease, 11.5% higher risk for foreign born people than US born
Asthma is the most common chronic disease in children, blacks, Hispanics, and American Indians compared to whites or Asians
suprasternal notch/ costal angle
feel the hallow u shape depression just above the sternum between the clavicles
right and left costal margins form an angle where they meet at the xiphoid process
Hemoptysis/ Orthopnea
Hemoptysis – coughing up blood
Orthopnea - difficulty breathing while lying down, tripod positioning normally helps
Adventitious Lung Sounds
added sounds that are not normally heard in the lungs
Rhonchi/ Atelectasis
Rhonchi – gurgling or bubbling sounds heard during inspiration and exhalation
Atelectasis – crackles are short, popping, crackles that last only a few breaths
Expected age related changes of lungs
Increased calcifications and rigidity in older adults = less surface area for gas exchange, lung bases become less ventilated, increased risk for illness
supply oxygen, eliminate Co2, maintain homeostasis, maintain heat exchange
Identifying location and characteristics of bronchial, bronchovesicular, and vesicular breath sounds
Bronchial- trachea, loud and clear
Bronchovesicular- in between shoulder blades and upper portion of the chest, moderate sound
Vesicular- over peripheral lung fields where air flows through bronchioles and alveoli, soft sounds
Wheezes/ Crackles
Wheezes (1)- continuous musical sounds heard mainly with expiration
Crackles – discontinuous popping sounds heard over inspiration
Kyphosis/ Barrel Chest
Kyphosis - exaggerated posterior curvature of thoracic spine (Humpback)
Barrel chest – caused by hyperinflation of lungs from emphysema and asthma (COPD)
assess breath sounds and note any abnormal/ adventitious breath sounds, perform bronchophony, whispered pectoriloquy, or egophony as needed. Use diaphragm stethoscope, side to side comparison is the most important