Nursing 205

  • View

  • Download

Embed Size (px)

Text of Nursing 205


2. ANTERIOR/POSTERIO R CHEST PREPARED BY ESTHER N. RIVERA 3. Thoracic Cage is the entire/outer structure of thethorax.= is a bony structure with a conical shape which isnarrower at the top.= it provides support and protection for manyimportant organs= is constructed of the Sternum 12 pairs of ribs 12 thoracic vertebrae Muscles Cartilage= it is narrower at its superior end and broader at itsinferior end and is flattened from front to back(Tortora: 222) 4. ANTERIOR THORACICLANDMARK 5. 1. Suprasternal notch is an important landmark= a U-shaped indentation located on the superior border of the manubrium or joint just above the sternum in between the clavicles.2. Sternum breastbone= flat bone which lies in the center of the chest anteriorly= measures about 15 cm (6 inches) in length= it is attached to the first 7 ribs 6. 3 parts:a. Manubrium the superior part=articulates with the costal cartilage of the 1st and the 2 nd ribsb. The body the middle and the largest part=articulates directly or indirectly with the costal cartilage of the 2nd through the 10th ribsc. Xiphoid process the inferior and the smallest part= no ribs are attached to it the xiphoid process provides attachment for some abdominal muscles3. Costal Angle - the right and left costal margins form anangle where they meet at the xiphoid process= usually 90 degrees or less, this angle increases when therib cage is chronically over inflated as its emphysema 7. 4. Manusbriosternal angle or sternal angle= also called the angle of Louis= this is the articulation of the manubrium and the body of the sternum and it is continuous with the 2nd rib and becomes a reference point for counting ribs and intercostal spaces (Jarvis, 448)5. Intercostal spaces are the spaces in between the ribs6. Ribs the 12 pairs of ribs give the structural support to the sides of the thoracic cavity= constitute the main structures of the thoracic cage= they are numbered superiorly to inferiorly, the uppermost pair is number one= each pair of ribs has a corresponding pair of ICS located immediately inferior to it 8. = anteriorly, the first 7 pairs articulate with thesternum by way of costal cartilages= the first pair of ribs curves up immediately underthe clavicle, so only a small portion of these ribsand 1st interspaces are palpable= ribs 2 to 6 are easy to count anteriorly= ribs 7 to 10 connect to the cartilages of the pairlying superior to them rather than to the sternum= 11th and 12th ribs are floating ribs because theydo not connect to either the sternum or anotherpair anteriorly, they are attached posteriorly tothe vertebra and their anterior tips are free andpalpable 9. = posteriorly, each pair of ribs articulates with therespective thoracic vertebra= the ribs are more difficult to palpate posteriorly(:297)7. Clavicle or the collar bone= a slender, doubly curved bone= it attaches to the manubrium of the sternum tothe acromion of the scapula= it acts as a brace to hold the arm away from thetop of the thorax and helps prevent shoulderdisclocation 10. POSTERIOR THORACICLANDMARK 11. 1. C 7 or vertebra prominens= the most prominent bony spur protruding atthe base of the neck when the head isflexed2. Spinous process= single projection arising from the posterior aspect of the vertebral arch= it alligns with their same numbered ribs only down to T4= after T4, the spinous processes angle downward from their vertebral body and overlies the vertebral body and rib below 12. 3. Scapula or the shoulder blades= they are triangular and are commonly called wings= it is not directly attached to the axial skeleton 2 important processes:a. Acromion - connects with the clavicle laterally at the acromioclavicular jointb. Coracoid the beaklike= points over the top of the shoulder and anchors some of the muscles of the joints (Jarvis:449) 13. REFERENCE LINEANTERIOR CHEST1.Midsternal line= passes throughthe center of thesternum2. Midclavicular line=an imaginary linethat descends fromthe middle of theclavicle(Smeltzer:447) 14. POSTERIOR CHEST1. Vertebral line= also called spinalline= overlies thespinous processesof the vertebrae2. Scapular line= drops from theinferior angle of thescapula (Bickley:212) 15. LATERAL CHEST1. Anterior axillary line= line extends fromthe anterior axillaryfold where the pectoralismajor muscle inserts2. Posterior axillary line= continues down fromthe posterior axillary foldwhere latissimus dorsimuscle inserts(Smeltzer:477)3. Midaxillary line= runs down from the apexof the axilla and lies betweenand parallel to the othertwo(Jarvis:450) 16. THE THORACIC CAVITYMediastinum is the middle section of thethoracic cavity containing the esophagus,trachea, heart and the great vessels= the right and the left pleural cavities, on eitherside of the mediastinum contains the lungsLungs are two coned-shaped, elastic structuresuspended within the thoracic cavity(Jarvis:457)= are paired but not precisely symmetricstructures 17. = the right lung is shorter than the left lungbecause of the underlying liver= the left lung is narrower than the right lungbecause the heart bulges to the left= at the point of the midclavicular line on theanterior surface of the thorax, the lungextends approximately to the 6 th rib= laterally, lung tissue reaches the level of the 8 thrib 18. = posteriorly, the lung base lies at about the 10 th rib= the right lung has 3 lobes= the left lung has 2 lobes (Jarvis:452) IN A HEALTHY ADULTS, DURING DEEPINSPIRATION, THE LUNGS EXTEND DOWNTO THE 8TH ICS ANTERIORLY AND 12THPOSTERIORLY DURING EXPIRATION, LUNGS RISE TO THE5TH OR 6TH ICS ANTERIORLY AND 10TH ICSPOSTERIORLY ( :300) 19. TRACHEA= is a flexible structure that lies anterior to theesophagus= begins at the level of the cricoid cartilage inthe neck= is approximately 10 to 12 cm long (adult)= help to maintain the shape and prevent itscollapse during respiration (:301) 20. BRONCHI= both bronchi are at an oblique position in themediastinum and enter the lungs at the hilum= the right main bronchus is shorter and morevertical than the left= the left bronchus is narrower and extends atmore of right angle of the trachea The trachea and the bronchi represent deadspace in the respiratory system= they function primarily as a passageway forboth inspired and expired air ( Phipps: 979) 21. LUNGS BORDERSANTERIOR1. Apex extends slightly above the clvicle= highest point of lung tissue is 3- 4 cm above the innerthird of the clavicle2. Base the broad lung area resting on the diaphragm atthe 6th rib in the midclavicular line (Jarvis: 452)POSTERIOR1.C 7 marks the apex of lung tissue2.T 10 usually corresponds to the base= deep inspiration expands the lungs and their lower borderdrops to the level of T12 (Jarvis:450) 22. PREPARATIONINSTRUCTIONS FOR THE PATIENT MUST BE CLEAR AND WITH COURTESY1. Draping2. Position3. Other provisions to ensure further comfort Provide warm room and conducive for examination= well lighted= well ventilated Provide privacy Wash your hands but be sure hands are not cold The diaphragm of your stethoscope must warm Request your client to empty his/her bladder Examination must not be interrupted 23. II. Observe for Chest Configuration Does the chest move equally on the twosides? Does breathing appear distressing? Is it noisy? Is breathing regular? Is there any prolongation of expiration? 24. INSPECTION=Thorax provides information about the musculoskeletalstructure, patients nutritional status, and respiratorysystem= the nurse must observe the skin over the thorax for color andturgor and for the evidence of loss of subcutaneoustissue= it is important to note symmetry, if present= when findings are recorded, anatomic landmarks are used aspoint of reference (Smeltzer:476)I. observe respiration1.Rate: normal, above normal. Below normal2.Rhythm: regular, irregular3.Depth: normal, deep, shallow4.Effort: use of accessory muscles 25. II. Observe for Chest Configuration Does the chest move equally on the twosides? Does breathing appear distressing? Is it noisy? Is breathing regular? Is there any prolongation of expiration? 26. 1. Barrel chest results as a result of ossification ofthe lungs= increase in the anteroposterior diameter of the thorax= patient with emphysema, the ribs are more widelyspace and the ICS tend to buldge on expiration2. Funnel chest (Pectus Excavatum) occurs whenthere is a depression in the lower portion of thesternum= this may compress the heart and the great vesselsresulting in murmurs= may occur with rickets or Marfans syndrome 27. 3. Pigeon chest (Pectus Carinatum) may occur asa result of displacement of the sternum= there is an increase in the anteroposteriordiameter= may occur with rickets, Marfans syndrome orsevere kyphoscoliosis4. Kyphoscoliosis characterized by elevation of thescapula and the corresponding S-shaped spine= this deformity limits lung expansion within thethorax= may occur with osteoporosis and other skeletaldisorders that affect the thorax (Smeltzer:476) 28. BREATHING PATTERNS AND RESPIRATORY RATENormal adult 12-19 breaths per minute (rate) 500-500 ml (depth) air moving in and out/respiration even (pattern)Ratio of pulse to respiration = 4:11. Eupnea normal breathing at 12-19 breaths/min2. Bradypnea slower than normal, less than breaths/min with normal depth and regular rhythm= associated with increase ICP, brain injury, and drug overdose3. Tachypnea rapid, shallow breathing, more than 24breaths/min= commonly seen in patient with pneumonia, pulmonaryedema. Metabolic acidosis, septicemia, severe pain andrib fracture 29. 4. Hyporventilation shallow, irregular breathing5. Hyperventilation increased rate and depth ofbreathing= associated with severe acidosis of diabetic, renalorigin (Kausmaul breathing)6. Apnea period of cessation of breathing= time of duration varies= may occur briefly during other breathing disorderssuch as sleep apnea= if sustained, apnea is life-threatening 30. 7. Cheyne stokes characterized by alterna