Suprasternal Notch

Sternum (manubrium, body, xyphoid process)

Manubriosternal angle (Angle of Louis)

Costal Angle

Vertebra Prominens = C7

Spinous Processes

Inferior border of Scapula

Right & Left

Contain Lungs

Apex: 3-4 cm above inner third of clavicles

Base: lower border, rests on diaphragm, 6th rib midclavicular line

shorter d/t liver

contains three lobes

oblique fissure and horizontal fissure

narrower d/t heart

contains oblique fissure

5th rib midaxillary line to 3rd intercostal space or 4th rib right sternal border

only on right lung

Visceral: lines lung tissue

Parietal: lines chest cavity

anterior to esophagus, 10-11 cm. in adults

begins at cricoid cartilage, bifurcates just below sternal angle into R & L main bronchi (R main bronchi shorter, wider, & more vertical)

bronchi continue to divide into smaller branches

Supply O₂ to body

Remove CO₂ from body

Maintain homeostasis of arterial blood - compensatory mechanism by adjusting the CO₂ level of blood

Maintain heat exchange

Pons and Medulla

Regulation is by CO₂ and O₂ levels

Normal drive is CO₂

enlarging uterus elevates the diaphrogm 4 cm during pregnancy, decreasing vertical diameter of thoracic cage

decrease compensated for by horizontal diameter (cm increase) and costal angle widens

growing increases O₂ demand on mom, increasing mother's tidal volume, may be interpreted as dyspnea by mother

Costal cartilages become calcified, resulting in less mobile thorax

Respiratory muscle strength declines from 50-70's

Decreased vital capacity, Increased residual volume

Less surface area available for gas exchange

Lung bases become less ventilated, increasing risk of dyspnea with exertion

Increased risk of pulmonary complications (due to decreased ability to cough, loss of protective airway reflexes and increased secretions

Incidence of TB: higher in Asian Americans, especially recent immigrants, incidence peaks within 2 months of entry into U.S.

Risk of TB: 112x higher for Vietnamese, 60x for Filipinos, 37x for Chinese, 28x for Koreans

Size of thoracic cavity in descending order:

whites, blacks, Asians and Native Americans

Premature black infants less at risk for RDS

shape and configuration

-check symmetry

-straight spine?

facial expression: calme, relaxed, pursed lip breathing

level of consciousness: decreased O₂ causes drowsiness, lethargy, restlessness, irritability

respirations: ease, quiet, using accessory muscles?

Pt to exhale and holt it, percuss to dullness and mark location

Pt to deeply inhale and hold it, start at first mark, percuss up and mark

should be = bilaterally ~3-5cm up to 7-8cm in active adults

may be somewhat higher on R side due to presence of liver

Bronchial: high pitched,loud, inspiration < expiration, harsh, hollow, tubular, location: trachea & larynx

Bronchovesicular: moderate pitched, moderately loud, inspiration = expiration, mixed quality, location: over major bronchi

Vesicular: low pitced, soft, inspiration > expiration, rustling like the sound of the wind in trees, location: over peripheral lung fields

adventitious breath sound

secretions, fluid, popping open of previously deflated airways.

• fine: pneumonia, CHF, interstitial fibrosis (like soda fizz)
• coarse: pulmonary edema, pneumonia, pulmonary fibrosis
• atelectatic: disappear after cough, elderly, bedridden patients

AP diameter 1:2

costal angle >90

horizontal ribs

barrel chest due to hyperinflation of the lungs

neck muscles increased

tripod position

cyanosis, capillary refill, clubbing

adventitious breath sound

grating sound - pleuritis accompanied by painful breathing

adventitious breath sound

high or low pitched sound, note timing (inspiration or expiration) - partial obstruction

adventitious breath sound

upper airway crowing sound - croup or epiglottis

Bronchophony: normal finding is muffled "99"

Egophony: normal finding is muffled "e" not "a"

Whispered Pectoriloquy: normal finding is whispered "1,2,3"

Abnormal finding indicative of consolidation or compression of lung tissue