Torace 123
description
Transcript of Torace 123
-
PHYSICAL ASSESSMENT
THE THORAX ANDLUNGS
-
Assessing The Thorax and Lungs
-
Anatomy of the Chest
-
Anatomy of the Chest Chest bones
Sternum Manubrium Xiphoid process Clavicles 12 Pairs of ribs 12 Thoracic
vertebrae Scalpula
-
Chest Landmarks Anatomical
mapping
right anterior axillary line
Right midclavicular line
Midsternal line
-
Chest Landmarks Anatomical
mapping
posterior axillary line
midaxillary line
Anterior axillary line
-
Chest Landmarks
Anatomical mapping
Vertebral line
Scapular line
-
Anatomy of the Lungs Lungs
Right has 3 lobes Left has 2 lobes Oblique fissure divides
upper & lower lobes Trachea
Anterior to esophagus Branches into right & left
bronchi Right wider, shorter,
more vertical (aspiration)
Bronchioles Alveoli
-
Anatomy of the Lungs
Mapping of the lungsAnterior
chest primarily upper lobes
-
Anterior Chest Landmarks
-
Anatomy of the Lungs
Mapping of the lungs Posterior
chestprimarily lower lobes
-
Posterior Chest Landmarks
-
Lateral Chest Landmarks
-
Chest Shape and Size
The adult chest The thorax is oval Anteroposterior diameter is half its
transverse diameter Elliptical Diameter is smaller at the top than at the
base
-
Deformities of the Chest
Pectus Carinatum Pigeon chest May be caused
by rickets Protruding
sternum Narrow
transverse diameter
-
Deformities of the ChestPectus
Excavatum Funnel Chest
Congenital defect
Depressed sternum
Narrow anteroposterior diameter
-
Deformities of the Chest
Barrel Chest Ratio of anteroposterior diameter to
transverse diameter is 1:1 seen in clients with kyphosis and
emphysema
-
Deformities of the Chest
Kyphosis Excessive
convex curvature of the thoracic spine
-
Deformities of the Chest
Lordosis
-
Deformities of the Chest
Scoliosis Lateral
deviation of the spine
-
Normal Breath Sounds Types of breath sounds
Vesicular Low pitch gently sighing Heard over lung fields 5:2 ratio inspiration:expiration
Bronchovesicular Medium pitch Blowing sounds Heard over main bronchus 1:1 ratio inspiration:expiration
Bronchial (tracheal/tubular) High pitch, loud Harsh sounds Heard over trachea 1:1 ratio, maybe 1:2
-
Adventitious Breath Sounds Crackles
Fine short interrupted crackling sounds
Gurgles Continuous, low-
pitched, coarse, gurgling, louder sounds
Friction rub Superficial, grating or
creaking sounds Wheeze
Continuous, high pitched, squeaky musical sounds
-
Normal and Abnormal Breath Sounds
-
Assessing the Thorax and Lungs
1. Introduce self, verify the clients identity and explain the procedure
2. Perform hand hygiene3. Provide for client privacy4. Inquire if the client has any history of
the following: Family history of illness including cancer,
allergies and tuberculosis Lifestyle habits such as smoking Occupational hazards Medications being taken Current problems
-
Assessing the Posterior Thorax
5. Inspect the shape and symmetry of the thorax form posterior to lateral views
6. Inspect the spinal alignment for deformities
Exaggerated spinal curvatures
-
Assessing the Posterior Thorax
7. Palpate the posterior thorax8. Palpate the posterior chest for
respiratory excursion
Full and symmetric chest expansion
Thumbs should move apart an equal distance and at the same time
Normally the thumb separates 3 to 5 cm during deep inspiration
-
Assessing the Posterior Thorax
9. Palpate the chest for vocal (tactile) fremitus
Bilateral symmetry of vocal fremitus
Decreased or absent, or increased fremitus
-
Assessing the Posterior Thorax
Palpating the chest for vocal fremitus using ulnar aspect of the hand
Palpating the chest for vocal fremitus using the palmar surfaces of the fingertips
-
Assessing the Posterior Thorax
10. Percuss the thorax.
Percussion Technique
Determine air, fluid or solid materials in the lungs
Determine the positions and boundaries of certain organs
Penetrates to a depth of 5-7cm (2-3 in)
-
Assessing the Posterior Thorax
Percussion pattern of the Posterior thorax
Percussion notes resonant, except over scapula
Asymmetry in percussion,areas of dullness or flatness over lung tissue
-
Assessing the Posterior Thorax
11. Percuss for diaphragmatic excursion
Excursion is 3 to 5 cm (1 to 2 in. bilaterally in women, 5 to 6 cm (2 to 3 in) in men
Diaphragm is usually slightly higher on the right side
-
Assessing the Posterior Thorax
12. Auscultate the chest using flat-disc diaphragm of the stethoscope
Areas and sequence in aucultating the posterior thorax
Normal Breath sounds
Adventitious breath sounds
Absence of breath sounds
-
Assessing the Anterior Thorax
13. Inspect breathing patterns.14. Inspect the costal angle and the angle and at
which the ribs enter the spine
Costal angle is less than 90 degrees
The ribs insert into the spine at approximately 45 degrees
Costal Angle is widened
-
Assessing the Anterior Thorax
15. Palpate the anterior chest.
16. Palpate for respiratory excursion
Fingers are placed laterally along the lower rib cage, and thumbs along the costal margins
Full symmetric excursion
Thumbs normally separates 3 to 5cm (1 to 2 in)
-
Assessing the Anterior Thorax
17. Palpate tactile fremitus in the same manner as for the posterior chest
Areas and sequence for palpating tactile fremitus on the anterior chest
Fremitus is normally decreased over the heart and breast tissue
-
Assessing the Anterior Thorax
18. Percuss the anterior chest systemetically
Percussion pattern of anterior thorax
Resonance down to the sixth rib at the level of the diaphragm
Flat over the areas of heavy muscles and bone
Dull on the areas over the heart and the liver
Tympanic over the underlying stomach
-
Assessing the Anterior Thorax
19. Auscultate the trachea.20. Auscultate the anterior chest.21. Document findings in the client
record.
-
Lifespan Considerations
I. Infants Thorax is rounded, cylindrical,
anteroposterior equal to transverse diameter
Tends to breath using the diphragm
II. Children 1:2 ratio at 6 years old Breath abdominally than thoracically Should be assessed for scoliosis by
age of 12
-
Lifespan Considerations
III. Elders Kyphosis and osteoporosis alter the size of
cavity Anteroposterior diameter of the chest widens Inspiratory muscles becomes less powerful Expiration may require use of accessory
muscles Elastic tissue of the alveoli loses its
strechability Cilia in the iarwy decerese in number
-
Breathing is so characteristic of life; studying, sleeping, talking, eating and exercising all involve breathing