RESPIRATORY SYSTEM (LECTURE)

ASSESSING THORAX & LUNGS

ASSESSING THORAX & LUNGS

STRUCTURE & FUNCTION

THORACIC CAVITY

-contains the distal portion of

trachea, lungs, bronchi,
bronchioles, alveoli (lower
respiratory system)

-lined by a thin, double- layered

serous (pleural membrane)

Thoracic cage - outer structure of

the thorax
ASSESSING THORAX & LUNGS

STRUCTURE & FUNCTION LUNG/S - is a two cone-shaped,

elastic structure suspended
within the thoracic cavity

-paired, not complete symmetric,

the right lung contain 3 lobes,
whereas the left lung contain
only 2 lobes

-apex of each lung extended

slightly above the clavicle, where
the base is at the level of
diaphragm
Mechanics of Respiration

4 Major Functions of the Respiratory System

1. Supply O2 for energy production

2. Remove CO2 , waste product of energy reactions

3. Homeostasis, acid-base balance of arterial blood

4. Heat exchange
 Respiration = breathing
• Inspiration – air rushes into the lungs as the
chest size increases

• Expiration – air expelled from the lungs as it

recoils

 CONTROL OF RESPIRATION

• Involuntary control by
respiratory center in the brain
stem consisting of the pons &
medulla

• Hypercapnia is an ↑ in CO2 in
the blood

• Hypoxemia – Decrease O2 in the

blood (increase respiration)

• Activity of respiratory muscles

is transmitted to & from the
brain by: Phrenic nerve &
Intercostal nerves
• Respiration maintains pH ( acid- base balance) of the
blood by supplying O2 & eliminating CO2.

• Normal Range Values of Arterial Blood Gases

• pH= 7.35- 7.45

• Pa CO2 = 35-45mmHg

• PaO2 = 80-100mmHg

• SaO2 = 94-98%

• Lungs help to maintain the pH balance by adjusting the

amount of CO2 through:

• Hypoventilation (slow shallow breathing), CO2 built up in the

blood

• Hyperventilation (rapid deep breathing) ,CO2 to be blown off

NOTE RESPIRATORY RATE

▸ Normal Adult- 12-20 cpm

▸ Pattern: even, coordinated, regular with occasional

sighs

▸ Men, children, singers, athletes: abdominal/

diaphragmatic breathing

▸ Women: Chest/ intercostal breathing

TEXT
 RESPIRATION PATTERNS

Type Description Pattern Clinical Indication

12-20 breaths/
Normal Normal breathing pattern
min ; regular

>24 breaths/ min; N-fever, anxiety, excercise

Tachypnea
shallow *respiratory insufficiency

N-athletes
<10 breaths/ min;
Bradypnea *medication induced, diabetic
regular
coma, neurologic damage
Extreme exercise, fear/anxiety;
Hyperventilation > rate & depth CNS disorders, severe anxiety,
salicylate overdose
<rate & depth;
Hypoventilation Narcotics/ anesthetics overdose
irregular pattern

Increasing
COPD, air trapped in the lungs
Air trapping difficulty in
during forced expiration
getting breath out
RESPIRATION PATTERNS

▸Apnea
▸absence of breathing
▸Stroke, head injury, deceased patient
Apneustic – prolonged, gasping inspiration followed by
extremely short, inefficient expiration
Biot’s - faster & deeper respirations than normal, with abrupt
irregular pauses in between
Kussmaul’s – rapid and deep without pauses;
hyperventilation associated with DKA
Cheyne-Stokes - alternating episodes of apnea and
periods of deep breathing
THORACIC CAGE

shape- bony, conical,

narrower at top borders – it
is defined by:
▪ Sternum
▪ Ribs – 12 pairs, 1st seven
attach to the sternum. Ribs
8,9,&10 attach to the
costal cartilage above, Ribs
11 & 12 are floating ribs
▪ 12 Thoracic vertebrae
▪ Diaphragm – the floor,
separates the thoracic
cavity from the abdomen
 ANTERIOR THORACIC LANDMARKS
▸ Suprasternal Notch – U shaped depression
▸ Sternum –“breastbone” - 3 parts (manubrium, body, xiphoid process)

▸ Angle of Louis – manubriosternal angle continuous with the 2nd Rib

▸ Costal angle- usually 900 or <. (increases when rib cage is chronically
overinflated)
POSTERIOR THORACIC LANDMARKS

▸Vertebra Prominens – Flex

head, feel most prominent
bony projection at base of
neck = C7 next lower one is T1

▸Spinous Processes – spinal

column

▸Scapula – symmetrical , lower

tip at the 7 -8th Rib

▸12th Rib = midway b/t spine &

scapula
THORACIC DEFORMITIES AND CONFIGURATION

Normal Chest
Barrel Chest
✓ rounded, bulging
chest that
resembles the
shape of a barrel

✓ Shows little
movement on
respiration
Pigeon Chest (pectus carinatum)

✓ Protrusion of the sternum and ribs

✓ Giving a bird-like appearance
Funnel Chest (Pectus excavatum)
✓ A caved-in or sunken
appearance of the chest

✓ Less space in the chest , can

limit heart and lung functions
Thoracic Kyphoscoliosis

✓Combination of kyphosis
(hunchback) and scoliosis (C or
S curve)

✓Limits lung expansion

Paradoxical Chest
Movement – “flail chest”


- life-threatening medical
condition that occurs
when a segment of the
rib cage breaks under
extreme stress and
becomes detached from
the rest of the chest wall
DEVELOPMENT VARIATIONS

INFANTS

❑Obligatory nose breathers

❑Respirations are primarily abdominal, & breath sounds are louder,

harsher & more bronchial

❑Respiratory rhythm is often irregular, with brief periods of apnea

(< 20 seconds)

❑Shape of chest is more round than oval, ribs in horizontal position

❑Newborns: 40-60 cpm

❑Infants: 30-40 cpm

Grunting- short, deep sound
Subcostal retractions - undraping of the abdomen
just below the rib cage; “belly breathing”
Sternal Retraction - condition in which the
breastbone retracts in toward the chest with breathing
PREGNANT WOMEN
▸20% increase in oxygen consumption

▸Diaphragm rises & costal angle widens to

accommodate the enlarging uterus
 OLDER ADULTS
▸Fibrotic alveoli – decrease surface
area for gas exchange

▸Breathing & lung capacity

decrease as a result of muscle
weakness & decreased elasticity

▸Weakening of intercostal muscle

& softening of rib cartilage -
Increase in anteroposterior
diameter

▸barrel chest

▸Mild kyphosis
CULTURAL VARIATIONS

▸Chinese Americans – smaller chest than Caucasians

or African Americans

▸African Americans in urban areas have a higher risk

of respiratory disease

▸Irish – higher risk for respiratory problems (coal

mining)

▸Navajo Indians – increased risk for respiratory disease

(close living quarters)
RESPIRATORY PROBLEM SYMPTOMS
DYSPNEA

▸ Subjective sensation of breathing

difficulty (DOB)

▸ Often described as SOB

▸ May be normal with overexertion

or anxiety

▸ Signal underlying
cardiopulmonary, neuromuscular
problem or allergic reactions
(+) DYSPNEA….COLDSPA
Characteristics: Describe the difficulty breathing
- COPD- not being able to “breathe or take a deep breath.”
- Anxious - feeling suffocated with tingling in the lips

Onset: When did it begin? Gradual=lung changes; sudden = viral or bacterial

Duration: How long did the dyspnea last?

- + continuous coughing (“smoker’s cough”) with lots of sputum, wheezing
- Asthma: + wheezing, frequent cough (mucous), and chest tightness

Severity: Dyspnea with activity; nonstrenuous activity

Palliative/Aggravating factors: What aggravates or relieves the dyspnea? Do any

specific activities cause the difficulty breathing? Do you have difficulty breathing when
you are resting/ sleeping? Do you snore when you sleep?
- Dyspnea can occur with stress and anxiety.

Associated Factors: Do you experience any other symptoms when you have difficulty
breathing? - Edema, angina, orthopnea, Paroxysmal nocturnal dyspnea
CHEST PAIN

▸Associated with the

parietal pleura, chest
wall & mediastinal
structures

▸Lungs & visceral pleura

do not have pain fibers
COUGH

❑Common respiratory complaint

❑Protective, reflexive mechanism that helps maintain a

patent airway

❑When and how often?

❑Sputum production, color, amount

❑ Wheezing
EDEMA

▸ Result from from right

side congestive heart
failure – complication of
chronic obstructive lung
disease (COPD)

▸ Located in lower
extremities

▸ or abdomen
FATIGUE

▸Hypoxia

▸People adapt to fatigue by

lowering activity (ADL)

▸Changes in rest & sleep

GASTROINTESTINAL SYMPTOMS

▸ Heartburn, frequent hiccups, chronic cough

▸ 75% of clients with asthma have GERD

PERTINENT HISTORY FINDINGS
▸ History of respiratory disease (medications); frequent URI

▸ Other medical problems (cardiac); GI Symptoms

▸ Family history of smoking & lung Cancer

▸ Allergy (reaction)

▸ Cough, SOB, chest pain

▸ Tobacco use ( kind, how much, how long)

▸ Occupation

▸ Address

▸ Last PPD (result)

▸ Chest X ray

▸ Immunization