RLENCM101 – HEALTH A.

(MIDTERM REVIEWER)
LUNGS AND THORAX
INTRODUCTION
•The lungs are a major organ that is
part of the respiratory system.
•Taking in fresh air and getting rid
of old, stale air.
•This mechanism of breathing also
helps to allow you to talk.
•by taking in fresh air, the lungs are
able to help oxygenate blood to be
carried around your body.
• This is done by inhaling the air
and bringing it in toward the
pulmonary capillaries, which then
become oxygen-filled cells that
help with respiration.
ANATOMY OF THE LUNGS
STRUCTURE
•They are the mediastinal surface,
diaphragmatic surface, and costal
surface.
•Lungs are protected by pleura, a
thin layer of tissue that provides
cushion and a small amount of
fluid to help the lungs breathe
smoothly.
•Inside the lungs are bronchi—
tubes that run from the trachea into
each lung.
•The bronchi branch off into
smaller tubes called bronchioles
which help air reach the alveoli,
which are tiny air sacs in each lung.
•There are approximately 30,000
bronchioles in each lung and 600
million alveoli in each lung
combined.

•There are two lungs (a right and

left) in the body, but they are
different sizes.
•The right lung is bigger and is
divided into three lobes (separated
by fissures),
•while the left lobe is smaller
consisting of two lobes.
•The left lobe is also smaller as it
has to make room for the heart.

•The left and right lungs are

suspended by the lung root and
separated by a mediastinum, a
partition between the two.
•Each lung has three surfaces,
named after their location in the
thorax.
•The lungs also consist of
pulmonary arteries, pulmonary
veins, bronchial arteries, as well as
lymph nodes.
•While most arteries carry
oxygenated blood to the tissues
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
and veins carry deoxygenated
blood back, this is reversed in the
lungs.
• Deoxygenated blood is sent from
the right ventricle of the heart to
the lungs via the pulmonary artery.
•The blood is oxygenated in the
lungs and exits through the
pulmonary vein to the left side of
the heart, where it is pumped out
to the circulate through the body.
•Bronchial arteries, which stem
from the aorta, get blood supply to
fuel areas like the bronchi, lung
roots, and surrounding structures.
FUNCTION OF THE LUNGS
• The lungs are responsible for
bringing in fresh air into the body.
• As you breathe in the diaphragm
helps move air up into the lungs by
tightening its muscles (relaxing
pushes air out).
•Once air enters the lungs by way
of the mouth and nose (with the
help of mucus which traps dust
and dirt from entering with the air),
the air travels through the trachea
and into the bronchi, filling up
alveoli.
• From there, air travels to the
blood vessels surrounding the
alveoli.
• The red blood cells release
carbon dioxide and exchange it for
oxygen,
• Which binds to hemoglobin
molecules.
• The oxygenated blood circulates
through the body.
• Carbon dioxide and other gases
the body doesn’t need are exhaled
out by the lungs.
• The act of the lungs exhaling is
also what helps you speak.
• The exhaled air goes back through
the trachea to the larynx and finally
the vocal cords, making them
vibrate and produce sound.
ANATOMY OF THE THORAX
•Thoracic cavity is a space in your
chest that contains organs, blood
vessels, nerves, and other important
body structures.
• It’s divided into three main parts:
right pleural cavity, left pleural
cavity and mediastinum.
• The five organs in your thoracic
cavity are your heart, lungs,
esophagus, trachea and thymus.
• Thoracic cavity’s boundaries at
different locations within your chest:
• TOP BOUNDARY: the top
boundary is your superior thoracic
aperture (also called your thoracic
inlet or thoracic outlet).
• This is an opening at the base of
your neck that connects your neck
with your chest.
• Your esophagus and trachea pass
through this opening to enter your
thoracic cavity.
• Many blood vessels, nerves and
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
other structures also pass through
it.

• BOTTOM BOUNDARY: The bottom

boundary is your diaphragm. This is
a dome-shaped muscle that sits
just beneath your heart and lungs.
• Your diaphragm is what separates
your thoracic cavity from your
abdominal cavity.
• Several blood vessels, nerves
and tissues pass through your
diaphragm as they travel between
your chest and belly.
• These include your aorta,
esophagus and vagus nerve.

• FRONT BOUNDARY: The front

boundary is your sternum
(breastbone). This is a long,
vertical bone that extends down
the middle of your chest.

• BACK BOUNDARY: Your back

boundary is your thoracic spine.
This is the middle section of your
spine, which extends from the base
of your neck to the bottom of your
ribcage.
• BOUNDARY AROUND THE SIDES:
These are your ribs. You have 12
pairs of ribs that wrap around the
sides of your body and protect the
structures inside your chest
cavity.
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
BREAST AND AXILLAE

BREAST AND AXILLAE

ASSESSMENT

• Is a step-by-step method that

can be conducted at least once a
month to detect signs of infection
and breast cancer.
• A regular time is best such as,
immediately following
menstruation, when breast
tenderness and fullness have
subsided, or on the first day of the
month.
ANATOMY
THE ROUGH BOUNDARIES OF THE
BREAST ARE AS FOLLOWS:
1. Superior aspect of the breast is
bounded by the clavicle
2. Inferiorly by the inframammary
crease ("bra line")
3. Medially by the sternum
4. Laterally by the axilla

• The breast is made up of milk-

producing glands that are arranged
into units known as lobules.
• These glands are connected via a
series of ducts that ultimately join
up to form a common drainage
path, terminating at the nipple.
• The nipple is surrounded by a ring
of pigmented tissue known as the
areola. RISK FACTORS
• Fibro-elastic and fatty tissue
NON-MODIFIABLE
support the rest of the structure
• Age
and allow the breast to maintain its
• Gender
distinctive shape.
• Race/ Ethnicity
• The breast lies on top of the
• Family History
pectoral muscle, which rests on
• Genes
the thoracic cage.
• High breast density
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
MODIFIABLE
• Weight
• Alcohol use
• Sedentary lifestyle
SIGNS AND SYMPTOMS
• Lumps or thickening
• Indentions, rippling, and dimpling
• Asymmetry of nipples
• Discoloration
• Discharge from the nipple
• Any change in the size or shape of
the breasts
HEART AND VASCULAR
WHAT IS THE FUNCTION OF THE
HEART?
• Its primary function is to propel
oxygen-rich blood to every tissue
and organ
• while simultaneously collecting
oxygen-depleted blood for
purification.
PUMPING ACTION
• The heart operates on a dual-
pump system, consisting of the
right and left sides, each with a
specific role.
• The right side receives
deoxygenated blood from the body
via the veins and pumps it to the
lungs for oxygenation.
• Meanwhile, the left side receives
oxygenated blood from the lungs
and pumps it out to the rest of the
body.
BLOOD CIRCULATION
• Blood enters the heart through
two main pathways: the venous
system, carrying deoxygenated
blood,
• and the pulmonary system,
carrying oxygenated blood.
• The heart efficiently channels
these two streams, ensuring that
oxygen-rich blood is distributed to
tissues and organs while carbon
dioxide and other waste products
are removed.
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
REGULATION OF BLOOD ANATOMY OF THE HEART
PRESSURE
OUTSIDE OF HEART
• The heart works in tandem with
the blood vessels and the nervous
system to regulate blood pressure.
• Through subtle adjustments in
heart rate and the force of
contraction,
•the heart can adapt to changing
demands.
• maintaining optimal blood
pressure to support vital
functions.

TRANSPORTATION OF NUTRIENTS
AND WASTE
• In addition to oxygen and carbon
dioxide, the blood carries essential
nutrients, hormones, and immune INSIDE OF HEART
cells to various parts of the body.
• The heart plays a crucial role in
ensuring the timely delivery of
these substances to cells while
facilitating the removal of
metabolic waste products.

ELECTRICAL CONDUCTION
• The heart's rhythmic
contractions are orchestrated by a
specialized conduction system
that generates electrical impulses.
• These impulses coordinate the
sequential contraction of the heart CARDIAC CYCLE
chambers,
• refers to the filling and emptying
• ensuring efficient blood flow with
of the heart’s chambers.
each heartbeat.
•The cardiac cycle has two
phases:
• Diastole (relaxation of the
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
ventricles, known as filling)
• and systole (contraction of the
ventricles, known as emptying).
HEART SOUNDS
• Heart sounds are produced by
valve closure.
• The opening of valves is silent.
• Normal heart sounds,
characterized as “lub dubb” (S1
and S2), and occasionally extra
heart sounds and murmurs can be
auscultated with a stethoscope
over the precordium,
• the area of the anterior chest
overlying the heart and great
vessels.
• The first heart sound (S1) is the
result of closure of the AV valves:
• the mitral and tricuspid valves.
• S1 correlates with the beginning of
systole.
• S1 (“lub”) is usually heard as one
sound but may be heard as two
sounds. 21-4).
• If heard as two sounds, the first
component represents mitral valve
closure (M1); the second
component represents tricuspid
closure (T1).
• M1 occurs first because of
increased pressure on the left side
of the heart and because of the
route of myocardial
depolarization.
• S1 may be heard over the entire
precordium but is heard best at the
apex (left MCL, fifth ICS).
• The second heart sound (S2)
results from closure of the
semilunar valves (aortic and
pulmonic) and correlates with the
beginning of diastole.
• S2 (“dubb”) is also usually heard
as one sound but may be heard as
two sounds.
• If S2 is heard as two sounds, the
first component represents aortic
valve closure (A2) and the second
component represents pulmonic
valve closure (P2).
• A2 occurs first because of
increased pressure on the left side
of the heart and because of the
route of myocardial
depolarization.
• If S2 is heard as two distinct
sounds, it is called a split S2.
• A splitting of S2 may be
exaggerated during inspiration and
disappear during expiration.
• S2 is heard best at the base of the
heart.
EXTRA HEART SOUNDS
• S3 and S4 are referred to as
diastolic filling sounds, or extra
heart sounds, which result from
ventricular vibration secondary to
rapid ventricular filling.
• If present, S3 can be heard early in
diastole, after S2. S4 also results
from ventricular vibration but,
contrary to S3,
• the vibration is secondary to
ventricular resistance
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
(noncompliance) during atrial which heart sounds radiate to the
contraction. chest wall.
• If present, S4 can be heard late in • Sounds always travel in the
diastole, just before S1. S3 is often direction of blood flow.
termed ventricular gallop, and S4
TRADITIONAL AREAS TO
is called atrial gallop.
AUSCULATATION
MURMUR
AORTIC AREA:
• Blood normally flows silently Second intercostal space at the
through the heart. right sternal border - the base of
• There are conditions, however, the heart
that can create turbulent blood
PULMONIC AREA:
flow in which a swooshing or
second / third intercostal space
blowing sound may be auscultated
over the precordium. at the left sternal border - the
• Conditions that contribute to base of the heart
turbulent blood flow include (1) ERB’S POINT:
increased blood velocity, (2) Third to fifth intercostal space at
structural valve defects, (3) valve the left sternal border
malfunction, and (4) abnormal MITRAL (APICAL):
chamber openings (e.g., septal Fifth intercostal space near the
defect). left mid-clavicular line - the apex
WHERE TO AUSCULTATE of the heart
TRICUSPID AREA:
• Heart sounds can be auscultated
Fourth / fifth intercostal space at
in the traditional five areas on the
the left lower sternal border
precordium,
• which is the anterior surface of
the body overlying the heart and
great vessels.
• The traditional areas include the
aortic area, the pulmonic area,
Erb’s point, the tricuspid area, and
the mitral or apical area.
• The four valve areas do not
reflect the anatomic location of
the valves.
• Rather, they reflect the way in
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
NECK VESSELS
• Assessment of the
cardiovascular system includes
evaluation of the vessels of the
neck:
• The carotid artery and the jugular
veins Assessment of the pulses of
these vessels reflects the integrity
of the heart muscle.
CAROTID ARTERY PULSE
• The right and left common carotid
arteries extend from the
brachiocephalic trunk and the
aortic arch and are located in the
groove between the trachea and
the right and left
sternocleidomastoid muscles.
• Slightly below the mandible, each
bifurcates into an internal and
external carotid artery.
• They supply the neck and head,
including the brain, with
oxygenated blood.
• The carotid artery pulse is a
centrally located arterial pulse.
• Because it is close to the heart,
the pressure wave pulsation
coincides closely with ventricular
systole.
• The carotid arterial pulse is good
for assessing amplitude and
contour of the pulse wave.
• The pulse should normally have a
smooth, rapid upstroke that occurs
in early systole and a more gradual
downstroke.
JUGULAR VENOUS PULSE AND
PRESSURE
• There are two sets of jugular
veins: internal and external.
• The internal jugular veins lie
deep and medial to the
sternocleidomastoid muscle.
• The external jugular veins are
more superficial; they lie lateral to
the sternocleidomastoid muscle
and above the clavicle.
• The jugular veins return blood to
the heart from the head and neck
by way of the superior vena cava.
• Assessment of the jugular
venous pulse is important for
determining the hemodynamics of
the right side of the heart.
• The level of the jugular venous
pressure reflects right atrial
(central venous) pressure and,
usually, right ventricular diastolic
filling pressure.
• Right-sided heart failure raises
pressure and volume, thus raising
jugular venous pressure.
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
ABDOMINAL ASSESSMENT
Abdomen is bordered superiorly by
the costal margins, inferiorly by
the symphysis pubis.
ANATOMY OF THE ABDOMEN
ABDOMINAL WALL MUSCLES
The abdominal wall is composed
of layers of muscle and fascia,
• rectus abdominis
• external oblique
• internal oblique
• transversus abdominis muscles
These muscles provide support and
protection to the abdominal
organs and assist in movements
such as bending and twisting
INTERNAL ANATOMY
SOLID VISCERA
Liver
pancreas
spleen
adrenal glands
kidneys, ovaries
uterus.
HOLLOW VISCERA
Stomach
gallbladder
small intestine
colon
bladder
NERVOUS SYSTEM
• The abdomen is innervated by the
autonomic nervous system,
• which controls involuntary
functions such as digestion and
regulates blood flow.
• The vagus nerve plays a
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
significant role in transmitting
signals between the brain and
abdominal organs.
VITAL ORGANS
STOMACH
Responsible for breaking down food
and releasing it to the small
intestine.
SMALL INTESTINE
Where most of the digestion and
absorption of nutrients occur.
LARGE INTESTINE (COLON)
Absorbs water and salts from
undigested food and forms feces.
LIVER
Performs various functions,
including detoxification,
metabolism of nutrients, and
production of bile.
GALLBLADDER:
Stores and concentrates bile
produced by the Liver, releasing it
into the small intestine to aid in
digestion.
PANCREAS: Produces digestive
enzymes and hormones such as
insulin and glucagon, which
regulate blood sugar levels.
SPLEEN
Part of the immune system, involved
in filtering blood and fighting
infections.
KIDNEYS
Filter blood to remove waste
products and excess fluids,
producing urine.
FUNCTIONS OF THE ABDOMEN
1. DIGESTION: The abdomen
houses many organs involved in
digestion, including the stomach,
liver, gallbladder, pancreas, and
intestines. These organs work
together to break down food and
absorb nutrients.
2. STORAGE: The abdomen provides
space for the storage of essential
organs such as the liver, which
stores glycogen, vitamins, and
minerals, and the intestines, which
store waste until it can be
eliminated.
3. PROTECTION: The abdomen
protects vital organs such as the
liver, kidneys, and intestines from
injury and trauma. The abdominal
muscles also provide support and
stability to the spine and pelvis.
4. CIRCULATION: Blood vessels in
the abdomen supply oxygen-rich
blood to the organs and tissues,
while veins carry oxygen-depleted
blood back to the heart and lungs
for oxygenation.
5. HORMONE REGULATION:
Organs in the abdomen, such as the
pancreas, produce hormones That
regulate blood sugar levels,
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
metabolism, and other important
bodily functions.
6. IMMUNE FUNCTION: The
abdomen contains lymph nodes
and tissues that help to defend the
body against infection and disease.
ANATOMIC DIVISIONS OF THE
ABDOMEN
ABDOMINAL QUADRANT
• Right Upper Quadrant (RUQ)
• Left Upper Quadrant (LUQ)
• Right Lower Quadrant (RLQ)
• Left Lower Quadrant (LLQ)
NINE REGIONS
Regions: The abdomen can also be
divided into nine regions:
• Right hypochondriac, epigastric,
left hypochondriac
• Right lumbar, umbilical, left
lumbar
• Right iliac (inguinal), hypogastric
(pubic), left iliac (inguinal)
ABDOMINAL EXAMINATION
• The abdominal examination is
the portion of the physical exam
evaluating the abdomen for signs
of disease.
• Along with information from the
history, the information gathered
from the physical examination of
the abdomen is used by the
physician to generate a differential
diagnosis and treatment plan for
the patient.
ASSESSMENT TECHNIQUES
INSPECTION: Contour, symmetry,
skin color, scars, masses, or visible
pulsations.
AUSCULTATION: Frequency,
intensity, and quality of sounds in all
quadrants.
PERCUSSION: assess the density of
underlying organs and detect areas
of fluid or air accumulation.
PALPATION: tenderness, masses,
organ enlargement, and abnormal
pulsations.
FREQUENCY OF BOWEL SOUNDS
Normoactive: 5–30 sounds per
minute
Hypoactive: < 5 sounds per minute
Hyperactive: > 30 sounds per
minute
Absent: no bowel sounds after 3
minutes of listening
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
TYMPANY AND DULLNESS • Body posture is assessed for
normal standing and sitting
Tympany: sounds like a drum, heard
positions.
over air-filled structures.
Dullness: sounds like a quiet thud, TREMORS
heard over fluid or solid organs.
An involuntary trembling of a limb
or body part.
• Intention Tremor
MUSCULOSKELETAL ASSESSMENT
• Resting Tremor
MUSCULOSKELETAL SYSTEM • Fasciculation Tremor

DEFINITION: A human body system

that provides the body with
movement, stability, shape, and
support

FUNCTION:
(1) MUSCLE - movement
production, joint stabilization,
maintaining posture and body heat
production.
(2) BONES - mechanical basis for
movement, provides framework for
the body, protects vital organs,
blood cells production and storage
of minerals.
• The nurse usually assess the
musculoskeletal system for
muscle, strength, tone, size, and
symmetry of muscle
development, and for tremors.
•Bones are assessed for normal
form.
• Joints are assessed for
tenderness, swelling, thickening,
crepitation (a crackling, grating
sound), and range of motion.
BONES - 206 bones
CARTILAGE - cushion, covers the
ends of 2 bones
LIGAMENTS - tissue that joins bone
to other bones
TENDONS - connective tissue that
attach muscle to bones
JOINTS - where two bones work
together
MUSCLES - movement of the body
BONES
• hold body upright
• protect internal organs
• help body movement
• made of collagen and calcium
phosphate
• undergo bone remodelling as
people age
• bone marrow = new blood cells
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
CARTILLAGE, LIGAMENT, TENDON
• Cartilage - cushion, covers the
ends of 2 bones
• Ligaments - tissue that joins bone
to other bones
• Tendons – connective tissue that
attach muscle to bones
JOINTS
• Joints connects bone to one, and
allows them to move.
•3 types of Joints:
Synovial
Cartilaginous
Fibrous
A. FIBROUS JOINTS
Fibrous joints allow no movement
just stability. They are held
together by strong fibrous
connective tissue. You have
fibrous joints in your skull.
B. CARTILAGINOUS JOINTS
Joints in the spine, pelvis and
between the ribs and the sternum
are cartilaginous joints. They
provide more stability but not as
much movement. There are two
types of cartilaginous joints in the
human body.
a. Symphyses
b. synchondrosis
RLENCM101 – HEALTH A. (MIDTERM REVIEWER)
SYMPHYSES

The bones are joined by

fibrocartilage (growing together)
and the joints between vertebral
bodies.

At the pubic symphysis, the pubic

portions of the right and left hip
bones of the pelvis are joined
together by fibrocartilage across a
narrow gap. DIFFERENT TYPES OF JOINTS

SYNCHONDROSIS a. PIVOT JOINT – between C1 and

In a synchondrosis, the bones are
connected or joined by hyaline
cartilage. These joints are
immovable.
Examples of permanent
synchondroses are found in the
first sternocostal joint of the
thoracic cage.
C. SYNOVIAL JOINTS
Cs vertebrae
b. HINGE JOINT- elbow
c. SADDLE JOINT- between
trapezium carpal bone and 1st
metacarpal bone
d. PLANE JOINT- between tarsal
bone
e. CONDYLOID JOINT- between
radius and carpal bone of wrist
f. BALL AND SOCKET JOINT - hip

Contain a space between the

bones that is filled with synovial
fluid; a lubricant that promotes a
sliding movement of the ends of
the bones. e.g. shoulders, wrists,
hips, knees, ankles.

Contain bursae, which are small

sacs filled with synovial fluid that
serve to cushion the joint.