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Lungs & Respiratory System


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process of moving gas in and out of the lungs with inspiration and expiration
movement of O2 and CO2 from an area of high concentration to low concentration across the alveolar capillary membrane to the pulmonary capillaries
structures w/in thorax
mediastinum, right and left pleural cavities
Mediastinum contains:
heart, aorta, superior vena cava, lower esophagus, and lower part of the trachea
Parietal pleura
protects the chest wall and the diaphragm
Visceral pleura
protects the outside of the lungs
Outer boundaries of lungs
anteriorly: 1.5 inches above first rib into base of the neck

posteriorly: apices rise to about T1, lower borders on deep inspiration expand to approx T12, and rise to T9 on expiration
Rib anatomy
12 pairs of ribs, connect posteriorly to 12 thoracic vertebrae. 7 pairs of ribs attached to sternum anteriorly.

costal cartilage of 8, 9, 10th ribs connect immediately superior to the ribs.

11th & 12th ribs "floating" anteriorly.

Tip of 11th rib in lateral thorax, tip of 12th rib in posterior thorax.
muscle action during inspiration
diapragm contracts and pushes abdominal contents down while intercostal muscles push chest wall outward.

Decreases interthoracic pressure for neg. lung pressure which causes lungs to fill with air.
muscle action during expiration
muscles relax, expelling air as interthoracic pressure rises.
Upper airway consists of
nose, pharynx, larynx, intrathoracic trachea
upper airway functions in respiration
conduct air to the lower airway

protect lower airway from foreign matter

warm, filter, and humidify inspired air
Lower airway consists of
trachea, right and left mainstem bronchi, segmental and subsegmental bronchi, and the terminal bronchioles
Trachea bifurcates where?
at T4/T5. Right bronchus is shorter, wider and more vertical than the left, so aspirated object more likely to lodge on the right.
Bronchi divides to
increasingly smaller bronchioles, each of which opens to an alveolar duct and terminates in multiple alveoli, where gas exchange occurs
costal angle
intersection of the costal margins, should be <90 degrees
vertebra prominens
spinous process of C7, visible and palpable with head bent forward
pack-year history
number of years client has smoked x number of packs of cigarettes smoked each day
highest lung cancer incidence and mortality rate amongst
native american men
tripod position
leaning forward with arms braced on knees, against chair or against a bed, opens up chest cavity in attempt to get more air - a sign of respiratory distress
Antero-posterior diameter to lateral diameter ratio
AP:L 1:2
Barrel chest
abnormal finding
costal angle >90 degrees
increased AP diameter
horizontal ribs

possible indicator of emphysema.
Pectus carinatum
pigeon chest - prominent sternum
Pectus excavatum
funnel chest, sternum indented above xiphoid process
normal rib angle
45 degrees relative to spine
cyanosis or pallor of nails, skin or lips
sign of inadequate oxygenation of tissues caused by underlying respiratory or cardiovascular condition
clubbing of nails
associated with chronic hypoxia
Normal BPM
12-20 (eupnea), smooth, easy and without effort.

chest wall should rise symmetrically. occasional sighing normal (deep breath) but frequent is abnormal.
respiratory rate of less than 12 bpm, still smooth and even
resp. rate of >20 bpm, still smooth and even

can be caused by fever, fear or activity
hyperventilation (hyperpnea)
increased rate AND depth of respiration
Kussmaul breathing
hyperventilation combined with ketoacidosis

deep and laborious
Biot breathing pattern
irregularly placed periods of apnea in disorganized and irregular pattern, rate, or depth.

may be caused by persistent intercranial pressure, resp. distress, or damage to medulla
intervals of apnea interspersed with deep and rapid breathing.

severe illness, brain damage or drug overdose
Air trapping
abnormal resp. pattern

seen in clients with COPD. Rapid inspirations with prolonged, forced expirations. Air not fully exhaled, becomes trapped in lungs, eventually leads to barrel chest.
Trachea not midline
could indicate chest mass, mediastinal shift or some degree of lung collapse
crinkly or crackly sensation under fingers on PE.

indicates air in subcut tissue causes by leak somewhere in resp. tree.
pleural friction rub
felt as coarse, grating sensation during inspiration, secondary to inflammation of pleural surface
assymetric muscle development or unstable chest wall
indicates a thoracic disorder
location to palpate posterior chest wall for thoracic expansion
T9/T10, thumbs on either side of spinous prodesses, extend fingers laterally. Thumbs should move apart symmetrically with deep breaths.
abnormal thoracic expansion findings
unilateral or unequal movement could be caused by pain, Fx ribs or chest wall injury, pneumonia, and/or collapsed lung.
Vocal/tactile fremitus
vibration felt on palpation as a result of vocalization (1,2,3 or 99,99,99)

should be equal bilaterally
abnormal tactile fremitus
absent when vibrations blocked, could be emphysema, pleural effusion, pulmonary edema or bronchial obstruction.

increased when vibrations enhanced - occurs when lung tissue congested or consolidated (pneumonia, tumor)
client position for percussion of thorax posterior
sitting with arms folded in front of them, head bent forward
thorax percussion normal finding
resonance - loud intensity, low pitch, long duration, hollow quality.
client position for percussion of thorax anterior
arms raised above the head, percuss down anterior and lateral aspects of chest moving from side to side
abnormal thorax percussion findings
hyperresonance - overinflation of the lungs. Loud resonance of low pitch, lasts longer than normal and seems booming. Could be emphysema.

Dull tones in pneumonia, pleural effusion, atelectasis.

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