Exam (elaborations)
NSG 521 FUNDAMENTALS UNIT 7 DISORDERS OF THE THORAX, LUNGS, BREASTS AND AXILLAE
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NSG 521 FUNDAMENTALS UNIT 7 DISORDERS OF THE THORAX, LUNGS, BREASTS AND AXILLAE...
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Structure and Function ThoraxProper functioning of the thorax and lungs—proper respiration and breathing—
is vital to survival. The nursing assessment is designed to evaluate how well the
lungs and breathing are functioning. Specific respiratory symptoms include
shortness of breath, coughing, sputum production, and chest discomfort.
Objective data describe the correct techniques for assessing breathing and
identifying normal and abnormal breath sounds. Auscultation is performed
during a complete physical examination and is also part of an ongoing
assessment. Although challenging, lung auscultation provides important
information to assist the nurse in identifying accurate nursing diagnoses, patient
outcomes, and interventions.
True
Structure and Function: Foundation for Assessment
Structurally, the respiratory system is divided into upper and lower portions.
The upper portion warms moisturizes, and transports air to the lower portion,
where oxygenation and ventilation occur.
TrueRead More
Thorax
Visual
Lobes of the Lung
Visual
CLINICAL SIGNIFICANCE
It is important to note that the RML is auscultated using an anterior approach,
although a small portion of it can be auscultated laterally. Accurate auscultation
of the RML can be challenging in women, however, because of its location
underlying the right breast.
, True
Lobes of Lung
True
SAFETY ALERT
The apex of each lung rises above the clavicle, where lung sounds are audible.
When a central venous catheter is being inserted through the chest wall, the
needle may accidentally nick the lung apex, causing a pneumothorax (collapsed
lung). Therefore, it is essential to auscultate and compare lung sounds in each
apex following this procedure.
True
SAFETY ALERT
The structure of the right mainstem bronchus makes it more susceptible to
aspiration and unsuccessful endotracheal intubation. This occurs when the tube
is inserted too far and enters the right bronchus, essentially blocking off the left
lung. This is why lung sounds are always auscultated after a patient is
intubated; if sounds are heard only on the right side, the tube is slowly
withdrawn until sounds are heard equally on both sides, confirming correct
placement.
True
Mechanics of Respiration
Respiration is primarily an automatic process initiated by the respiratory center
of the brainstem (pons and medulla) based on cellular demands (Moini, 2016).
The main trigger for breathing is an increased level of carbon dioxide in the
blood. Decreased oxygen or increased acidity also may stimulate breathing.
Some medications (e.g., drug overdoses, opiates, and sedatives) may reduce the
ability of the brain to trigger breathing, causing hypoventilation (slow
breathing) or apnea (no breathing at all). Anxiety or brain injury may stimulate
breathing, causing hyperventilation (fast breathing).
Mechanics of Breathing
When breathing is triggered, the diaphragm contracts and flattens, pulling the
lungs down. The thorax and lungs elongate, increasing the vertical diameter.
The external intercostal muscles open the ribs and lift the sternum, and the
anteroposterior diameter of the thorax increases. With increased thoracic size,
pressure within the thorax is less than pressure in the atmosphere. As a result,
approximately 500 to 800 ml of air enters the lungs with each breath in adults
(Broaddus et al., 2016).
Expiration is primarily a passive process. Because the diaphragm, internal
intercostal muscles, and abdominal muscles relax, pressure in the lungs is
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