THORAX & LUNGS.pptx.. in the ncm 103 ...

About the thorax and lungs

1. Thorax & Lungs CAIREL, GALBO, MIRANDA, PANDASIGUE Presented by:

2. Understand the anatomy and physiology of the thorax ang lungs, including respiratory mechanics and gas exchange processes. OBJECTIVES Apply appropriate diagnostic and therapeutic interventions for managing thoracic and pulmonary conditions, promoting optimal respiratory and function and patient well-being. Recognize common thoracic and pulmonary pathologies and their clinical manifestations.

3. Anatomy of Thorax 01

4. THORAX also called the chest superior part of the trunk located between the neck and abdomen. it houses the heart and our lungs encased by the ribs. Consists of several components

5. COMPONENTS OF THORAX 1. Thoracic wall Openings:  superior and inferior thoracic apertures. Skeleton:  sternum, twelve pairs of ribs, twelve thoracic vertebrae 2. Thoracic Cavity The mediastinum is located centrally and bordered by two pleural cavities laterally. The mediastinum consists of superior and inferior mediastinal cavities . The inferior mediastinal cavity is comprised of anterior, middle, and posterior compartments. 3. Neurovascular Arterial: the three largest thoracic arteries (brachiocephalic trunk, left common carotid artery, left subclavian artery) originate from the thoracic aorta 4. Organs Heart, lungs, thymus, trachea, esophagus

6. STRUCTURE AND FUNCTION

7. Shape- bony, conical shape, narrower at top borders– It is defined by: Sternum – 3 parts: Manubrium, Body, Xiphoid process Ribs – 12 pairs, 1 st seven attach to the sternum (costal cartilages) Ribs 8, 9, and 10 attach to the costal cartilage above, Ribs 11 & 12 are floating ribs 12 Thoracic vertebrae Diaphragm – the floor, that separates the thoracic cavity from the abdomen THORACIC CAGE/CAVITY STRUCTURE AND FUNCTION

8. Suprasternal Notch – U-shaped depression located on the superior border of the manubrium. Sternum – “breastbone” Angle of Louis – manubriosternal angle continuous with the 2 nd Rib Costal angle – usually 90 ° or < (less than). ANTERIOR THORACIC LANDMARKS STRUCTURE AND FUNCTION

9. Anterior Thoracic Cage STRUCTURE AND FUNCTION

10. Vertebra Prominens – Flex head, feel most prominent bony projection at base of neck = C7 next one is T1 Spinous Processes – spinal column Scapula – symmetrical, lower tip at the 7-8 th Rib 12 th Rib – midway before the spine & side POSTERIOR THORACIC LANDMARKS STRUCTURE AND FUNCTION

11. Posterior Thoracic Landmarks STRUCTURE AND FUNCTION

12. ANTERIOR CHEST Midsternal line Midclavicular line REFERENCE LINES STRUCTURE AND FUNCTION

13. POSTERIOR CHEST Vertebral line – midspinal Scapular line STRUCTURE AND FUNCTION REFERENCE LINES

14. LATERAL CHEST Anterior Axillary line Posterior Axillary line Mid-axillary line REFERENCE LINES STRUCTURE AND FUNCTION

15. Mediastinum middle of the thoracic cavity & contains; Esophagus Trachea Heart Great Vessels Pleural Cavities on either side of the mediastinum contains the lungs THORACIC CAVITY STRUCTURE AND FUNCTION

16. NORMAL CHEST CONFIGURATION Area Assessed: Entire chest region, including ribs, sternum, and vertebral column

17. ABNORMALITIES

18. BARREL CHEST Area Assessed: Upper chest, involving ribs and sternum Findings: Increased anterior-posterior diameter of the chest Rounded appearance resembling a barrel Often associated with chronic obstructive pulmonary disease (COPD) or advanced age ABNORMALITIES

19. POSSIBLE TREATMENT While there is no specific treatment for barrel chests , for many people, treating the underlying health condition may significantly reduce barrel chest. If you have a lung condition like asthma or COPD, you will need daily medications to help keep it under control. Managing lung diseases can help prevent barrel chest and other symptoms. ABNORMALITIES

20. PECTUS EXCAVATUM Area Assessed: Lower chest specifically the sternum and ribs Findings: Sunken or depressed appearance of the chest, often at the sternum “Funnel chest” appearance Potential respiratory and cardiac symptoms due to compression of the heart and lungs. ABNORMALITIES

21. POSSIBLE TREATMENT Pectus excavatum can be surgically repaired . However, surgery is usually reserved for people who have moderate to severe signs and symptoms. The two most common surgical procedures to repair pectus excavatum; 1. Nuss procedure 2. Ravitch technique ABNORMALITIES

22. PECTUS CARINATUM (PIGEON CHEST) Area Assessed: Lower chest, sternum and ribs Findings: Forward protrusion of the sternum Elevated appearance of the chest resembling a pigeon’s breast May cause cosmetic concerns and potential respiratory issues ABNORMALITIES

23. POSSIBLE TREATMENT While pectus carinatum is not a health threat , it doesn't go away or get better on its own. The two main options for treatment are; 1. bracing 2. surgery. Doctors also might recommend physical therapy and exercises to strengthen weak chest muscles. ABNORMALITIES

24. SCOLIOSIS Area Assessed: Entire spine, including thoracic and lumbar regions Findings: Abnormal lateral curvature of the spine Visible asymmetry in the shoulders, waistline, or rib cage Potential back pain, respiratory issues, or cosmetic concerns ABNORMALITIES

25. POSSIBLE TREATMENT Scoliosis treatments vary, depending on the size of the curve. Bracing or surgery may be needed if the spinal curve is moderate or large. Factors to be considered include: 1. Maturity - If a child's bones have stopped growing, the risk of curve progression is low 2. Size of curves - Larger curves are more likely to worsen with time. 3 . Sex - Girls have a much higher risk of progression than do boys. ABNORMALITIES

26. SCOLIOSIS BRACE

27. KYPHOSIS Area Assessed: Upper back, particularly the thoracic spine Findings: Excessive outward curvature of the thoracic spine, leading to a rounded upper back Forward head posture Potential back pain, difficulty standing upright, or respiratory compromise in severe cases ABNORMALITIES

28. POSSIBLE TREATMENT Kyphosis treatment depends on the cause and severity of your condition. Kyphosis treatment may include: - Pain relievers - Osteoporosis medications - Therapy - Surgery ABNORMALITIES

29. ABNORMALITIES

30. NEXT ROUND

31. Anatomy of Lungs 02

32. LUNGS major organs of the respiratory system anatomically, lungs have an apex , three borders , and three surfaces . - Three borders: anterior, posterior, and inferior borders - Three surfaces: costal, medial, and diaphragmatic surfaces Each lung has a base resting on the diaphragm and an apex extending superiorly to a point approximately 2.5 cm superior to the clavicle

33. STRUCTURE AND FUNCTION

34. Anterior Chest Apex 3-4cm. Inner 1/3 of the clavicles Base – rests on the diaphragm, 6 th rib Lateral Chest Extends from Axilla apex to 7 th -8 th rib Posteriorly Apex of lung is at C7 – Base T10 ( on deep inspiration to T12) LUNG BORDERS STRUCTURE AND FUNCTION

35. RIGHT LUNG 3 lobes, upper, middle, lower Shorter due to liver LEFT LUNG LUL = Left Upper and Lower (2 lobes) Narrower due to heart STRUCTURE AND FUNCTION LOBES OF LUNG

36. Left lung – no middle lobe Anterior chest contains upper & middle lobes with very little lower lobe Posterior chest has almost all lower lobes. Related to the middle lobe does not project into the posterior chest 3 IMPORTANT POINTS Diagonal Sloping segments Oblique fissures LOBES STRUCTURE AND FUNCTION

37. Major structures of the Respiratory System

38. The Pleurae form an envelope before the lungs & chest wall Visceral pleura – lines outside the lungs Parietal pleura – lines inside of chest wall & diaphragm Pleural Cavity – the inside of the envelope- space before the visceral & parietal pleura, lubrication. Normally, it has a vacuum or negative pressure. PLEURAE STRUCTURE AND FUNCTION

39. PARTS OF THE ANATOMY Trachea – anterior to esophagus 10-11cm long, begins at cricoid cartilage Bifurcates just below the sternal angle Right Main Stem Bronchus – shorter, wider, more vertical Left Main Stem Bronchus – longer, more horizontally The trachea & bronchi provide the passage for air to get into the lungs from the environment = Dead Space (no air exchange takes place here) TRACHEAL & BRONCHIAL TREE

40. Secrete mucus – captures particles Cilia – moves the trapped particles up to be expelled or swallowed BRONCHI Functional respiratory unit consisting of, Bronchioles, alveolar ducts, alveolar sacs, & alveoli Gaseous exchange in the alveolar duct & alveoli. ACINUS PARTS OF THE ANATOMY

41. MECHANICS OF RESPIRATION Supply O2 for energy production Remove CO2, waste product of energy reactions Homeostasis, acid-base balance of arterial blood Heat exchange 4 Major Functions of Respiratory System Respiration maintains the pH of the blood supplying O2 and eliminating CO2.

42. Hypoventilation Hyperventilation Lungs help to maintain the pH balance by adjusting the amount of CO2 through: MECHANICS OF RESPIRATION

43. Inspiration Expiration Control of Respiration Involuntary control by the respiratory center in the brain stem consisting of the pons & medulla Hypercapnia is an increase of CO2 in the blood and provides the normal stimulus to breath Hypoxemia Respiration = Breathing MECHANICS OF RESPIRATION

44. A. Anterior view of lung position B. Posterior view of lung position

45. C. Lateral view of lung left position D. Lateral view of right lung position

46. NEXT ROUND

47. HEALTH ASSESSMENT 03

48. Collecting Subjective Data: The Nursing Health History

49. Collecting Subjective Data: The Nursing Health History

50. Collecting Subjective Data: The Nursing Health History

51. Collecting Subjective Data: The Nursing Health History

52. Collecting Subjective Data: The Nursing Health History

53. Collecting Subjective Data: The Nursing Health History

54. COLLECTING OBJECTIVE DATA: PHYSICAL EXAMINATION Have the client remove all clothing from the waist up and put on an examination gown or drape. The gown should open down the back and is used to limit examination. Examination of a female client’s chest may create anxiety because of embarrassment related to breast exposure. Explain that exposure of the entire chest is necessary during some parts of the examination. To further ease the client anxiety, explain the procedures before initiating the examination. PREPARING THE CLIENT

55. For the beginning of the examination, ask the client to sit in an upright position with arms relaxed at the sides. Provide explanations during the examination as you perform the various assessment techniques. Encourage the client to ask questions and to inform the examiner of any discomfort or fatigue experienced during the examination. Try to make sure that the room temperature is comfortable for the client. PREPARING THE CLIENT COLLECTING OBJECTIVE DATA: PHYSICAL EXAMINATION

56. EQUIPMENT Examination gown or drape Gloves Stethoscope Light source Mask Skin marker Metric ruler

57. During examination of the client, remember these key points: Provide privacy for the client. Keep your hands warm to promote the client’s comfort during examination. Remain nonjudgemental regarding the client’s habits and lifestyle, particularly smoking. At the same time, educate and inform about risks, such as lung cancer and chronic obstructive pulmonary disease (COPD), related to habits.the PHYSICAL ASSESSMENT COLLECTING OBJECTIVE DATA: PHYSICAL EXAMINATION

58. Collecting Objective Data: Physical Examination

59. Collecting Objective Data: Physical Examination

60. Collecting Objective Data: Physical Examination

61. Collecting Objective Data: Physical Examination

62. Collecting Objective Data: Physical Examination

63. Collecting Objective Data: Physical Examination

64. Collecting Objective Data: Physical Examination

65. Collecting Objective Data: Physical Examination

66. Collecting Objective Data: Physical Examination

67. Collecting Objective Data: Physical Examination

68. Collecting Objective Data: Physical Examination

69. Collecting Objective Data: Physical Examination

70. Collecting Objective Data: Physical Examination

71. Collecting Objective Data: Physical Examination

72. Collecting Objective Data: Physical Examination

73. BREATHING SOUNDS

74. ANALYSIS OF DATA after collecting subjective and objective data about the thorax and lung assessment, identify abnormal findings and client strength. Then cluster data to reveal any significant patterns or abnormalities. These data may then be used to make clinical judgments about the status of the client’s thorax and lungs. Diagnostic Reasoning

75. HEALTH PROMOTION DIAGNOSIS Selected Nursing Diagnosis Readiness for enhanced breathing patterns. Health- seeking behaviors: requests information on TB skin testing, how to quit smoking, or on exercises to improve respiratory status. ANALYSIS OF DATA

76. Risk for respiratory infection related to exposure to environmental pollutants and lack of knowledge of precautionary measures. Risk for activity intolerance related to imbalance between oxygen supply and demand Risk for imbalanced nutrition: less than body requirements related to fatigue secondary to dyspnea Risk for ineffective health maintenance related to lack of knowledge of the condition, infection transmission, and prevention of recurrence Risk for impaired oral mucous membranes related to mouth breathing. An ANALYSIS OF DATA Selected Nursing Diagnosis RISK DIAGNOSIS

77. Anxiety related to dyspnea and fear of suffocation Activity intolerance related to fatigue secondary to inadequate oxygenation. Ineffective airway clearance related to the inability to clear thick, mucous secretions secondary to pain and fatigue Impaired gas exchange related to chronic lung tissue damage secondary to chronic smoking Ineffective airway clearance related to bronchospasm and increased pulmonary secretions ANALYSIS OF DATA Selected Nursing Diagnosis ACTUAL DIAGNOSIS

78. Ineffective breathing pattern: hyperventilation related to hypoxia and lack of knowledge of controlled breathing techniques Disturbed sleep pattern related to excessive coughing Impaired gas exchange related to poor muscle tone and decreased ability to remove secretions secondary to the aging process. ANALYSIS OF DATA Selected Nursing Diagnosis ACTUAL DIAGNOSIS

79. RISK COMPLICATIONS Selected Collaborative Problems Atelectasis Pneumonia Chronic obstructive pulmonary disease Asthma Bronchitis Pleural effusion Pneumothorax Pulmonary edema Tuberculosis ANALYSIS OF DATA

80. THANK YOU. :) CAIREL, GALBO, MIRANDA, PANDASIGUE Presented by: