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THORAX ASSESSMENT

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THORAX ASSESSMENT. Basic Anatomy and Physiology of the Thorax Systems. UNDERSTAND. DESCRIBE. Proper Assessment Techniques. DEMONSTRATE. Findings. LANDMARKS : Suprasternal notch Midsternal line Midclavicular lines Axillary lines Spine. EXTERNAL STRUCTURES. STRUCTURES :

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slide2

Basic Anatomy and Physiology of the Thorax

Systems

UNDERSTAND

DESCRIBE

Proper Assessment Techniques

DEMONSTRATE

Findings

slide3

LANDMARKS:

    • Suprasternal notch
    • Midsternal line
    • Midclavicular lines
    • Axillary lines
    • Spine

EXTERNAL STRUCTURES

  • STRUCTURES:
    • Skin and Hair Growth
    • Breasts; nipples, areolas, breast tissue,
    • Thoracic cage
slide4

INTERNAL STRUCTURES

SKELETAL: sternum, 12 pairs of ribs, intercostal spaces, vertebrae, clavicles, scapulae.

PLEURA: the lungs

PLEURALMEMBRANE: linings of the interior thorax and the lungs.

PLEURALSPACE: potential space between pleural linings.

MEDIASTINUM: heart, large blood vessels, lower trachea, esophagus.

DIAPHRAGM

slide5

ASSESSMENTS

  • INSPECT & PALPATE (Sitting and Supine Position
  • Symmetry, color
  • Skin: color, temperature, texture, turgor, moisture, irregularities, lesions, marks
  • Contour (spinal curvatures)
  • Movements & posture
  • Breasts: placement, symmetry, irregularities,
  • Respiratory efforts
slide6

ABNORMAL FINDINGS

  • Spinal curvatures;
    • Lordosis
    • Scoliosis
    • Kyphosis
    • Kyphoscoliosis
  • Fail chest
  • Pain, tenderness, lumps or nodules
  • Cyanosis
  • Differences in strength and coordination
  • Note any excessive or unusual body odor
slide8

ABNORMAL FINDINGS

  • Pallor, redness, jaundice, bruising or pigmentation changes is moles or lesions
  • Rashes, edema, lesions, exudate from nipples
  • Depression or protrusion of sternum
  • Pain, tenderness, lumps or nodules
  • Clubbing of fingers

Asymmetry of chest cavity

  • Retractions
  • Barrel Chest
  • Cyanosis
slide10

FUNCTIONS OF THE THORAX

  • SUPPORT AND PROTECT THE LUNGS
  • PROTECT THE MEDIALSTINAL PROCESS
slide11

FUNCTIONS OF THE THORAX

  • ASSISTS RESPIRTATIONS
  • Inspiration and expiration
  • Gas exchange; through ventilation pulmonary perfusion and diffusion
  • (at the aveolar/capillary membrane)
slide12

RESPIRATORY ASSESSMENT

  • BREATHING METHODS
    • Thoracic common, abdominal normal,
    • ABNORMAL; pursed lip, use of accessory neck muscles
  • PERCUSSION: Over intercostal spaces
    • Resonance is normal
    • Hyperresonance is usual in children or thin adult.
    • Dullness over organs
slide13

RESPIRATORY ASSESSMENT

  • AUSCULTATION
  • Techniques
  • Assess breath sounds and detect airflow
    • Use diaphragm of stethoscope (bell for infants)
    • Patient breath through mouth
    • Listen full inhalation/exhalation each spot
    • Move side to side, top bottom, front-side-back
slide14

Breath & Lung Sound Links

Breath Sounds

http://www.med.ucla.edu/wilkes/lungintro.htm

Rubs, Gallops, and Continuous Murmurshttp://www.med.ucla.edu/wilkes/Rubintro.htm

Diastolic Murmurshttp://www.med.ucla.edu/wilkes/Diastolic.htm

Systolic Murmurs - Aortic Stenosishttp://www.med.ucla.edu/wilkes/Systolic.htm

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ABNORMAL RESPIRATORY

EFFORTS

HYPERPNEA

TACHYPNEA

BRADYPNEA

HYPERVENTILLATION

CHEYNE-STOKES

APNEA

KUSSMAUL’S

slide16

DIAGNOSTIC EXAMS

ABG: ARTERIAL BLOOD GAS

XRAY

PFT

slide17

THE ANATOMY

AND PHYSIOLOGY

OF THE CIRCULATORY SYSTEM

  • HEART (Base at T2 Apex in midclavicular line at 5th intercostal)
    • 4 Chambers (atria, ventricles, major vessels)
    • Pericardium (sac)
    • Valves (heart and veins)
    • CONDUCTION SYSTEM
  • Sinoatrial (SA node-pacemaker), Atrioventricular (AV node)
slide18

FUNCTIONS OF THE HEART

Cardiac cycle

BLOOD FLOW

SYSTOLE: contraction

DIALSTOLE: relaxation

slide19

Oxygen-poor blood (shown in blue) flows from the body into the right atrium.        Blood flows through the right atrium into the right ventricle.        The right ventricle pumps the blood to the lungs, where the blood releases waste gases and picks up oxygen.        The newly oxygen-rich blood (shown in red) returns to the heart and enters the left atrium.

Blood flows through the left atrium into the left ventricle.       The left ventricle pumps the oxygen-rich blood to all parts of the body.

slide20

BLOOD

FLOW

PulmonaryArtery

Aorta

Superior Vena Cava

Left Atria

Pulmonary Vein

Right Atria

Left Ventricle

Right Ventricle

Inferior Vena Cava

slide22

ARTERIES: carry blood away from the heart.

VEINS: returns blood to the heart.

CAPILLARIES: gas and nutrient exchange.

slide23

INSPECT

AUSCULTATE

PALPATE

INSPECTION

Appearance & Vital Signs

Deformities (Clubbing)

Color (pallor, cyanosis)

slide24

INSPECT

AUSCULTATE

PALPATE

  • AUSCULTATE
  • (Over Heart and Pulse Points)
    • “Lub-dub” S1 S2
    • S1- systole (Ventricles contract, valves open, ventricle empties)
    • S2- Diastole (Ventricles relax, valves close, ventricles fill)
    • Additional sounds (S3, S4, Murmurs, Clicks, Swishing
slide25

INSPECT

AUSCULTATE

PALPATE

  • PALPATION
    • Location
    • Duration and presence of any pulsations.
  • PERCUSSION:
    • Estimate cardiac size
slide26

ABNORMAL FINDINGS

IRREGULAR RHYTHMS

TACHYCARDIA

BRADYCARDIA

EXTRA NOISES OVER HEART

BRUITS

DURING PREGNANCY: BP elevation >30SBP AND 15DBP

slide27

palpate points

  • PULSES: Compare pulse points side to side for equality in strength, note rate, regularity of rhythm (can auscultate with stethoscope or doppler)
    • Checked with head to toe assessment.
  • Compare side to side for equality in strength.
  • Note rate, regularity of rhythm.
  • Can auscultate with stethescope or doppler.
slide29

pulse points

TEMPORAL: Lateral to eye orbit, anterior to ear.

BRACHIAL: Anterior surface of elbow.

POSTERIOR TIBIAL: Behind & slightly below malleolus of ankle.

CAROTID: Medial to trachea, and below jaw.

Palpate one at a time.

slide30

pulse points

DORSALIS PEDIS: Medial dorsum of foot with toes pointed down.

FEMORAL: Groin just below midpoint of inguinal ligament.

POPITEAL: Fossa behind knee (flexed).

RADIAL: Below thumb, palm surface of wrist.

blood pressure classification in adults category

Category

Systolic

Diastolic

Normal

<140

<90

Isolated Systolic Hypertension

>140

<90

Mild Hypertension

140-159

90-99

Moderate Hypertension

160-179

100-109

Severe Hypertension

180-209

110-119

Crisis Hypertension

>210

>120

Blood Pressure Classification in Adults Category

VITAL SIGNS PARAMETERSADULT TPR:

Temp (po) 98.6-99.5º F

Pulse 60-100bpm

Respiration 12-20/min

slide33

PEDIATRIC

NORMAL VITAL SIGN RANGES

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