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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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Basic Anatomy and Physiology of the Thorax

Systems

UNDERSTAND

DESCRIBE

Proper Assessment Techniques

DEMONSTRATE

Findings


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  • LANDMARKS:

    • Suprasternal notch

    • Midsternal line

    • Midclavicular lines

    • Axillary lines

    • Spine

EXTERNAL STRUCTURES

  • STRUCTURES:

    • Skin and Hair Growth

    • Breasts; nipples, areolas, breast tissue,

    • Thoracic cage


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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


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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


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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



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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



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FUNCTIONS OF THE THORAX

  • SUPPORT AND PROTECT THE LUNGS

  • PROTECT THE MEDIALSTINAL PROCESS


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FUNCTIONS OF THE THORAX

  • ASSISTS RESPIRTATIONS

  • Inspiration and expiration

  • Gas exchange; through ventilation pulmonary perfusion and diffusion

  • (at the aveolar/capillary membrane)


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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


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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


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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


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DIAGNOSTIC EXAMS

ABG: ARTERIAL BLOOD GAS

XRAY

PFT


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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)


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FUNCTIONS OF THE HEART

Cardiac cycle

BLOOD FLOW

SYSTOLE: contraction

DIALSTOLE: relaxation


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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.


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BLOOD the right atrium.

FLOW

PulmonaryArtery

Aorta

Superior Vena Cava

Left Atria

Pulmonary Vein

Right Atria

Left Ventricle

Right Ventricle

Inferior Vena Cava


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THE VASCULAR SYSTEM the right atrium.


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ARTERIES: carry blood away from the heart. the right atrium.

VEINS: returns blood to the heart.

CAPILLARIES: gas and nutrient exchange.


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INSPECT the right atrium.

AUSCULTATE

PALPATE

INSPECTION

Appearance & Vital Signs

Deformities (Clubbing)

Color (pallor, cyanosis)


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INSPECT the right atrium.

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


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INSPECT the right atrium.

AUSCULTATE

PALPATE

  • PALPATION

    • Location

    • Duration and presence of any pulsations.

  • PERCUSSION:

    • Estimate cardiac size


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ABNORMAL FINDINGS the right atrium.

IRREGULAR RHYTHMS

TACHYCARDIA

BRADYCARDIA

EXTRA NOISES OVER HEART

BRUITS

DURING PREGNANCY: BP elevation >30SBP AND 15DBP


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palpate points the right atrium.

  • 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.


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pulse points the right atrium.

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.


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pulse points the right atrium.

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.


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NORMAL VITAL SIGN PERAMETERS the right atrium.

IN ADULTS AND PEDS


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Category the right atrium.

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


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PEDIATRIC the right atrium.

NORMAL VITAL SIGN RANGES


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