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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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THORAX ASSESSMENT


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    1. THORAX ASSESSMENT

    2. Basic Anatomy and Physiology of the Thorax Systems UNDERSTAND DESCRIBE Proper Assessment Techniques DEMONSTRATE Findings

    3. LANDMARKS: • Suprasternal notch • Midsternal line • Midclavicular lines • Axillary lines • Spine EXTERNAL STRUCTURES • STRUCTURES: • Skin and Hair Growth • Breasts; nipples, areolas, breast tissue, • Thoracic cage

    4. 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

    5. 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

    6. 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

    7. SPINAL CURVATURES

    8. 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

    9. CLUBBING OF FINGERS

    10. FUNCTIONS OF THE THORAX • SUPPORT AND PROTECT THE LUNGS • PROTECT THE MEDIALSTINAL PROCESS

    11. FUNCTIONS OF THE THORAX • ASSISTS RESPIRTATIONS • Inspiration and expiration • Gas exchange; through ventilation pulmonary perfusion and diffusion • (at the aveolar/capillary membrane)

    12. 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

    13. 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

    14. 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

    15. ABNORMAL RESPIRATORY EFFORTS HYPERPNEA TACHYPNEA BRADYPNEA HYPERVENTILLATION CHEYNE-STOKES APNEA KUSSMAUL’S

    16. DIAGNOSTIC EXAMS ABG: ARTERIAL BLOOD GAS XRAY PFT

    17. 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)

    18. FUNCTIONS OF THE HEART Cardiac cycle BLOOD FLOW SYSTOLE: contraction DIALSTOLE: relaxation

    19. 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.

    20. BLOOD FLOW PulmonaryArtery Aorta Superior Vena Cava Left Atria Pulmonary Vein Right Atria Left Ventricle Right Ventricle Inferior Vena Cava

    21. THE VASCULAR SYSTEM

    22. ARTERIES: carry blood away from the heart. VEINS: returns blood to the heart. CAPILLARIES: gas and nutrient exchange.

    23. INSPECT AUSCULTATE PALPATE INSPECTION Appearance & Vital Signs Deformities (Clubbing) Color (pallor, cyanosis)

    24. 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

    25. INSPECT AUSCULTATE PALPATE • PALPATION • Location • Duration and presence of any pulsations. • PERCUSSION: • Estimate cardiac size

    26. ABNORMAL FINDINGS IRREGULAR RHYTHMS TACHYCARDIA BRADYCARDIA EXTRA NOISES OVER HEART BRUITS DURING PREGNANCY: BP elevation >30SBP AND 15DBP

    27. 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.

    28. 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.

    29. 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.

    30. NORMAL VITAL SIGN PERAMETERS IN ADULTS AND PEDS

    31. 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

    32. PEDIATRIC NORMAL VITAL SIGN RANGES