Exam 3 Review
LUNGS
-Four major functions of the respiratory system:
-Supplying oxygen to the body for energy production.
-Removing CO2 as a waste product of energy reactions.
-Maintaining homeostasis (acid-base balance) of arterial blood. By supplying oxygen to blood and excess CO2,
respiration maintains pH or acid-base balance of blood.
-Maintaining heat exchange (less important in humans).
-What are the lobes, what do they do?
-The right lung has three lobes: the superior, middle, and inferior lobes.
-The left lung has two lobes: the superior and inferior lobes.
-Anterior chest: on the anterior chest the oblique fissure crosses the 5th rib in the midaxillary line and
terminates at the 6th rib in the midclavicular line. The right lung also contains the horizontal fissure, which divides the
right upper and middle lobes. This fissure extends from the 5th rib in the right midaxillary line to the 3rd intercostal
space or 4th rib at the right sternal border.
-Posterior chest: The most remarkable point about the posterior chest is that it is almost all lower lobe. The
upper lobes occupy a smaller band of tissue from their apices at T1 down to T3 or T4. At this level the lower lobes
begin, and their inferior border reaches down to the level of T10 on expiration and t12 on inspiration. Not that the
right middle lobe does not project onto the posterior chest at all. If the person abducts the arms and places the hands
on the back of the head, the division between the upper and lower lobes corresponds to the medial border of the
scapulae.
-Lateral chest: Lung tissue extends from apex of axilla down to seventh or eighth rib.
-Left lung: Has no middle lobe, anterior chest contains mostly upper and middle lobe with very little lower
lobe, posterior chest contains almost all lower lobes.
-Alveoli: is where the lungs and the blood exchange oxygen and carbon dioxide during the process of breathing in and
breathing out. Oxygen breathed in from the air passes through the alveoli and into the blood and travels to the
tissues throughout the body.
-Trachea and bronchi- transport gases between the environment and the lung parenchyma.
-Pleurae- serous membranes that form an envelope between the lings and the chest wall.
VALVES, PMI
-Aortic Valve- 2nd R interspace
-Pulmonic Valve- 2nd L interspace
-Tricuspid Valve- L lower border
-Mitral Valve- 5th interspace at around L midclavicular line
, -PMI stands for Point of Maximum Impulse, and it is the area that has the strongest force of blood flow and is the
location where the cardiac impulse is best palpated on the chest wall. The PMI lies right at the apex. It is located in
the apical pulse, in the 5th intercostal to the lift of the sternum at the midclavicular line.
THRILL, BRUIT
-A thrill is a palpable vibration. It feels like the throat of a purring cat. The thrill signifies turbulent blood flow and
directs you to locate the origin loud murmurs. However, absence of a thrill does not rule out the presence of a
murmur.
-A bruit is a blowing, swishing sound indicating blood flow turbulence; normally none is present. A bruit indicates
turbulence from a local vascular cause and is a marker for atherosclerotic disease.
CHEST SHAPES AND CONFIGURATIONS:
-Anteroposterior (AP) diameter of chest is less than the transverse diameter with a ratio of 1:2.
-Expected variations: older clients might have thickened or barreled chest or kyphosis (exaggerated curvature of the
thoracic spine; humpback that causes significant back pain and limited mobility.
-Unexpected findings:
-Barrel Chest: COPD or aging. Most often in the tripod position to breath.
-Funnel chest( pectus excavatum)- sunken sternum and costal cartilage.
-Pigeon chest (pectus carinatum)- forward protrusion of the sternum.
ABDOMEN SHAPES
- It is expected for the abdomen to be flat, even, slightly convex, or rounded.
-An expected variation is a scaphoid abdomen shape, which is sunken looking, that can be expected for a client who
has a thin frame.
-Another expected variation is a round abdomen in patients who are obese, with rolls of subcutaneous fat present
along their sides.
ORDER OF ASSESSMENT FOR CV, ABDOMEN, AND RESPIRATION. WHY?
-Respiration:
1. Inspection- thoracic cage, respirations, skin color and condition, person’s position, facial expression, level of
consciousness.
2. Palpation- confirm symmetric expansion, tactile fremitus, detect any lumps, masses or tenderness.
3. Percussion- percuss over lung fields
4. Auscultation- assess normal breath sounds, note any abnormal breath sounds. If abnormal breath sounds
are present perform a bronchophony, whispered pectoriloquy, and egophony. Note any adventitious sounds.
-Cardiovascular:
-Neck- carotid pulse- observe and palpate, observe jugular venous pulse, estimate jugular venous pressure
-Precordium Inspection and Palpation- describe location of apical impulse, note any heave (lift) or thrill
LUNGS
-Four major functions of the respiratory system:
-Supplying oxygen to the body for energy production.
-Removing CO2 as a waste product of energy reactions.
-Maintaining homeostasis (acid-base balance) of arterial blood. By supplying oxygen to blood and excess CO2,
respiration maintains pH or acid-base balance of blood.
-Maintaining heat exchange (less important in humans).
-What are the lobes, what do they do?
-The right lung has three lobes: the superior, middle, and inferior lobes.
-The left lung has two lobes: the superior and inferior lobes.
-Anterior chest: on the anterior chest the oblique fissure crosses the 5th rib in the midaxillary line and
terminates at the 6th rib in the midclavicular line. The right lung also contains the horizontal fissure, which divides the
right upper and middle lobes. This fissure extends from the 5th rib in the right midaxillary line to the 3rd intercostal
space or 4th rib at the right sternal border.
-Posterior chest: The most remarkable point about the posterior chest is that it is almost all lower lobe. The
upper lobes occupy a smaller band of tissue from their apices at T1 down to T3 or T4. At this level the lower lobes
begin, and their inferior border reaches down to the level of T10 on expiration and t12 on inspiration. Not that the
right middle lobe does not project onto the posterior chest at all. If the person abducts the arms and places the hands
on the back of the head, the division between the upper and lower lobes corresponds to the medial border of the
scapulae.
-Lateral chest: Lung tissue extends from apex of axilla down to seventh or eighth rib.
-Left lung: Has no middle lobe, anterior chest contains mostly upper and middle lobe with very little lower
lobe, posterior chest contains almost all lower lobes.
-Alveoli: is where the lungs and the blood exchange oxygen and carbon dioxide during the process of breathing in and
breathing out. Oxygen breathed in from the air passes through the alveoli and into the blood and travels to the
tissues throughout the body.
-Trachea and bronchi- transport gases between the environment and the lung parenchyma.
-Pleurae- serous membranes that form an envelope between the lings and the chest wall.
VALVES, PMI
-Aortic Valve- 2nd R interspace
-Pulmonic Valve- 2nd L interspace
-Tricuspid Valve- L lower border
-Mitral Valve- 5th interspace at around L midclavicular line
, -PMI stands for Point of Maximum Impulse, and it is the area that has the strongest force of blood flow and is the
location where the cardiac impulse is best palpated on the chest wall. The PMI lies right at the apex. It is located in
the apical pulse, in the 5th intercostal to the lift of the sternum at the midclavicular line.
THRILL, BRUIT
-A thrill is a palpable vibration. It feels like the throat of a purring cat. The thrill signifies turbulent blood flow and
directs you to locate the origin loud murmurs. However, absence of a thrill does not rule out the presence of a
murmur.
-A bruit is a blowing, swishing sound indicating blood flow turbulence; normally none is present. A bruit indicates
turbulence from a local vascular cause and is a marker for atherosclerotic disease.
CHEST SHAPES AND CONFIGURATIONS:
-Anteroposterior (AP) diameter of chest is less than the transverse diameter with a ratio of 1:2.
-Expected variations: older clients might have thickened or barreled chest or kyphosis (exaggerated curvature of the
thoracic spine; humpback that causes significant back pain and limited mobility.
-Unexpected findings:
-Barrel Chest: COPD or aging. Most often in the tripod position to breath.
-Funnel chest( pectus excavatum)- sunken sternum and costal cartilage.
-Pigeon chest (pectus carinatum)- forward protrusion of the sternum.
ABDOMEN SHAPES
- It is expected for the abdomen to be flat, even, slightly convex, or rounded.
-An expected variation is a scaphoid abdomen shape, which is sunken looking, that can be expected for a client who
has a thin frame.
-Another expected variation is a round abdomen in patients who are obese, with rolls of subcutaneous fat present
along their sides.
ORDER OF ASSESSMENT FOR CV, ABDOMEN, AND RESPIRATION. WHY?
-Respiration:
1. Inspection- thoracic cage, respirations, skin color and condition, person’s position, facial expression, level of
consciousness.
2. Palpation- confirm symmetric expansion, tactile fremitus, detect any lumps, masses or tenderness.
3. Percussion- percuss over lung fields
4. Auscultation- assess normal breath sounds, note any abnormal breath sounds. If abnormal breath sounds
are present perform a bronchophony, whispered pectoriloquy, and egophony. Note any adventitious sounds.
-Cardiovascular:
-Neck- carotid pulse- observe and palpate, observe jugular venous pulse, estimate jugular venous pressure
-Precordium Inspection and Palpation- describe location of apical impulse, note any heave (lift) or thrill
