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Chapter 18Thorax and Lungs
Assessment
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function Overview
• Upper and lower divisions
– Upper airway warms, moisturizes
– Lower airway, where oxygenation and ventilation
occur
• The thorax
– One of the most dynamic regions of the body
– Bony thoracic cage
– Thoracic cavity
– Thoracic nerves in the chest (T1 to T12)
• Phrenic nerve
• Intercostals nerves
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Structure and Function Overview (cont.)
• The thorax (cont.)
– Thoracic muscles
– Arterial blood supply
– Numerous veins
– Lung: pulmonary artery and two pulmonary veins
– Locations must be identified
• vertically (up and down): ribs
• Horizontally (side to side): a series of lines
provides horizontal reference marks
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Structure and Function Overview (cont.)
• Anterior thoracic landmarks
– Involve the ribs and their associated
interspaces
– Suprasternal (jugular) notch
– Sternal angle
• Site of the apex of the heart
• Bifurcation of the right and left mainstem
bronchi
– Intercostal space (ICS)
– Costal angle
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Structure and Function Overview (cont.)
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Structure and Function Overview (cont.)
• Posterior thoracic landmarks
– Less important
– Vertebral processes
– Spinous process of T1
– Lower tip of the scapula
– 11th floating rib
– 12th floating rib
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Structure and Function Overview (cont.)
• Reference lines
– Anterior
• Midsternal
• Midclavicular
• Anterior axillary lines
–
Posterior
• Vertebral line
• Scapular line
• Posterior axillary line
• Midaxillary line
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Structure and Function Overview (cont.)
• Lobes of the lungs
– Oblique fissure
– The left lung has two lobes
– The right lung has three
– Horizontal (minor) fissure
– RML
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Structure and Function Overview (cont.)
• Lobes of the lungs
– Upper, middle, and lower lung fields
– Base
– Apex
– Auscultate
– Anteriorly
– Posteriorly
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Structure and Function Overview (cont.)
• Lower respiratory tract
– Trachea bifurcates
– Right main bronchus
– Dead space
– Bronchioles
– Breath sounds
– Alveoli
– Pulmonary arterioles
– Pulmonary thromboembolism (PE)
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Structure and Function Overview (cont.)
• Lower respiratory tract (cont.)
– Pleurae
• Visceral pleurae
• Parietal pleura
• Pleural space
– Mediastinum
– Pulmonary cavities
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Structure and Function Overview (cont.)
• Upper respiratory tract
– Responsible for moisturizing inhaled air and filtering
noxious particles
• Mechanics of respiration
– Primarily an automatic process
– Main trigger for breathing
– Some medications (e.g., opiates) or an overdose of
drugs
– The diaphragm
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Structure and Function Overview (cont.)
• Mechanics of respiration (cont.)
– Expiration is primarily passive
– Pressure in the lungs
• Diseases or problems of the spinal cord
• Extreme obesity
• Progressive loss of muscle function
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Question
• The nurse caring for a patient diagnosed with a 2nd rib
fracture should know the location of the sternal angle
also called what?
A. Apex
B. Angle of Louis
C. Base
D. 2nd ICS
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Answer
• B. Angle of Louis
• Rationale: From the suprasternal notch, walk your fingers
down approximately 5 cm to the bony ridge that joins the
manubrium to the sternum. This ridge, called the sternal
angle (also known as the Angle of Louis or
manubriosternal angle), varies in prominence and is
usually easier to locate in thinner people. The sternal
angle is continuous with the 2nd rib.
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Lifespan Considerations
• Pregnant women
• Infants and children
• Older adults
• Cultural and environmental considerations
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Acute Assessment
• Acute shortness of breath
– Immediate assessments
– Lungs are auscultated
– Simultaneously, oxygen is administered and inhalers
may be given
– Head of the bed is elevated
– Patients are stable, but fatigue limits collection of
assessment data
• Prioritize the subjective data collected
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Subjective Data Collection
• Begins with the health history
• Areas for health promotion/Healthy People
– Patient education, health promotion, and risk
reduction
• Assessment of risk factors
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Subjective Data Collection (cont.)
• Risk assessment and health-related patient teaching
– Smoking cessation
– Prevention of occupational exposure
– Prevention of asthma
– Immunizations
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Subjective Data Collection (cont.)
• Focused health history related to common symptoms
– Common respiratory symptoms
• Lifespan considerations
– Pregnant women
– Newborns, infants, and children
– Older adults
– Cultural and environmental considerations
• Therapeutic dialogue: collecting subjective data
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Objective Data Collection
• Equipment
• Preparation
• Common and specialty or advanced techniques
• Initial survey
• Comprehensive physical examination
– Breath sounds
• Documentation of normal findings
• Documenting abnormal findings
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Objective Data Collection (cont.)
• Lifespan considerations
– Pregnant women
– Newborns, infants, and children
– Older adults
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Evidence-Based Critical Thinking
• Organizing and prioritizing
• Laboratory and diagnostic testing
• Diagnostic reasoning
– Nursing diagnoses, outcomes, and interventions
– Analyzing findings
• Collaborating with other health care professionals
• Pulling it all together: reflection and critical thinking
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Question
• Acute shortness of breath is a medical emergency.
Immediate assessments are necessary. What is the
priority assessment the nurse would make with a patient
who has acute shortness of breath?
A. Administer inhalers
B. Administer oxygen
C. Raise the head of the bed
D. Auscultate lungs
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Answer
• B. Auscultate lungs
• Rationale: Acute shortness of breath: Immediate
assessments; lungs are auscultated; simultaneously,
oxygen is administered and inhalers may be given; and
the head of the bed is elevated.
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