NR 302 FINAL EXAM STUDY GUIDE
January 2021
Thorax and Lungs
-What data can be gathered on a patient in respiratory distress from general survey only?
-Do they use accessory muscles when breathing? Position-tripod, Barrel chest, Nasal flaring,
color
-Structure and Function: The thorax
-Thoracic cage
-Sternum, 12 pairs of ribs
-12 thoracic vertebrae
-Muscles and cartilage
-Thoracic Cavity
-Mediastinium
-Pleural cavity
-Lung (Apex and base)
Structure and Function: Pleural Membranes
-Parietal pleura-lines the whole cavity
-Visceral pleura-lines the organs
-Pleural space/cavity-both above total
Structure and Function: The respiratory system
-Trachea
-Bronchi
-Bronchioles
-Alveolar Sacs
-Alveoli
Landmarks-Visualize what you cannot see!
-Anterior chest
-Suprasternal notch “U shaped”
-Sternum
-Sternal angle (Angle of Louis) continuous with 2nd rib
-Ribs & intercostals
-Costal angle (at xiphoid) 90 degrees
-Posterior chest
-Vertebra prominence C7
-Spinous processes T1 is 1st rib
-T3 separates upper and lower lobes
-Inferior border of the scapula 8th rib
-12th rib
, Subjective Data
-Difficulty breathing, sleeping, chest pain, cough and sputum (Rusty-TB), smoking history,
environmental exposure
TO calculate smoking pack-years
1. Multiple the number of cigarettes smoked per day by number of years smoked
2. Divide by 20
i.e 10 cigarettes smoked per day x 10 years / 20 = 5 pack years
Objective Data
-Inspection of patient: Resp. rate & effort to breathe (Nasal flaring, accessory muscles,
positioning) skin color, nails, configuration of chest (Chest deformities)
-Palpation of anterior and posterior chest: Tenderness, lumps, crepitus (Subcutaneous air-rice
krispis under skin), tactile fremitus (99), respiratory expansion
-Percussion of lung fields: Resonance, hyper-resonance, dull, diaphragmatic excursion
-Auscultation of chest: Normal, adventitious, voice sounds, measurements of pulmonary
function: For screening**Begin at the moment of contact
Normal breath sounds
-Bronchial (Tracheal) –Over trachea & larynx E>1
-Bronchovesicular—Over major bronchi I=E
-Vesicular—over peripheral lung fields I>E
Normal Assessment Findings
-Inspection: RR 14 reg,even & unlabored (eupnea), skin & nails pink, no cyanosis noted, relaxed
posture, shape symmetric AP: Transverse 1:2, costal angle <90 degrees
-Palpation: Chest expansion symmetric, tactile fremitus symmetric, no tenderness, no crepitus,
no lumps or masses
-Percussion: Resonance throughout, diaphragmatic excursion equal bilaterally
-Auscultation: Normal breath sounds
Adventitious Breath sounds
-Crackles/rales
-Pleural friction rub
-wheeze
-Rhonchi
Voice Sounds
-Bronchophony “99”
-Egophony “EEEEEE”
-Whispered Pectoriloquy “one-two-three”
Abnormal breathing patterns
-Tachypnea
-Bradypnea
-Hyperventilation
January 2021
Thorax and Lungs
-What data can be gathered on a patient in respiratory distress from general survey only?
-Do they use accessory muscles when breathing? Position-tripod, Barrel chest, Nasal flaring,
color
-Structure and Function: The thorax
-Thoracic cage
-Sternum, 12 pairs of ribs
-12 thoracic vertebrae
-Muscles and cartilage
-Thoracic Cavity
-Mediastinium
-Pleural cavity
-Lung (Apex and base)
Structure and Function: Pleural Membranes
-Parietal pleura-lines the whole cavity
-Visceral pleura-lines the organs
-Pleural space/cavity-both above total
Structure and Function: The respiratory system
-Trachea
-Bronchi
-Bronchioles
-Alveolar Sacs
-Alveoli
Landmarks-Visualize what you cannot see!
-Anterior chest
-Suprasternal notch “U shaped”
-Sternum
-Sternal angle (Angle of Louis) continuous with 2nd rib
-Ribs & intercostals
-Costal angle (at xiphoid) 90 degrees
-Posterior chest
-Vertebra prominence C7
-Spinous processes T1 is 1st rib
-T3 separates upper and lower lobes
-Inferior border of the scapula 8th rib
-12th rib
, Subjective Data
-Difficulty breathing, sleeping, chest pain, cough and sputum (Rusty-TB), smoking history,
environmental exposure
TO calculate smoking pack-years
1. Multiple the number of cigarettes smoked per day by number of years smoked
2. Divide by 20
i.e 10 cigarettes smoked per day x 10 years / 20 = 5 pack years
Objective Data
-Inspection of patient: Resp. rate & effort to breathe (Nasal flaring, accessory muscles,
positioning) skin color, nails, configuration of chest (Chest deformities)
-Palpation of anterior and posterior chest: Tenderness, lumps, crepitus (Subcutaneous air-rice
krispis under skin), tactile fremitus (99), respiratory expansion
-Percussion of lung fields: Resonance, hyper-resonance, dull, diaphragmatic excursion
-Auscultation of chest: Normal, adventitious, voice sounds, measurements of pulmonary
function: For screening**Begin at the moment of contact
Normal breath sounds
-Bronchial (Tracheal) –Over trachea & larynx E>1
-Bronchovesicular—Over major bronchi I=E
-Vesicular—over peripheral lung fields I>E
Normal Assessment Findings
-Inspection: RR 14 reg,even & unlabored (eupnea), skin & nails pink, no cyanosis noted, relaxed
posture, shape symmetric AP: Transverse 1:2, costal angle <90 degrees
-Palpation: Chest expansion symmetric, tactile fremitus symmetric, no tenderness, no crepitus,
no lumps or masses
-Percussion: Resonance throughout, diaphragmatic excursion equal bilaterally
-Auscultation: Normal breath sounds
Adventitious Breath sounds
-Crackles/rales
-Pleural friction rub
-wheeze
-Rhonchi
Voice Sounds
-Bronchophony “99”
-Egophony “EEEEEE”
-Whispered Pectoriloquy “one-two-three”
Abnormal breathing patterns
-Tachypnea
-Bradypnea
-Hyperventilation
