Thorax & Lungs
Prof. lopez, MSN, RN
NSG 103: Health assessment
Structure and Function
Position and surface
landmarks
Thoracic cage is a bony
structure with a conical
shape, which is narrower
at top.
Defined by sternum,
12 pairs of ribs, and
12 thoracic vertebrae
Floor is the
diaphragm
Costochondral 2
Anterior Thoracic Landmarks I 3
Suprasternal notch, sternum, sternal angle, costal
angle
Suprasternal notch: feel this hollow U-shaped
depression just above sternum between clavicles.
Sternum: breastbone has three parts;
manubrium, body, and xiphoid process.
Walk fingers down manubrium a few centimeters until
you feel distinct bony ridge, the manubriosternal angle
Anterior thoracic landmarks
Sternal angle
Articulation of the manubrium & body of sternum
Continuous with 2nd rib AKA ANGLE OF LOUIS
(MANUBRIOSTERNAL ANGLE)
SITE OF TRACHEAL BIFURCATION into R/L main
bronchi
Costal angle
R/L costal margins form an angle where they meet at the
xiphoid process
Posterior Thoracic
Landmarks
Vertebral prominens
Spinous processes: C-7
Interior border of the scapula
Scapula located symmetrically
in each hemithorax
12th rib
Palpate midway b/w spine &
persons side to identify its
free tip
Reference Lines
Anterior chest
Midsternal line
Midclavicular line
Posterior chest
Vertebral or midspinal
Scapular line
Reference Lines II
Lift arm up to 90
degrees
Divide lateral chest
into 3 lines
Anterior axillary
Posterior axillary
line
Mid-axillary
Thoracic Cavity: Anterior Lung Borders
Mediastinum: middle Right and left pleural cavities,
section of thoracic cavity on either side of mediastinum,
contain lungs
esophagus, trachea,
Lung borders: In anterior chest,
heart, and great vessels
apex of lung tissue is 3 or 4 cm
above inner third of clavicles.
Base
rests on diaphragm at about
sixth rib in midclavicular line.
Laterally, lung tissue extends from
apex of axilla down to seventh or
Thoracic Cavity
Lobes of the lungs
Right
_________lobes
Left
_________lobes
Lobes of Anterior Chest
Anterior chest
On anterior chest, oblique fissure
crosses fifth rib in mid-axillary line
and terminates at sixth rib in
midclavicular line.
Right lung also contains horizontal
(minor) fissure, which divides right
upper and middle lobes.
This fissure extends from fifth rib in
right midaxillary line to third
intercostal space or fourth rib at right
sternal border.
Lobes of the Lung Lateral Chest
Lateral chest
Lung tissue extends from apex of
axilla down to seventh or eighth rib.
Right upper lobe extends from apex of
axilla down to horizontal fissure at
fifth rib.
Right middle lobe extends from
horizontal fissure down and forward to
sixth rib at midclavicular line.
Right lower lobe continues from fifth
rib to eighth rib in mid-axillary line.
11
Lobes of the Lung Posterior
Chest
Posterior chest
Upper lobes occupy a smaller
band of tissue from their apices
at T1 down to T3 or T4.
At this level, lower lobes begin,
and their inferior border
reaches down to level of T10 on
expiration and to T12 on
inspiration.
Right middle lobe does not
project onto posterior chest at
all.
12
Lobes of the Lung Left
Left lung contains only two lobes,
upper and lower.
Left upper lobe extends from apex
of axilla down to fifth rib at mid-
axillary line.
Left lower lobe continues down to
eighth rib in mid-axillary line.
13
Plurae
Plurae
Thin, serous, slippery pleurae form an envelope
between lungs and chest wall.
Visceral pleura
lines outside of lungs
Parietal
Lines inside of the chest wall & diaphragm
Pleurae II 15
Pleural cavity normally has a
vacuum, or negative pressure,
which holds lungs tightly against
chest wall.
Pleurae extend about 3 cm
below level of lungs, forming
the costodiaphragmatic
recess.
Lungs slide smoothly and
noiselessly up and down during
respiration, lubricated by a few
milliliters of fluid.
Trachea and Bronchial Tree I
Trachea lies anterior to esophagus
and is 10 to 11 cm long in the adult.
Begins at level of cricoid cartilage in
neck and bifurcates just below
sternal angle into right and left
main bronchi.
Posteriorly, tracheal bifurcation is at
level of T4 or T5.
Right main bronchus is shorter,
wider, and more vertical than the 16
Mechanics of Respiration
Four major functions of respiratory system
1. Supplying oxygen to the body for energy production
2. Removing carbon dioxide as a waste product of
energy reactions
3. Maintaining homeostasis (acid-base balance) of
arterial blood
1. By supplying oxygen to blood and eliminating excess
carbon dioxide, respiration maintains pH or acid-base
balance of blood.
4. Maintaining heat exchange (less important in
Mechanics of Respiration II
Body tissues are bathed by blood that normally has a
narrow acceptable range of pH.
Although a number of compensatory mechanisms
regulate pH, lungs help maintain balance by
adjusting level of carbon dioxide through respiration.
Hypoventilation (slow, shallow breathing) causes
carbon dioxide to build up in blood, and
hyperventilation (rapid, deep breathing) causes
carbon dioxide to be blown off.
Control of Respirations
Involuntary control of respirations mediated by
respiratory center in medulla
Major feedback loop: humoral regulation or
change in CO2 & O2 levels in blood
Normal stimulus to breathe: Hypercapnia
Hypoxemia: decrease O2 in blood
Mechanics of Respirations
Respiration
Physical act of breathing
Inspiration
Increase in chest size
as air rushes into
lungs
Expiration
Air expelled as chest
recoils
Developmental Competence I 21
Infants and children
During first 5 weeks of fetal life, primitive lung bud
emerges.
16 weeks: conducting airways same # as adults
32 weeks: SURFACTANT present
Birth: over 70 million primitive alveoli ready to start
respiration
Utero: goes off moms circulation until birth
Smoking and prenatal exposure to smoke increases
risk to child
Pregnancy
Enlarging uterus elevates diaphragm 4 cm during pregnancy
Increased demand on body from growing fetus
Met by increasing tidal volume
Increased awareness to breathe: PHYSIOLOGICAL DYSPNEA
Developmental Competence: Older Adult
Aging adult
Costal cartilages become calcified
Aging lung is more rigid structure
Respiratory muscle strength declines after 50 y
Histological changes
Lung bases become less ventilated
Histologic changes also increase the older persons
risk of postoperative pulmonary complications
