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Chapter 2
Chest
Bony Thorax
• 1 - __________ (Breastbone)• 2 - Clavicles (Collar bones)• 2 - ________ (Shoulder Blades)• 12 - Rib Pairs• 12 - ________Vertebrae
2 Lungs
• Right has _______ lobes– Superior, middle, ___________– Separated by two deep fissures
• Left has ________ lobes– _________ and inferior– Separated by one deep fissure
Lungs• _________
– Rounded superior area
• ___________– Inferior concave area. – Rests on the diaphragm
• ____________ angle– Inferiolateral corners where the diaphragm
meets rib
Lung Tissue
• ___________– Functional tissue
– Spongy and elastic– Allows lungs to ______________(Breathing)
Pleura
• _____________– Sac the lungs are held in
– Two parts• __________Pleura - Outer layer• __________ (Visceral) Pleura - Inner layer
– Pleural cavity • ________space between parietal and pulmonary
pleura
Pleura Problems• _______________
– Air in the Pleural cavity
• Pleural ____________– Accumulation of fluid in the pleural cavity
• Hemothorax – Blood • Empyema - Pus
Diaphragm
• Primary muscle of breathing– Two ________________
• 3 openings– Aorta– ___________– Inferior Vena Cava
Pharynx(Upper Airway)
• Three Parts – ____________ - Posterior to nasal cavity– ___________ - Posterior to oral cavity
(mouth)– ____________ - At the junction between
larynx and esophagus
Accessory Parts– Hard & Soft Palate, Uvula,
Larynx(Voice Box)
• Cartilaginous structure• From _____________• Suspended by _____________• Contains 3 cartilage structures
– _____________– Thyroid Cartilage– Cricoid Cartilage
Trachea(Windpipe)
• Inferior to __________• Fibrous Muscular structure
– 3/4 inch diameter– 4 1/2 inches long– Surrounded by 20 cartilaginous rings – From ______________
• Branches into right and left at the distal trachea at the ____________
Bronchi
• Right Bronchi– Wider and __________ than left– Branches into the three right lobes
• Left Bronchi– Smaller and ___________ than right– Branches into the two lobes of the left
Mediastinum
• Part of the _______________cavity between the lungs.
• Extending from the _____________ column and contains all thoracic organs excepts the lungs.
Mediastinum Organs
• Thymus Gland
• __________and great vessels
• ___________
• Esophagus
Hilum
• A ____________________at that part of an organ where vessels and nerves enter.
• In the lungs:– __________– Blood Vessels – Lymph Vessels– ___________
Taking a Chest X-ray
• Consider body habitus– _____________
• short and wide - 14 X 17 crosswise
– Sthenic• Agerage - 14 X 17 cross or lengthwise
– _____________• longer and more narrow - 14 X 17 lengthwise
– Asthenic• long and narrow - 14 X 17 lengthwise
Topographical Landmarks
• Vertebra Prominens– ________– Apex of lungs
• Jugular Notch– __________– Top of Sternum
• Xiphoid Tip– ____________– Anterior Diaphragm
Technical FactorsAdult CXR
• Erect• High kV ____________
– Long scale– Low _________
• mAs determined by pt• ____________
Pediatric CXR
• Use immobilizer for erect image.
• Decrease kV to __________
• CR to mid thorax (___________)
• Crying is ____________!
Patient Prep
• Remove all _________ around neck area• Remove shirts with ______, snaps, etc..• Remove _________ with clips• Look for anything around lung field
– Oxygen tubes, hair braids, etc..• Nipple markers*
Patient Instructions• Typically done on ___________
– To get the best inspiration – “Breath in and blow it out take another
breath in and ________________”• Can do on expiration
– Pneumothorax, foreign body, lack of diaphragm movement, comparisons.
– “Take in a breath blow it all the way out and ______________.”
Patient PositioningPA
• Erect• ____________• No rotation• Chest against bucky• Hands on hips• Shoulder “__________” forward• Chin up
Left Lateral
• Left side against IR• Erect• 72” SID• No rotation• ___________
CR Positioning
• Mid ___________ (T7)
• 7-8” __________ to Vertebra Prominens (C7)
• Hand spread method (pg 83)
• Once CR is positioned, center _________
Guidelines for a perfect CXRPA and Lt Lat
• No rotation– PA - look at ____________
• Equidistance from spine
– Lateral - look at ___________ posterior ribs• No more than 1/4” to ______ separation
CXR Guidelines
• Adequate Inspiration– Minimum of ____________on PA
• Adequate technique PA– T-Spine vertebrae seen with ____________
Other Chest Projections
• AP - Supine or Semi erect– Slight ____________(5 degrees)
– CR to be perpendicular to the ____________
– Center to mid sternum (_____ inferior to jugular notch)
Decubitus
• Lt/Rt Lateral Decubitus– Pt recumbent on lt/rt side
– CR shot AP/PA to mid sternum
– For _______________or fluid levels
Others continued
• AP Lordotic– To visualize apices _____________– Pt stands ______ away from bucky an leans
back– Hand positioned as per _________ chest– CR straight at mid sternum
• Can do supine– ____________degree cephalad angle at mid
sternum
LAO and RAO
• LAO– 45 degree anterior
oblique– Left side closest to
bucky– Rt arm up – Lt arm on hip– ________seen
best• CR
– Level of T7– Mid body
• RAO– 45 degree anterior
oblique– Right side closest
to bucky– Lt arm up– Rt arm on hip– ________seen
best• CR
– Level of T7– Mid body
LPO and RPO
• LPO– 45 degree
posterior oblique– Lt side closest to
bucky– Lt arm up– Rt arm on hip and
rolled back– _______seen
best• CR
– T7– Mid body
• RPO– 45 degree
posterior oblique– Rt side closest to
bucky– Rt arm up– Lt arm on hip and
rolled back– _________seen best
• CR– T7– Mid body
S.T. Neck Factors
• _________SID for Lateral• _________SID for AP• 75 - 80 kVp • Slow deep inspiration
– Fill __________ with air
S.T NeckUpper Airway
• Lateral– Rt or Lt– Recumbent or
erect– Chin slightly
elevated– Shoulders rolled
back• CR
– Between thyroid cartilage and ________
• AP– Recumbent or
erect– Pt to look straight
ahead• CR
– Between thyroid and jugular notch
– _____above jugular notch