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Chapter 2 Chest
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Bony Thorax 1 - __________ (Breastbone) 2 - Clavicles (Collar bones)
2 - ________ (Shoulder Blades) 12 - Rib Pairs 12 - ________Vertebrae
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2 Lungs Right has _______ lobes Left has ________ lobes
Superior, middle, ___________ Separated by two deep fissures Left has ________ lobes _________ and inferior Separated by one deep fissure
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Lungs _________ ___________ ____________ angle Rounded superior area
Inferior concave area. Rests on the diaphragm ____________ angle Inferiolateral corners where the diaphragm meets rib
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Lung Tissue ___________ Functional tissue Spongy and elastic
Allows lungs to ______________(Breathing)
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Pleura _____________ Sac the lungs are held in Two parts
__________Pleura - Outer layer __________ (Visceral) Pleura - Inner layer Pleural cavity ________space between parietal and pulmonary pleura
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Pleura Problems _______________ Pleural ____________
Air in the Pleural cavity Pleural ____________ Accumulation of fluid in the pleural cavity Hemothorax – Blood Empyema - Pus
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Diaphragm Primary muscle of breathing 3 openings Two ________________
Aorta ___________ Inferior Vena Cava
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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,
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Larynx (Voice Box) Cartilaginous structure From _____________
Suspended by _____________ Contains 3 cartilage structures _____________ Thyroid Cartilage Cricoid Cartilage
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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 ____________
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Bronchi Right Bronchi Left 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
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Mediastinum Part of the _______________cavity between the lungs.
Extending from the _____________ column and contains all thoracic organs excepts the lungs.
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Mediastinum Organs Thymus Gland __________and great vessels
___________ Esophagus
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Hilum A ____________________at that part of an organ where vessels and nerves enter. In the lungs: __________ Blood Vessels Lymph Vessels ___________
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Taking a Chest X-ray Consider body habitus _____________ Sthenic
short and wide - 14 X 17 crosswise Sthenic Agerage X 17 cross or lengthwise longer and more narrow - 14 X 17 lengthwise Asthenic long and narrow - 14 X 17 lengthwise
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Topographical Landmarks
Vertebra Prominens ________ Apex of lungs Jugular Notch __________ Top of Sternum Xiphoid Tip ____________ Anterior Diaphragm
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Technical Factors Adult CXR
Erect High kV ____________ Long scale Low _________ mAs determined by pt ____________
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Pediatric CXR Use immobilizer for erect image.
Decrease kV to __________ CR to mid thorax (___________) Crying is ____________!
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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*
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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 ______________.”
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Patient Positioning PA
Erect ____________ No rotation Chest against bucky Hands on hips Shoulder “__________” forward Chin up
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Left Lateral Left side against IR Erect 72” SID No rotation
___________
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CR Positioning Mid ___________ (T7)
7-8” __________ to Vertebra Prominens (C7) Hand spread method (pg 83) Once CR is positioned, center _________
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Guidelines for a perfect CXR PA and Lt Lat
No rotation PA - look at ____________ Equidistance from spine Lateral - look at ___________ posterior ribs No more than 1/4” to ______ separation
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CXR Guidelines Adequate Inspiration Adequate technique PA
Minimum of ____________on PA Adequate technique PA T-Spine vertebrae seen with ____________
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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)
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Decubitus Lt/Rt Lateral Decubitus Pt recumbent on lt/rt side
CR shot AP/PA to mid sternum For _______________or fluid levels
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Others continued AP Lordotic Can do supine
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
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LAO and RAO LAO CR RAO CR 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
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LPO and RPO LPO CR RPO CR 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
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S.T. Neck Factors _________SID for Lateral _________SID for AP
kVp Slow deep inspiration Fill __________ with air
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S.T Neck Upper Airway AP Lateral CR CR Recumbent or erect Rt or Lt
Pt to look straight ahead CR Between thyroid and jugular notch _____above jugular notch Lateral Rt or Lt Recumbent or erect Chin slightly elevated Shoulders rolled back CR Between thyroid cartilage and ________
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