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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 Factors Adult 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 Positioning PA • • • • • • • 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 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 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 Neck Upper 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