TEACH FOR NURSES LESSON PLAN
Chapter 19: Thorax and Lungs
CHAPTER OBJECTIVES
1. Name the components of the thoracic cage.
2. Describe the surface landmarks on the thorax.
3. List the contents of the mediastinum.
4. Describe the borders of the lung.
19-2
STUDENT RESOURCES
understand
• Textbook Chapter 19
• Sherpath for Medical-Surgical Nursing*
• Animations (Evolve website)
• Answer Keys: Study Guide & Lab Manual
• Audio glossary (Evolve)
• Pocket Companion for Physical Examination and Health Assessment*
• Clinical Skills Critical Care*
apply
• Case Studies (Evolve)
• Elsevier Adaptive Quizzing*
• HESI Case Studies*
INSTRUCTOR RESOURCES
before class
• Nursing Curriculum Standards (below)
19-3
in class
• PowerPoint Presentations (Evolve)
• Image Collection (Evolve)
* Sold separately from textbook.
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
POSITION AND SURFACE
LANDMARKS
Anterior Thoracic
Landmarks
Posterior Thoracic
Landmarks
Bring in a skeletal model
and let students perform
hands-on exploration of
the thoracic cage.
Define the surface
landmarks and each part
of the thoracic cage from
• Activity: Hand out diagrams, and have the class draw the reference lines for the thoracic cage.
• Activity: Have students play “Password” with the names of the thoracic landmarks. These terms
need to be committed to memory to communicate findings clearly either verbally or in writing.
• Discussion Topic: Discuss the clinical significance of the fact that the posterior chest consists of
almost all lower lobe.
19-4
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
Pleurae
Trachea and Bronchial
Bring in a model of the
lungs and let the students
examine it closely. Ask a
Explain the function and
structure of the pleural
cavity. Demonstrate how
the pleurae work, showing
what happens when the
cavity fills with air or fluid.
MECHANICS OF
RESPIRATION
Define the four major
functions of the
respiratory system. Have
• Discussion Topic: Discuss the effects of environment and smoking on the unborn fetus and on
children.
• Online Activity: Have students research fetal respiratory development or phases of lung
19-5
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
Infants and Children
The Pregnant Woman
Explain involuntary control
of respiration. Have
students do jumping jacks
or run in place to
Show a video of
respiration. Demonstrate
the use of the accessory
neck muscles because of
forced inspiration.
19-6
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
Give examples of ethnic
groups with an increased
SUBJECTIVE DATA
Additional History for
Infants and Children
Additional History for the
Aging Adult
this section, discussing
Review each question the
examiner asks and explain
the rationale. Discuss
other problems that can
arise from having a long-
standing cough.
• Small Group Activity: Have students work in pairs. One student is the “patient,” and the other
student is the “nurse.” Provide the “patient” with a list of symptoms to present to the “nurse” for
diagnosis. Observe and assist students as they practice asking questions to collect data for the
examination.
OBJECTIVE DATA
INSPECT THE POSTERIOR
CHEST
Review how to prepare the
patient and complete an
examination.
• Activity: Observe and assist class members as they practice palpation and percussion.
• Activity: Obtain foam cups with lids. Fill one with water or dirt and leave the other empty. Have
students practice listening for the difference in percussion notes between the two cups. The sounds
will be exaggerated, but this is a useful beginning.
19-7
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
PALPATE THE POSTERIOR
CHEST
Lung Fields
AUSCULTATE THE
POSTERIOR CHEST
Breath Sounds
proper positioning of the
hands. Discuss the
importance of noting the
Demonstrate how to
confirm symmetric chest
expansion.
Review the factors that
affect the normal intensity
of tactile fremitus.
• Activity: Have students document the results of the respiratory assessment completed on a patient.
Have students critique each other’s documentation techniques.
19-8
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
INSPECT THE ANTERIOR
CHEST
PALPATE THE ANTERIOR
CHEST
Breath Sounds
Measurement of Pulmonary
Function Status
DEVELOPMENTAL
CONFIDENCE
Discuss conditions for
which noisy breathing is a
symptom.
Demonstrate palpating
symmetric chest
Demonstrate and explain
hand positioning on the
chest.
Define how to evaluate
normal, abnormal, and
adventitious sounds.
• Online Activity: Have students find audio clips of adventitious lungs sounds. Discuss what makes
these sounds.
19-9
TEACHING STRATEGIES
Content Focus
Content Highlights
Learning Activities
or a child. Explain the
Apgar scoring system.
Review Table 19.2.
Emphasize the importance
of patient care for the
aging adult during the
examination.
IN-CLASS/ONLINE CASE STUDY
M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough.
Subjective Data
PMH: HTN, DM
Cough is productive, bringing up green phlegm
Runny nose, sore throat
Denies fever
19–10
Objective Data
Vital signs: T 37 P 72 R 14 BP 134/64
Lungs: + Rhonchi bilateral upper lobes, wheeze
Questions
1. What other questions should the nurse ask about the cough?
2. Develop a problems list from the objective and subjective data.
3. What nursing diagnoses can be derived from the problems list?
4. What should be included in the plan of care?
5. What risk factors are associated with this age group?
6. Based on the readings, what is the most likely cause of this patient’s cough?
Answers
1. Questions or assessments associated with cough include the following:
19–11
NURSING CURRICULUM STANDARDS
QSEN/NLN COMPETENCIES
• Patient-Centered Care/Human Flourishing
o Symmetric Expansion
o Additional History for Infants and Children
o Additional History for the Aging Adult
19–12
• Informatics/Nursing Judgment
o Documentation and Critical Thinking
NURSING CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. F. (2017). Concepts for nursing practice (2nd ed.).
St. Louis: Elsevier. The specific exemplars chosen and listed below for each concept have been tailored specifically to correspond to the Jarvis
textbook.
A full Concept-Based Curriculum Map covering the entire book can be found in the “Download by Resource Type” folder on Evolve.
THEME: Homeostasis and Regulation
BSN ESSENTIALS
• Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
o Table 19.7: Diagnostic Clues to Chronic Dyspnea and Associated Systems
• Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes
o Anterior Thoracic Landmarks
19–13
ANSWERS TO QUESTIONS IN THE STUDY GUIDE
Note: Answers to these questions can be found on Evolve site. Click here.