Assessing The Thorax and The Lungs
Assessing The Thorax and The Lungs
Assessing The Thorax and The Lungs
Learning Objectives:
At the end of the respiratory system assessment the learner should be able to:
Reference lines
- Anterior
Midsternal
Midclavicular
Anterior axillary lines
- Posterior
Vertebral line
Scapular line
Posterior axillary line
Midaxillary line
Pleurae
Visceral pleura- lines outside of lungs, dipping down into the fissures
Parietal pleura- lines inside of chest wall and diaphragm
Lubricating fluid between the pleurae prevents friction
Trachea and Bronchi
Transport gasses between environment and lung
Dead space is space filled with air (about 150 ml) but not available for gaseous exchange
Goblet cells in bronchi secrete mucus that entraps particles
Cilia in bronchi sweep particles upward
Considerations
General Considerations
Warm equipment, such as a stethoscope, before using it to prevent chilling the patient.
Attempt to reduce the noise level in the room while auscultating for breath sounds to
ensure accuracy in listening. Also, the presence of chest hair may mimic the sound of
crackles and bumping the stethoscope against clothing may distort the sound.
Obtain the patient’s subjective data as well as the physical examination findings. For
example, the physical data may be normal; however, the patient may verbalize that he
or she is having difficulty breathing. In this case, the patient needs to be monitored
closely to assess for possible complications.
Lifespan Considerations
Avoid anterior thorax chest percussion in an infant because it is often unreliable due to
the infant’s small chest size.
Auscultate a child’s lungs before performing other assessment techniques that may
cause crying.
Expect to hear breath sounds that are harsher or more bronchial than those of an adult.
In the older adult patient, expect to find a reduction in respiratory effort due to age
related changes. A common finding in the elderly is kyphoscoliosis, a skeletal deformity
affecting the spinal column, which causes the anteroposterior (AP) diameter to increase
and the thorax to shorten. Also, the alveoli of the lung tissue decreases, which reduces
the amount of alveolar surface area available for gas exchange.
Equipment Needed
STEPS
- Introduce yourself
- Identifies client using 3 identifiers
- Explain the procedure and purpose of the client
- Gather necessary equipment
- Perform medical asepsis (hand wash) don gloves if necessary/ if situation requires
- Provide privacy for the client
- Position the client comfortably, seated if possible
Posterior Thorax
Inspect the spinal alignment for Spine vertically aligned Exaggerated spinal curvatures
deformities: Have the client (kyphosis, lordosis)
stand. From a lateral position, Spinal column is straight, right
observe the three (3) normal and left shoulders and hips are Spinal column deviates to one
curvature: cervical, thoracic, and at same height. side, often accentuated when
lumbar. To assess for lateral bending over. Shoulders or hips
deviation of the spine (scoliosis), not even.
observe the standing client from
the rear. Have the client bend
forward at the waist, and
observe from behind.
Palpation
Percussion
- Determines whether underlying tissue is filled with air, liquid or solid material
- Position and boundaries of certain organs
Percussion
PROCEDURE
1. Positioning
Make sure the patient is undressed down to the waist.
Position the patient on the examination table at a 30- to 45-degree angle and approach
from the right side. Examining the posterior of the lung requires the patient to be
leaning forward or sitting on the edge of the bed.
2. Percussion
Place non-dominant hand with middle finger (pleximeter finger) pressed and
hyperextended firmly on the patient's right or left mid-back area (lower levels of lungs
posteriorly). The firmer the finger is pressed to the chest wall, the louder the percussion
note tends to be.
Make sure the other fingers and palm are not pressed against the patient's chest.
Use the tip of the middle finger (plexor finger) of the dominant hand to tap firmly on the
top third (middle or distal phalanx) of the pleximeter finger of the nondominant hand at
least twice (it is advisable to keep fingernails short). The sound should be hollow,
representing an air-filled lung.
Pattern of Assessment for Percussion