PRS Thorax Lungs by Weber

XAVIER UNIVERSITY
PERFORMANCE RATING SCALE

ASSESSING THE THORAX & LUNGS
SCALE DESCRIPTION INDICATORS
4 Very Good Student performs behaviors/tasks reflecting the highest level of

performance: consistent, independent, effective
3 Good Student performs behaviors/tasks reflecting mastery of performance with
minimal supervision
2 Fair Student performs behaviors/tasks reflecting development and movement
towards mastery of performance with help or direct supervision in some
aspect
1 Needs Student performs behaviors/tasks reflecting beginning level of
Improvement performance; tasks not done properly majority of the time but demonstrate
understanding of concepts involved with tasks
PROCEDURE 4 3 2 1 REMARKS
1. Perform hand hygiene and put on PPE, if indicated.
2. Iden9fy the pa9ent.
3. Close curtains around bed and close the door to the room, if
possible. Explain the purpose of the thorax and lung examina9on and
what you are going to do. Answer any ques9ons.
4. Help the pa9ent undress, if needed, and provide a pa9ent gown.
Assist the pa9ent to a siFng posi9on and expose the posterior
thorax.
5. Use the bath blanket to cover any exposed area other than the one
being assessed. Inspect the posterior thorax. Examine the skin,
bones, and muscles of the spine, shoulder blades, and back as well as
symmetry of expansion and accessory muscle use during respira9ons.
General Appearance: InspecAon
6.Inspect for nasal flaring and pursed lip breathing.
7. Observe color of face, lips, and chest.
8. Inspect color and shape of nails.
Posterior Thorax: InspecAon
9. Inspect configura9on. Client sits w/ arms at sides, stand behind &
observe the posi9on of scapulae & the shape & configura9on of the
chest wall.
10. Observe use of accessory muscles. Watch as the client breathes
and note use.
11. Inspect the client’s posi9oning. Note client’s posture & ability to
support weight while breathing comfortably.
Posterior Thorax: PalpaAon
12. Palpate for tenderness and sensa9on.
13. Palpate for crepitus.
14. Palpate surface characteris9cs. Put on gloves and use your fingers
to palpate any lesions that you no9ced during inspec9on. Also feel
for any unusual masses.
15. Palpate for Fremitus. As you move your hand to each area, ask
the client to say “ninety-nine.” Assess all areas for symmetry and
intensity of vibra9on.
16. Assess chest expansion. Place hands on posterior chest wall w/
thumbs at the level of T9 or T10 & pressing together a small skin fold.
As the client takes a deep breath, observe the movement of your
thumbs.
Posterior Thorax: Percussion
17. Percuss the tone. Start at the apices of the scapulae and percuss
across the tops of both shoulders. Then percuss the intercostal
spaces across and down, comparing sides. Percuss to the lateral
aspects at the bases of the lungs, comparing sides.
18. Percuss for diaphragma9c excursion. Ask the client to exhale
forcefully and hold the breath. Percuss downward un9l the tone
changes from resonance to dullness. Mark this level and allow the
client to breathe. Next ask the client to inhale deeply and hold it.
Percuss the intercostal spaces from the mark downward un9l
resonance changes to dullness. Mark the level and allow the client to
breathe. Measure the distance between the two marks. Perform on
both sides of the posterior thorax.
Posterior Thorax: AuscultaAon
19. Auscultate for breath sounds.Ask the client to breathe deeply
through his or her mouth for each area of ausculta9on (each
placement of the stethoscope) in the ausculta9on sequence so you
can best hear inspiratory and expiratory sounds.Be alert to the
client’s comfort and offer 9mes for rest and normal breathing if
fa9gue is becoming a problem.
20. Auscultate for adven99ous sounds.
21. Auscultate voice sounds. Bronchophony: Ask the client to repeat
the phrase “ninety-nine” while you auscultate the chest wall.
22. Perform Egophony: Ask the client to repeat the leber “E” while
you listen over the chest wall.
23. Whispered Pectoriloquy: Ask the client to whisper the phrase
“one–two–three” while you auscultate the chest wall.
Anterior Thorax: InspecAon
24. Have the client sit with her arms at her sides. Stand in front of the
client and assess shape and configura9on.
25. Inspect posi9on of the sternum.Observe the sternum from an
anterior and lateral viewpoint.
26. Watch for sternal retrac9ons.
27. Inspect slope of the ribs. Assess the ribs from an anterior and
lateral viewpoint.
28. Observe quality and pabern of respira9on. Note breathing
characteris9cs as well as rate, rhythm, and depth.
29. Inspect intercostal spaces. Ask the client to breathe normally and
observe the intercostal spaces.
30. Observe for use of accessory muscles. Ask the client to breathe
normally and observe for use of accessory muscles.
Anterior Thorax: PalpaAon
31. Palpate for tenderness, sensa9on, & surface masses.Use fingers
to palpate for tenderness & sensa9on. Start with your hand
posi9oned over the led clavicle (over the apex of the led lung) &
move your hand led to right, comparing findings bilaterally. Move
your hand systema9cally downward toward the midline at the level
of the breasts and outward at the base to include the lateral aspect
of the lung.
32. Palpate for tenderness at costochondral junc9ons of ribs.
33. Assess for crepitus as you would on the posterior thorax.
34. Also palpate any surface masses or lesions.
35. Palpate for fremitus. Using the sequence for the anterior chest
above, palpate for fremitus using the same technique as for the
posterior thorax.
36. Palpate anterior chest expansion. Place hands on the client’s
anteroateral wall with your thumbs along the costal margins and
poin9ng toward the xiphoid process. As the client takes a deep
breath, observe the movement of your thumbs.
Anterior Thorax: Percussion
37. Percuss for tone. Percuss the apices above the clavicles. Then
percuss the intercostal spaces across and down, comparing sides.
Anterior Thorax: AuscultaAon
38. Auscultate for anterior breath sounds, adven99ous sounds, and
voice sounds. Place the diaphragm of the stethoscope firmly &
directly on the anterior chest wall. Auscultate from the apices of the
lungs slightly above the clavicles to the bases of the lungs at the sixth
rib. Ask the client to breathe deeply through his mouth in an effort to
avoid transmission of sounds that may occur with nasal breathing. Be
alert to the client’s comfort and offer 9mes for rest and normal
breathing if fa9gue is becoming a problem, par9cularly for the older
client.
39. Assist the pa9ent in replacing the gown. Remove gloves and any
addi9onal PPE, if used. Perform hand hygiene. Ini9ate appropriate
referral to other healthcare prac99oners for further evalua9on, as
indicated. Document findings.
Actual Score/Total Score x 100

A (92 – 100)
A- (84 – 91.99)
B (76 – 83.99)
B- (68 – 75.99)
C (60 – 67.99)
F (< 60)
Student’s Signature : ________________________

Clinical Instructor’s Signature : ________________________

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XAVIER UNIVERSITY

PERFORMANCE RATING SCALE

SCALE DESCRIPTION INDICATORS

4 Very Good Student performs behaviors/tasks reflecting the highest level of

Actual Score/Total Score x 100

Student’s Signature : ________________________

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