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    Thorax and Lung Assessment 1 PDF

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    Alesi Tabbang
    The document outlines procedures for inspecting and examining various aspects of the thorax, including shape, symmetry, respiration rate and pattern, palpation, percussion, and diaphragmatic excursion. Normal findings are described as well as various abnormal findings. The goal is to systematically evaluate the thorax through visual inspection and physical examination techniques.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Thorax and Lung Assessment 1 PDF

    Uploaded by

    Alesi Tabbang
    35 views62 pages
    The document outlines procedures for inspecting and examining various aspects of the thorax, including shape, symmetry, respiration rate and pattern, palpation, percussion, and diaphragmatic excursion. Normal findings are described as well as various abnormal findings. The goal is to systematically evaluate the thorax through visual inspection and physical examination techniques.

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    Thorax-and-lung-Assessment-1.pdf

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    The document outlines procedures for inspecting and examining various aspects of the thorax, including shape, symmetry, respiration rate and pattern, palpation, percussion, and diaphragmatic excursion. Normal findings are described as well as various abnormal findings. The goal is to systematically evaluate the thorax through visual inspection and physical examination techniques.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views62 pages

    Thorax and Lung Assessment 1 PDF

    Uploaded by

    Alesi Tabbang
    The document outlines procedures for inspecting and examining various aspects of the thorax, including shape, symmetry, respiration rate and pattern, palpation, percussion, and diaphragmatic excursion. Normal findings are described as well as various abnormal findings. The goal is to systematically evaluate the thorax through visual inspection and physical examination techniques.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 62

    TITLE

    Slide Title
    Slide Title
    Slide Title
    INSPECTION

    SHAPE of Thorax

    1. Stand in front of the pt.


    2. Estimate visually the transverse diameter of the thorax.
    3. Move to either side of pt.
    4. Estimate visually the width of the AP diameter of thorax.
    5.Compare the estimates of these 2 visualizations
    Slide Title

    NORMAL

    1.AP:T = 1:2 for normal adult


    2.Wider from side to side than from front to back
    3.Slightly elliptical in shape
    4. Barrel chest normal in infants & older adults
    Slide Title
    Slide Title

    Abnormal

    1. Barrel chest - ratio is 1:1,


    chest is circular or barrel shaped
    Slide Title

    2. Pectus Carinatum - or
    pigeon chest, is a marked
    protrusion of sternum
    Slide Title

    3. Pectus excavatum – or funnel


    chest, is a depression in the body
    of sternum
    Slide Title

    4. Kyphosis orhunchback, an
    excessive convexity of
    thoracic vertebrae
    Slide Title

    5. Scoliosis - a lateral
    curvature of the thorax or
    lumbar vertebrae
    Slide Title
    SYMMETRY of CHEST WALL

    1. Stand in front of the pt


    2. Inspect R & L thoraxes
    3. Note shoulder height
    4. Move behind pt
    5. Inspect R & L posterior
    thoraxes
    Note position of scapula
    Slide Title

    Normal
    1.Shoulders at same height
    2.Scapula at same height
    3.No masses
    Abnormal

    1.Having one
    shoulder or
    scapula higher
    than the other
    Slide Title

    1.Stand in front of pt
    2.Visually locate the costal margin
    3.Estimate the angle formed by the costal
    margins during exhalation & at rest
    4.Gently move your fingertips medially to the
    xiphoid process
    5.As your hands approaches the midline,feel
    the ribs as they meet at the apex of costal
    margin
    Slide Title

    1. < 90° during


    exhalation & at rest
    2. Widens slightly
    during inhalation
    due to expansion of
    thorax
    Abnormal

    Costal margins
    > 90° - due to
    hyperinflation of
    lungs
    (emphysema)
    Angle of Ribs

    1. Stand in front of pt
    2. Visually locate the midsternal area
    3. Estimate the angle at which the
    ribs articulate with the sternum
    4.In a heavy/obese pt, place your
    fingertips on midsternal area
    5.Move fingertips along a rib laterally
    to anterior axillary line
    Intercostal Spaces

    1.Stand in front of pt
    2.Inspect the ICS throughout
    the respiratory cycle

    Note any bulging of ICS & any


    retractions

    Normal: absence of retraction


    & bulging of ICS

    Abnormal: presence of
    retraction
    Muscles for Respiration

    1.Stand in front of pt.


    2.Observe pt’s breathing for a few resp.
    cycle, paying close attention to the
    anterior thorax & neck

    Note all the muscles that are being used by


    the pt.
    Respiration

    1.Rate
    2.Pattern
    3.Depth
    4.Symmetry
    5.Audibility
    6.Patient position
    7. Mode
    Respiration RATE

    1.Stand in front of pt to right side


    2.Observe the pt’s breathing
    without stating what you are doing
    3.Count the # of resp cycles X 1 full
    minute

    *Eupnea: 12-20
    *Tachypnea: >20
    *Bradypnea: <12
    *Apnea: lack of spontaneous resp
    for >10 seconds
    Respiration Pattern

    1.Stand in front of pt to right side


    2. While counting the RR, note the
    rhythm or pattern of breathing for
    regularity or irregularity

    Normal: regular & even in pattern


    Abnormal

    1. Cheyne-Stokes Respirations –
    regularly irregular

    2. Biot’s Respirations or ataxic


    respirations - irregularly irregular

    3. Apneustic respirations - prolonged


    gasping during inspiration followed
    by very short, inefficient
    respiration
    Slide Title

    4. Agonal
    respirations -
    irregularly irregular,
    they are of varying
    depths and pattern
    Slide Title
    Respiration - DEPTHS

    1.Stand in front of pt.


    2.Observe the relative depth with which
    the pt. draws a breath during respiration

    *Normal: Non- exaggerated and


    effortless

    *Abnormal: Shallow (hypoventilation),


    hyperpnea, air trapping, kussmaul’s,
    sighi
    Respiration - SYMMETRY

    1. Stand in front of pt.


    2. Observe the symmetry with which the
    chest rises & falls in unison in the respiration
    cycle.

    *Normal: Thorax rises and falls in unison in


    the resp cycle. There is no paradoxical
    movement

    *Abnormal: Unilateral expansion


    Respiration - AUDIBILITY

    1. Stand in front of pt.


    2. Listen to the audibility of
    respirations

    *Normal: normally heard by


    unaided ear a few centimeters
    from pt’s nose or ears

    *Abnormal: audible at few feet


    from pt, upper airway sounds
    may also be heard
    Respiration – POSITION

    1.Ask pt to sit upright


    2.Note if pt. can breathe normally when in
    supine position
    3.Note if pillows are used to prop upright
    to facilitate breathing

    *Normal: breathes comfortably in


    supine, prone or upright position

    *Abnormal: Orthopnea
    Respiration – MODE OF BREATHING

    1.Stand in front of pt.


    2.Note whether the pt. is using
    the nose, mouth, or both to
    breathe

    *Normal: may vary among


    individuals, but in general, most
    pts inhale & exhale through the
    nose

    *Abnormal: Continuous mouth


    breathing, pursed- lip breathing
    Slide Title
    Palpation of the Thorax : ANTERIOR

    1.Stand in front of pt.


    2.Place finger pads of dominant hand on
    apex of right lung (above clavicle)
    3.Using light palpation, assess the
    integument
    4.Move it down to the clavicle & palpate
    5.Proceed with palpation, moving down to
    each rib & ICS, with tenderness last
    6.Repeat on left anterior thorax
    Palpation of the THORAX: POSTERIOR

    1.Stand in front of pt
    2.Place finger pads of dominant hand
    on apex of right lung (level of T1)
    3.Using light palpation, assess the
    integument
    4.Move it down to the 1st thoracic
    vertebrae & palpate
    5.Proceed with palpation, moving
    down to each thoracic vertebrae &
    ICS of right posterior thorax
    6.Repeat on left posterior thorax
    Palpation of the Thorax : LATERAL

    1.Stand to pt’s right side


    2.Have pt lift arm over head
    3.Place finger pads of dominant
    hand beneath right axillary fold
    4.Move finger pads down to each
    rib & ICS of right lateral thorax
    5.Move to the left side
    6. Repeat on left lateral thorax
    Thoracic: EXPANSION

    1.Stand directly behind the pt


    2.Place thumbs of both hands at level of 10th
    spinal vertebrae, approx 1-3 inches apart
    3.Gather a small fold of skin between thumbs to
    assist with the visualization of the result of this
    technique
    4.Lay your outstretched palms on posterolateral
    thorax
    5.Instruct pt. to take a deep breath
    6.Observe movement of thumb . Both in
    direction & in distance
    7.Ask patient to exhale
    8.Observe movement of thumbs as they return to
    midline
    NORMAL

    Thumbs separate an equal


    amount from spinal column or
    xiphoid process (distance) &
    remain in the same plane of
    the 10th spinous vertebra or
    costal margin (direction).
    Normal distance: 3-5cm
    TACTILE FREMITUS

    1.Place the ulnar/bolar aspect of hand on pt’s


    anterior apex (above clavicle)
    2.Instruct pt to say “99” or “1,2,3”, with same
    intensity every time you place your hand on
    thorax
    3.Feel any vibration on ulnar aspect of hand as pt
    phonates. If no fremitus is palpated, you may
    need to have pt speak more loudly
    4.Move hand on same location on left
    anterior thorax
    5.Compare vibrations on R & L apices
    6.Move hand down 2-3 inches & repeat process
    on right & then on left
    Slide Title
    NORMAL

    1. Felt as buzzing on the ulnar aspect of hand


    2. More pronounced near major bronchi (2ICS anteriorly,T1
    & T2 posteriorly) & the trachea, less palpable in periphery
    of lungs

    ABNORMAL
    1.Increased tactile fremitus
    2.Decreased or absent
    3.Pleural friction fremitus
    4.Tussive fremitus
    5.Rhonchal fremitus
    TRACHEAL POSITION

    1.Place finger pads of index finger on


    patient’s trachea in the suprasternal notch
    2.Move the finger pad laterally to right &
    gently move the trachea in the space
    created by the border of the inner aspect
    of the SCM (sternocleidomastoids) & the
    clavicle
    3.Move the finger pad laterally to the left &
    repeat the procedure

    *Normal:
    Trachea is in the midline
    in the suprasternal notch
    Slide Title

    ABNORMAL

    1.Tracheal deviation to
    the side
    2.Tracheal deviation to
    the unaffected side
    PERCUSSION : ANTERIOR THORAX

    1.Place pt in upright sitting position


    with shoulders back
    2.Percuss 2-3 strikes along right lung apex
    3.Repeat to the left lung apex Note sound
    produced from each
    percussion strike & compare from each other
    4.Move down approx 5cm, or every ICS
    5.Percuss in same position on contralateral side
    Continue to move down until entire
    lung has been percussed
    PERCUSSION : POSTERIOR THORAX

    1.Place pt in upright sitting position with slight forward tilt.


    2.Have pt bend head down & fold arms in front of waist
    3.Percuss the right lung apex located along the top of shoulder, approx 3X
    4.Repeat to the left lung apex Note sound produced from each percussion
    strike & compare from each other
    5.Move down approx 5cm, or every ICS Percuss in same position on
    contralateral side
    6.Continue to move down until entire lung has been percussed
    Slide Title

    NORMAL
    1.Normal lung tissue produces a RESONANT sound
    2.Diaphragm & cardiac silhouette emit dull sounds
    3.Ribs sounds are flat
    4.Hyperresonance is normal in thin & decreased musculature adults
    Slide Title
    Slide Title
    DIAGRHAMATIC EXCURSION

    1.Position pt in for posterior thoracic expansion


    2.Patient breathing normally, percuss right lung from apex to below the diaphragm
    3.Note level at which percussion note changes quality to orient your assessment to the pt’s
    percussion sound
    4.Instruct to inhale as deeply as possible & hold that breath
    5.With pt holding breath, percuss the right lung in the scapular line from below the scapula to
    the location where resonance changes to dullness
    6.Mark this location & tell pt to exhale & breathe normally
    7.When pt has recovered, instruct to inhale as deeply as possible, exhale fully, & hold exhaled
    breath
    8.Repercuss the right lung below the scapula in the scapular line in a caudal direction. Mark
    spot where resonance changes to dullness
    9.Measure distance between two marks
    10.Repeat for posterior thorax
    Slide Title
    Slide Title

    NORMAL
    1.Normal distance is 3-5cm
    Level of diaphragm is T12 on inspiration &
    T10 on expiration
    Right side is usually higher than left

    ABNORMAL
    1.Diaphragmatic excursion of less tan 3cm
    *High level diaphragm
    AUSCULTATION : ANTERIOR THORAX

    1.Place pt in upright sitting position with


    shoulders back
    2.Instruct to breath only through mouth
    3.Instruct & inhale & exhale deeply &
    slowly
    4.Place stethoscope on apex of right
    lung & listen for 1 complete resp cycle
    5.Note sound ausculated Repeat on left
    apex 6.Compare on each side
    7.Continue to move down 5cm or every
    ICS comparing contralateral side
    AUSCULTATION : POSTERIOR THIORAX

    1.Place pt in upright sitting position with slight


    forward tilt. 2.Have pt bend head down & fold
    arms in front of waist
    3.Place stethoscope firmly on pt’s right lung
    apex. Ask to inhale & exhale deeply & slowly
    4.Repeat on left lung apex
    5.Move stethoscope down approx 5cm or
    every ICS
    6.Auscultate in the same position on the
    contralateral side
    Continue to move inferiorly until lung has been
    assessed
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