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    Unit 06 Assessment of Thorax and Lung

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    huma
    The document provides guidelines for assessing the thorax and lungs through obtaining a patient history, inspecting the chest, palpating the chest, percussing the chest, auscultating breath sounds, and documenting examination findings. Key steps include inspection for symmetry and respiratory pattern, palpation for tenderness and masses, percussion for resonance and dullness, and auscultation of breath sounds and adventitious sounds. Proper documentation of objective and subjective findings is also emphasized.

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    Unit 06 Assessment of Thorax and Lung

    Uploaded by

    huma
    710 views55 pages
    The document provides guidelines for assessing the thorax and lungs through obtaining a patient history, inspecting the chest, palpating the chest, percussing the chest, auscultating breath sounds, and documenting examination findings. Key steps include inspection for symmetry and respiratory pattern, palpation for tenderness and masses, percussion for resonance and dullness, and auscultation of breath sounds and adventitious sounds. Proper documentation of objective and subjective findings is also emphasized.

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    UNIT 06 ASSESSMENT OF THORAX AND LUNG

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    The document provides guidelines for assessing the thorax and lungs through obtaining a patient history, inspecting the chest, palpating the chest, percussing the chest, auscultating breath sounds, and documenting examination findings. Key steps include inspection for symmetry and respiratory pattern, palpation for tenderness and masses, percussion for resonance and dullness, and auscultation of breath sounds and adventitious sounds. Proper documentation of objective and subjective findings is also emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    710 views55 pages

    Unit 06 Assessment of Thorax and Lung

    Uploaded by

    huma
    The document provides guidelines for assessing the thorax and lungs through obtaining a patient history, inspecting the chest, palpating the chest, percussing the chest, auscultating breath sounds, and documenting examination findings. Key steps include inspection for symmetry and respiratory pattern, palpation for tenderness and masses, percussion for resonance and dullness, and auscultation of breath sounds and adventitious sounds. Proper documentation of objective and subjective findings is also emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    The document discusses the assessment of the thorax and lungs, including anatomy, physical examination techniques, and documentation.

    The lungs are located in the thoracic cavity. The right lung has three lobes while the left has two. They are composed of the trachea, bronchioles and alveoli which are responsible for respiration.

    Inspection, palpation, percussion and auscultation of the chest are described as the key physical examination techniques. Vital signs, breath sounds, use of accessory muscles and appearance should all be assessed.

    In The Name of

    God

    UNIT 07
    ASSESSMENT OF
    THORAX AND
    LUNGS
    Azra Khanum
    Objectives

    • By the end of the unit, learners will be able to:


    • Describe the component of health history that should be
    elicited during the assessment of thorax and lungs.
    • Identify the structural landmarks of thorax and lungs.
    • Describe specific assessments to be made during the
    physical examination of the above systems.
    • Document findings.
    Anatomy of Lungs
    • Organs of respiration
    • Located in thoracic cavity
    • Right lung-3 lobes
    • Left lung- 2 lobes
    • Important to know landmarks of thorax
    • Composed of trachea, bronchioles &
    alveoli
    Conti….

    4
    Structures of the Respiratory System
    Conti…
    Mechanics of Respiration
    (cont.)
    Anatomical Landmarks
    • Anteriorly: Apex of lung ¾ -1 and
    ½” (2-4cm) above clavicle.
    • Anteriorly: Base to 6th rib
    midclavicular, 8th rib midaxillary.
    • Posterior: Apex- first
    thoracic vertebrae.
    • Posterior: Base T-10 expiration and
    T-12 deep inspiration.
    Anterior Lobes of Lung
    Posterior Thoracic
    Cage
    Posterior Lobes of Lung
    Anterior Thoracic
    Cage
    Chest Landmarks
    Reference Lines (Lateral)
    History Taking
    • Symptoms of the respiratory
    tract
    • History of previous illness
    • Family history
    • Environmental exposure
    • Cigarette smoking
    • Occupational history
    The six principal symptoms
    of the respiratory tract
    • Cough
    • Epiglottitis causes a Barking quality cough
    • Cough that is worse at night is suggestive of asthma or heart failure
    • Sputum:
    • Large volume of purulent (Yellow Or Green) e.g. bronchiectasis or lobar pneumonia
    • Pink frothy secretions from trachea in Pulmonary Edema
    • Haemoptysis
    • Dyspnea:
    • Dyspnea can be graded from I to IV based on the New York
    Heart Association classification:
    • Class I - dyspnea only on heavy exertion
    • Class II - dyspnea on moderate exertion
    • Class III- dyspnea on minimal exertion
    • Class IV- dyspnea at rest
    • Chest pain
    • Wheeze
    Inspection of Thorax and
    Lungs
    • With patient sitting up- uncovered
    • Observe for lesions, chest symmetry,
    ventilatory pattern, depth, rate and
    rhythm, muscles used & skin color
    • Note both posterior view and anterior
    view.
    • Note spinal deformities
    • AP (anteroposterior) diameter should be
    less than transverse (1/2)
    PECTUS EXCAVATUM
    • Are there any chest
    wall deformities? (e.g.
    pectus excavatum /
    pectus carinatum)
    • Does the chest appear
    over expanded? (i.e.
    Barrel shaped chest ) PECTUS CARINATUM (PEGION CHEST)
    • Is there any Kyphosis
    or Scoliosis present?
    • Abnormal retraction
    • Impaired movement
    Normal Anterior-Posterior: Transverse
    Diameter
    Increased Anterior-Posterior: Diameter
    Kyphosis
    Scoliosis

    27
    Palpation of Posterior
    • Thorax
    Using fingers palpate chest wall note:
    • Tenderness
    • Alignment
    • Any Bulging or retractions
    • Palpate for masses
    • Palpate for any crepitus- coarse,
    crackling sensation palpable over skin
    surface in subcutaneous emphysema.
    May follow thoracic injury or surgery.
    Palpate Tactile Fremitus
    • First say “ahhhh” and feel own neck =
    fremitus.

    • Palpate the patient’s back to right and left


    of spine as the pt. says 99 and examiner
    palpates with palm of hand, compare
    bilaterally.

    • Decreased fremitus- anything obstructs


    transmission of vibrations, e.g., obstructed
    bronchus, pneumothorax, emphysema. It is
    Palpate Chest
    •Expansion/Excursion
    Posterior- place hands along outer edge of
    costal margin with thumbs toward middle of
    spine

    • Have patient take a deep breath

    • Should observe yours hands moving equally


    far apart.

    • Unequal expansion could be due to marked


    atelectasis, pneumonia, trauma to thorax.
    Or pneumothorax.
    Chest expansion/
    excursion
    Chest
    excursion
    Percuss the
    • Apices toThorax
    bases
    • Anterior
    • Lateral
    • Posterior- fold arms across chest
    • Hear resonance and dullness
    alternately with lung or ribs.
    • Avoid percussion over scapulae and
    ribs.
    Hyperresonance found when too much air is present
    (emphysema, pneumothorax) Dullness signals
    abnormal density (pneumonia, tumor)
    Diaphragmatic Excursion
    • Distance between deep inspiration
    and full expiration.
    • Normally ranges from 3-6 cm
    • Exhale and hold, percuss and
    mark location of diaphragm:
    change dull- resonance
    • Deep inspiration and hold it, percuss
    + mark change again
    Diaphragmatic
    excursion
    Auscultation
    • Beginning at apices to base, compare
    bilaterally.
    • Listen for full cycle, note quality and
    intensity
    • Instruct patient to breathe through
    mouth, a little deeper (but not faster)than
    usual
    • Use stethoscope diaphragm firmly vs
    chest wall
    Normal Breath Sounds
    • Bronchial- heard over trachea and larynx.
    High pitch, loud, harsh. Inspiration <
    expiration

    • Bronchovesicular- heard over major


    bronchi. Moderate pitch and
    loudness. Inspiration=expiration

    • Vesicular- heard over lung fields. Low


    pitch, soft sound. Inspiration>expiration
    Adventitious sounds
    • Crackles/ Crepitations - (rales) rub hair between
    fingers cracking/popping sound. Secondary to fluid
    in airway or to opening of collapsed alveoli in
    atelectasis.

    • Wheezes- continuous musical and high pitched, due


    to constricted bronchi. E.g. Asthma, Chronic
    Emphysema,

    • Rhonchi- lower pitched, coarse, snoring, due to


    thick secretions.

    • Pleural friction rub- lower pitched, dry, rough,


    Assess Lungs
    • Note:decreased or absent breath sounds
    • Bronchial tree obstructed at some point
    by secretions, mucus plug or foreign
    body
    • Emphysema
    • Anything that obstructs sound transmission:
    pleurisy, pleural thickening, air
    (pneumothorax), fluid (pleural effusion),
    in pleural space.
    Increased Breath Sounds
    • Sounds are louder than they should be, e.g.,
    bronchial sounds heard over peripheral lung
    fields.

    • They occur when consolidation e.g.,


    pneumonia or compression creates a
    denser lung area that enhances
    sound transmission.
    Vocal Resonance
    /Further Assessment
    • Auscultation of the chest while the patient speaks can
    provide extra information about the patient’s lungs.

    • Bronchophony- say “99”, if heard loud and distinct, it is


    abnormal. increased over solid areas, decreased by pleural
    fluid

    • Whispered pectoriloquy- whisper “99” or “1,2,3”should


    be muffled. Abnormal= loud & distinct means there is
    consolidation.

    • Egophony – say “E”, the E changes to an “A” sound


    over
    area of consolidation, pleural effusion or abscess.
    Sample Charting
    • SUBJECTIVE
    • No cough, shortness of breath, or chest
    pain with breathing. No history of
    respiratory diseases. Has “one or no”
    colds per year.

    • Has never smoked. Works in well-ventilated


    office-smoking coworkers are restricted to
    smoke in lounge. Last TB skin test 4 years
    PTA, negative. Never had chest x-ray.
    Sample Charting (cont.)
    • OBJECTIVE
    • Inspection AP < transverse diameter. Respirations
    16/min, relaxed and even
    • Palpation. Chest expansion symmetric. Tactile
    fremitus equal bilaterally and decrease at the base.
    No tenderness to palpation. No lumps or
    lesions.
    • Percussion. Resonant to percussion over lung
    fields. Diaphragmatic excursion 5 cm and
    = bilaterally.
    • Auscultation. Vesicular breath sounds clear over
    lung fields. No adventitious sounds.
    Summary: Respiratory
    Assessment
    • Respiratory rate and rhythm
    • Lung sounds
    • Use of accessory muscles?
    • Nasal flaring?
    • Color- skin, nail beds, lips.
    • Clubbing of nails.
    • Pulse Ox +/or ABG
    • Orthopnea?, SOB?, Dyspnea?
    Reference
    • Weber. J. R., & Kelley. J.H., (2014), Health
    assessment in Nursing (5th Ed). Wolters
    Kluwer Health, Lippincott Williams &
    Wilkins.

    • Bickly L.S, B.(2011) Bates guide to physical


    examination and history taking (10th
    ed).Philadelphia: J.B.Lippincott

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