Assessing The Thorax and Lungs

PHYSICAL ASSESSMENT PROCEDURE
ASSESSING THE THORAX AND LUNGS
Definition: Evaluating tool of the thorax and lungs using the correct techniques of inspection,
auscultation, palpation, and percussion
Purpose:
 To gather accurate nursing history of the thorax and lungs.
 To analyze the data from the interview and physical assessment of the lungs and thorax to
formulate valid nursing diagnoses, collaborative problems, and or referrals.
 To differentiate normal and abnormal respiratory system findings
Procedure Return 1 2 PE
Demo
1. Explain the procedure to the patient. Provide privacy.
Preparation
2. Inspect the patient for any signs of respiratory difficulty.
a. Observe the patient’s facial expression—it should be
relaxed and calm.
b. Observe level of consciousness.
c. Assess the patient’s color for cyanosis, especially the
face, mucous membranes, and nail beds.
d. Listen to the patient’s breathing. Are there any audible
sounds.
e. Observe the neck and the shape of the chest.
Posterior Thorax
3. Inspect the shape and symmetry of the thorax from
posterior and lateral views.
4. Inspect the spinal alignment for deformities. Have the
client stand. From a lateral position, observe the three
normal curvatures: cervical, thoracic, and lumbar. To
assess for lateral deviation of spine (scoliosis), observe the
standing client from the rear. Have the client bend
forward at the waist and observe from behind.
5. Palpate the posterior thorax. For clients who have no
respiratory complaints, rapidly assess the temperature
and integrity of all chest skin. For clients who do have
respiratory complaints, palpate all chest areas for bulges,
tenderness, or abnormal movements. Avoid deep
palpation for painful areas, especially if a fractured rib is
suspected.
6. Palpate the posterior chest for respiratory excursion. Place
the palms of both your hands over the lower thorax, with
your thumbs adjacent to the spine and your fingers
stretched laterally. Ask the client to take a deep breath
while you observe the movement of your hands and any
lag in movement.
7. Palpate the chest for vocal (tactile) fremitus. Place the
palmar surfaces of your fingertips or the ulnal aspect of
your hand or closed fist on the posterior chest, starting
near the apex of the lungs. Ask the client to repeat such
words as “blue moon” or “one, two, three”. Repeat the
two steps, moving your hands sequentially to the base of
the lungs. Compare the fremitus on both lungs and
between the apex and the base of each lung, either 1)
using one hand and moving it from one side of the client
to the corresponding area on the other side or 2) using
two hands that are placed simultaneously on the
corresponding areas of each side of the chest.
8. Percuss the thorax. Percuss for diaphragmatic excursion.
a. Hyperextend the middle finger of your left hand,
known as the pleximeter finger. Press its distal
interphalangeal joint firmly on the surface to be
percussed.
b. Position your right forearm quite close to the surface,
with the hand cocked upward. The middle finger
should be partially flexed, relaxed, and poised to
strike.
c. With a quick, sharp but relaxed wrist motion, strike
the pleximeter finger with the right middle finger, or
plexor finger. Aim at your distal interphalangeal joint.
d. Strike using the tip of the plexor finger, not the finger
pad. Your finger should be almost at right angles to
the pleximeter.
e. Withdraw your striking finger quickly to avoid damping
the vibrations you have created.
9. Auscultate the chest using the flat disc diaphragm of the
stethoscope. Use the systematic zigzag procedure used in
percussion. Listen at each point to the breath sounds
during a complete inspiration and expiration. Compare
findings at each point with the corresponding point of the
opposite side of the chest.
a. Ask the client to take slow, deep breaths through the
mouth.
b. Ask the patient to say “ninety-nine” or “ee.”
c. Ask the patient to whisper “ninety-nine” or “one-two-
three.”
Anterior Thorax
10. Inspect breathing patterns.
11. Observe the shape of the patient’s chest and the
movement of the chest wall. Inspect the costal angle and
the angle at which the ribs enter the spine.
12. Palpate the anterior chest for respiratory excursion.
a. Place the palms of both your hands on the lower
thorax, with your fingers laterally along the lower rib
cage and your thumb along the costal margins.
b. As you position your hands, slide them medially a bit
to raise loose skin folds between your thumbs.
c. Ask the client to take a deep breath while you observe
the movement of your hands.
13. Palpate tactile fremitus in the same manner as for the
posterior chest. If the breasts are large and cannot be
retracted adequately for palpation, this part of the
examination is usually omitted.
14. Percuss the anterior chest systematically. Begin above the
clavicles in the supraclavicular space, and proceed
downward to the diaphragm. Compare one side of the
lung to the other. Displace female breasts for proper
examination.
15. Auscultate the trachea. Auscultate the anterior chest.
16. Use the sequence used in percussion, beginning over the
bronchi between the sternum and the clavicles.
17. Documentation
Ability to answer questions
Total Score
Equivalent Grade
● With Client
Final Grade
Signature of C.I.
Signature of Student
Date Performed

Assessing The Thorax and Lungs

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PHYSICAL ASSESSMENT PROCEDURE

ASSESSING THE THORAX AND LUNGS

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