ASSESSMENT OF THE

CHEST AND LUNGS

NCM-101
MS. CHINGBEE G. PURO, RN
ANTERIOR VIEW
POSTERIOR VIEW
RIGHT LATERAL VIEW
LEFT LATERAL VIEW
 COMMON MEDICAL TERMS

 1. INTERSPACE- a space between two structures or organs in the body

 2. EMPHYSEMA- is a lung condition that causes shortness of breath ( the air sacs in the lungs “alveoli” are
damage
 3. ATELECTASIS- is a complete or partial collapse of the entire lung or area (lobe) of the lung
 4. PNEUMONIA- is an infection that inflames the air sacs in one or both lungs
 5. PLEURAL EFFUSION- is the build up of excess fluid between the layers of the pleura outside the lungs
 6. PLEURA- are thin membranes that line lungs and the inside of the chest cavity and act to lubricate and
facilitate breathing.
 7. FREMITUS- a vibration felt when an examiner palpates a body part (chest/lungs) of the patient while
speaking
 8. CREPITUS- describes any grinding, creaking , cracking, grating, crunching or popping that occurs when
moving a joint
 COMMON MEDICAL TERMS

 9. PNEUMOTHORAX- is a collapse lung. Occurs when air leaks into the space between the lung and chest
wall
 10. RESONANCE- the sound elicited on percussion of the chest
 11. EXCURSION- a movement outward and back from a mean position or axis
 12. ADVENTITIOUS- arising or occurring sporadically or in other than the usual location
 13. CRACKLES- are the clicking, rattling, or crackling noises that may be made by one or both lungs of a
human with a respiratory disease during inhalation
 14. WHEEZING- is a high pitched whistling sound made while breathing
 15. STRIDOR- is an abnormal, high pitch sound produced by turbulent airflow through a partially obstructed
airway
 COMMON MEDICAL TERM
 16. BRONCHOPHONY- is the abnormal transmission of sounds from the lungs or bronchi
 17. EGOPHONY- is an increased resonance of voice sounds heard when auscultating the lungs, often caused by
lung consolidation and fibrosis
 18. PECTORILOQUY- is the increased resonance of the voice through the lung structures, so that it is clearly
comprehensible using stethoscope on the chest. It usually indicates consolidation of the underlying lung
parenchyma
 19. PARENCHYMA- the functional tissue of an organ as distinguished from the connective and supporting tissue
 CHEST AND LUNGS
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
Have the client sit on the side of • Shoulders are level; breasts, lower • Movement of the chest wall is
examining table or bed. When examine rib margin are symmetrical asymmetrical on respiration,
in supine position, the client should lie shoulders are uneven, rib cage or
comfortably with arms somewhat • Chest wall rises and falls slightly breasts are asymmetrical;
abducted with inspiration and expiration • funnel chest (depression in sternum)
• barrel chest(increase AP diameter)
* Equal respiratory movement

* No retraction or bulging of the

interspaces should occur on inspiration
 EXAMINATION OF POSTERIOR CHEST

ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS

INSPECTION: *Thorax in normal adult is wider, its • Client has supraclavicular
Observe the shape and movement of lateral diameter is larger than in retractions or contractions of
the posterior chest. Compare one side anterioposterior (AP) accessory muscles during
with other. note: inspiration
1. Deformities or asymmetry
2. Abnormal retraction of the lower *AP diameter may increase with age • AP diameter may increase in
interspaces chronic obstructive pulmonary
3. Impairment in respiratory disease. (COPD)
movement
 EXAMINATION OF POSTERIOR CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS

PALPATION: • No tenderness, superficial lumps or • Tender pectoral muscles or costal

Palpate the posterior wall over areas masses cartilage
(palpate for tenderness, sensation, • normal skin mobility and turgor • Pain
crepitus, masses, lesions, and • Masses
fremitus)

INSPECTION: • Shoulders are even; scapulae are at • Structural deformities or

Stand behind the client and observe the same level; spine is midline asymmetry are present;
the posterior chest for shape and and straight • Scoliosis (lateral curvature);
movement • Posterior chest slightly rises and • Kyphosis (abnormal spinal
falls on respiration curvature and vertebral rotation
deform chest)
 EXAMINATION OF POSTERIOR CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
INSPECTION AND PALPATION: * Chest expansion is symmetric • An abnormally wide costal angle
1. Assess chest expansion on the with little inspiratory variation
posterior chest occurs with emphysema
a. Place your hands in the • A lag in expansion occurs with
posterolateral chest wall with atelectasis and pneumonia
thumbs at the level of T9 or T10 • Pain accompanied deep breathing
b. Slide your hands medially to pinch when the pleura are inflamed
up a small fold of skin between
your thumb
c. Ask the client to take a deep
breath
d. Watch your thumbs’ move apart
symmetrically and not smooth
chest expansion with your finger
 EXAMINATION OF POSTERIOR CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
I2. Assess tactile (vocal) fremitus * Vibrations should feel the same in • A palpable grating sensation
a. Begin palpating by using the the corresponding area on each side with breathing indicates pleural
ball or ulnar surface of your friction fremitus
hand from the lung apices • Decrease fremitus occurs when
b. Touch the client’s chest while anything obstructs transmission
he/she repeat the words “ninety- of vibration e.g. obstructed
nine” or “blue moon” bronchus, pleural effusion,
c. Compare vibration from one pneumothorax or emphysema
side to the other • Increase fremitus occurs with
compression or consolidation of
lung tissue, e.g. lobar pneumonia
EXAMINATION OF POSTERIOR CHEST
ABNORMAL FINDINGS
• Rhoncial fremitus is palpable
with thick bronchial secretions

• Pleural friction fremitus is

palpable with inflammation of the
pleura
 EXAMINATION OF POSTERIOR CHEST

ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS

PERCUSSION (Lung fields) * Resonance is normal lung sound: • Dullness replaces resonance when
Percuss the posterior chest PC except heart area because heart fluid or solid tissue replaces air
1. Percuss the PC the apices and then normally produces dullness bound, containing lung or occupies the
to interspaces with a 5cm interval liver produces dullness, stomach pleural space e.g. pneumonia,
2. Note any abnormal findings produces tympany, muscle and bone pleural effusion, atelectasis, or
produces flat tumor
• Hyper resonance is found in COPD
and asthma
• Hyper resonant or tympanitic in
pneumothorax
 EXAMINATION OF POSTERIOR CHEST

ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS

PERCUSSION * The diaphragm excursion should be * An abnormal high level of dullness
DIAPHRAM EXCURSION equal bilaterally and measure about 3- or absence of excursion occurs with
1. Ask the client to exhale and hold it 5 cm in adults pleural effusion or atelectasis of the
briefly while you percuss down the lower lobes
scapular line
2. Continue percussion until the
sounds changes from resonant to
dull on each side
3. Mark the spot
 EXAMINATION OF POSTERIOR CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS

AUSCULTATION • Breath sounds are usually louder in • Decreased or absent breath sounds
1. Listen to the breath posteriorly upper anterior lung fields occur e.g. atelectasis, pleural
with mouth open and more deeply • Bronchial, broncho-vesicular, effusion, pneumothorax, COPD
than the normal (note intensity, vesicular sounds are normal breath • Increased breath sounds occur
identify any variation and any sounds when consolidation or compression
adventitious sounds, • None adventitious sound yields a dense lung area e.g.
bronchophony, egophony, and pneumonia, fluid in the intra-
whispered pectoriloquy) pleural space

2. Repeat auscultation in the posterior

chest
 EXAMINATION OF THE ANTERIOR
CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
INSPECT AP diameter of chest, slope • Symmetrical expansion • An abnormal wide costal angle
of ribs, and color of chest • Smooth chest expansion with little inspiratory variation
Note quality and pattern of occurs with emphysema
respiration(rate,rhythm & depth) • A lag expansion occurs with
PALPATE THE ANTERIOR atelectasis or pneumonia
CHEST • A palpable grating sensation with
1. Assess symmetric expansion breathing indicates pleural fremitus
a. Place your hands on the anterolateral
wall with your thumbs along the costal
margins and pointing toward the
xiphoid process
b. Ask the client take a deep breath
c. Watch your hand move apart
symmetrically (palpate for tenderness,
masses, lesions, fremitus, and anterior
chest expansion
 EXAMINATION OF THE ANTERIOR
CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
PALPATE THE ANTERIOR * Vibrations should feel the same in *A palpable grating sensation with
CHEST the corresponding area on each side breathing indicates pleural friction fremitus
1. Assess tactile fremitus * Decrease fremitus occurs when anything
a. Begin palpating over the lung obstructs transmission of vibration e.g.
obstructed bronchus, pleural effusion,
apices in the supraclavicular areas
pneumothorax or emphysema
b. Compare vibrations from one side * Increase fremitus occurs with
to other side while repeating compression or consolidation of lung
“ninety-nine” tissue, e.g. lobar pneumonia
c. Avoid palpating over female breast * Rhoncial fremitus is palpable with thick
tissue because normally clamps the bronchial secretions
sound * Pleural friction fremitus is palpable with
2. Palpate the anterior chest wall (note inflammation of the pleura
any tenderness, and detect any
superficial lumps or masses, skin
mobility, turgor, skin temperature and
moisture)
 EXAMINATION OF THE ANTERIOR
CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
PERCUSS THE ANTERIOR • * Resonance is normal lung sound: * Lungs with chronic emphysema
CHEST except heart area because heart result in hyper resonance
1. Begin percussing the apices in the normally produces dullness bound,
supraclavicular areas liver produces dullness, stomach
2. Percuss the interspaces and produces tympany, muscle and
compare one side to the other bone produces flat
3. Move down the anterior chest
 EXAMINATION OF THE ANTERIOR
CHEST
ACTION/PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS
AUSCULTATION
1. Auscultate the lung fields over the • Breath sounds are usually louder in • Decreased or absent breath sounds
anterior chest from the apices in upper anterior lung fields occur e.g. atelectasis, pleural
the supraclavicular areas down to • Bronchial, broncho-vesicular, effusion, pneumothorax, COPD
the 6th rib vesicular sounds are normal breath
2. Progress from side to side and sounds • Increased breath sounds occur
listen to one full respiration in • None adventitious sound when consolidation or compression
each location yields a dense lung area e.g.
3. Evaluate normal breath sounds and pneumonia, fluid in the intra-
note abnormal breath sound pleural space