Assessing the Thorax and Lungs

five sections to this procedure

1. inspect the chest and lungs 2. palpate the chest and lungs 3. percuss the chest and lungs 4. auscultate the chest and lungs 5. assess pulmonary function and sputum

Which of the following indicates normal respiratory function? A. Symmetrical chest expansion B. Nasal flaring C. Use of accessory muscles D. Lip pursing

A Rationale: Symmetrical chest expansion is a sign of normal respiratory function. Nasal flaring is not a normal finding and may be a sign of respiratory distress. Use of accessory muscles is not a normal finding and may be a sign of respiratory distress. Lip pursing is not a normal finding and is often taught to COPD patients to control shortness of breath.

Normal breath sounds include: A. Vesicular sounds B. Rhonchi C. Wheezes D. Crackles

A Rationale: Vesicular sounds are normal breath sounds heard over the periphery of the lung. Rhonchi, wheezes, and crackles are adventitious sounds.

Inspect the chest from the front and back. Note seven characteristics.

Assess its size and shape. Check for symmetry. Consider the thoracic landmarks, the costal angle, angle of the ribs, and intercostal spaces. Note the color of the skin. Check for supernumerary nipples. Look for superficial venous patterns. Observe the prominence of the ribs.

Auscultate for vocal resonance as the patient repeats numbers or words.

Bronchophony Whispered pectoriloquy Egophony

Assess respirations for two characteristics.

Count the respiratory rate. Note the pattern (or rhythm) of respirations.

Describe any abnormal breath sounds with these five terms.

Crackles Rhonchi Wheezes Friction rub Mediastinal crunch

When palpating the thorax, which of the following would be an abnormal finding? A. Tenderness B. Pulsations C. Masses D. All of the above

D Rationale: All three of the answers are considered abnormal findings. Tenderness, pulsations, and masses are not a normal finding when palpating the thorax.

When auscultating the lungs, it is important to: A. Compare each side bilaterally. B. Note abnormal sounds. C. Ask the patient to take slow, deep breaths. D. All of the above.

D Rationale: All three of the answers are important considerations during auscultation of the lungs. Comparing each side of the lungs bilaterally during auscultation will allow the nurse to assess whether there is decreased aeration in any of the lung fields. Noting abnormal sounds during auscultation and documenting where the abnormal sounds are heard is part of a complete assessment of the lungs. Asking the patient to take slow, deep breaths will assist in thorough auscultation of all lung fields and help keep the patient from hyperventilating.

When percussing the thorax, which of the following would be a normal finding? A. Dullness over the lung fields B. Resonance over the lung fields C. Dullness over the ribs, heart, and diaphragm D. Both B and C

D Rationale: Both B and C are normal findings. Dullness over the lung fields during percussion is not a normal finding. Resonance over the lung fields during percussion is a normal finding. Dullness over the ribs, heart, and diaphragm during percussion is a normal finding.

assess pulmonary function and sputum

Describe any cough. Coughing produces sputum, note its color, clarity, consistency, amount, timing, and the presence of blood or pus. Measure the peak expiratory flow rate; use a peak flow meter.

Palpate the thoracic muscles and skeleton.

Expected findings are bilateral symmetry, rib cage elasticity, relative inflexibility of the sternum and xiphoid, and a rigid thoracic spine. Unexpected findings include crepitus and pleural friction rub.

supplies

Gooseneck lamp Alcohol swabs Stethoscope Tape Ruler Drapes

Measure diaphragmatic excursion following seven steps

Have the patient inhale deeply and hold their breath. Percuss down the scapular line to the lower border, where resonance changes to dullness. Mark that point with a skin pencil. Have the patient take a few breaths, exhale fully, and hold their breath. Percuss up from the first point and mark where the tone changes from dullness to resonance. Repeat these actions on the other side. Measure the distance between the marks on each side.

Observe chest wall movement during respiration, noting three characteristics.

Inspect for symmetry. Check for use of accessory muscles. Look for bulging or retractions.

Look for clues to respiratory problems in four peripheral areas.

Inspect the lips and nails. Observe the lips for pursing. Check the fingers for clubbing. Inspect the alae nasi for flaring.

Percuss the chest directly or indirectly, comparing sides in three areas

Percuss on the posterior chest. Percuss on the lateral chest. Percuss on the anterior chest.

Describe abnormal respirations with these seven terms

Tachypnea Bradypnea Hyperpnea Kussmaul Hypopnea Cheyne-Stokes Biot

Auscultate the chest. Provide these instructions

Tell the patient to breathe slowly and deeply through the mouth at a comfortable pace. Auscultate the posterior chest, instruct the patient to sit with their head bent forward with the arms folded in front. Auscultate the lateral chest, have the patient sit more erect with their arms overhead. Auscultate the anterior chest, ask the patient to sit erect with their shoulders back.

ALERT

The patient who holds his or her chest wall while breathing may be experiencing localized chest pain. Assess the nature of the chest pain, including onset, severity, precipitating factors, quality, region, and radiation.

Listen to the breath sounds. Expect to hear three types of normal breath sounds

Vesicular sounds. Bronchovesicular sounds. Bronchial sounds.