THORAX AND LUNGS - LEC/RLE

• Fremitus


  • A palpable vibration felt on the chest wall, specifically during the assessment of the lungs by palpation while the patient speaks or coughs
• Normal Percussion of Tone:

  • Resonant
  • Dull
  • Flat
  • Typanitic
• Bronchial Sound


  • Normal sound of trachea
  • Normally heard over the trachea in the anterior chest and the second intercoastal
• Vesicular sounds


  • Normal lung sound
• Bronchovesicular sound


  • Normal, medium-pitched sound heard during both inspiration and expiration
• Excursion


  • Should be equal bilaterally and measure 3-5cm in adults
• Fine crackles


  • High pitched, short popping sound heard during inspiration and not cleared with coughing
  • Air passages that are coated with sticky with exudates
  • Associated with crackles
• Pneumonia and Congestive Heart failure


  • Crackles occuring late in inspiration are associated with restrictive diseases such as:
• Crackles occuring early in inspiration are associated with obstructive disorders such as:

  • Bronchitis
  • Asthma
  • Emphysema
• Coarse crackles


  • Low pitched bubbling, moist sounds that may persist from early inspiration to early expiration; also described as softly seperating velcro
  • Inhales air comes into contact with secretions in the large bronchi and trachea
  • Associated with Pneumonia, pulmonary edema, fibrosis, COPD
• Pleural friction rub


  • Low pitched dry, dry grating sound; sound is much like crackles, only more superficial and occuring during both inspiration and expiration
  • Rubbing of two inflamed pleural surfaces
  • Associated with pleuritis
• Wheeze (sibilant)


  • High, pitched musical sounds heard primarily during expiration but may also be heard on inspiration
  • Air passes through constricted passages (caused by swelling secretions, or tumor)
• Sibilant wheezing


  • Are often heard in cases of acute asthma or chronic emphysema
• Wheezes (Snorous)


  • Low pitches snoring or moaning sounds heard primarily during expiration but maybe heard throughout the respiratory cycle. These wheezes may clear with coughing
• Snorous wheezes


  • Are often heard in cases of bronchitis or single obstruction and snoring before an episode of sleep apnea
• Stridor


  • Is a harsh honking wheeze with sever bloncholaryngospasm, such as occurs with croup
• Bronchopony


  • Ask the client to repeat the phrase "99"
• Egophony


  • Ask the client to repeat the letter "E"
• Whispered petriloquy


  • Ask the client to whisper phrase "1-2-3"
• Funnel chest

  • Pectus Excavatum
• Pigeon chest


  • Pectus carinatum
• Scoliosis


  • Lateral deviation of spine
• Deep palpation


  • Could lead to displacement of the bone fragment against the lungs
• Full and symmetric chest expansion (normally the thumbs should seperate 3-5cm during deep inspiration)
• Ask the client to repeat word such as "Blue moon" or " 1-2-3"


  • In palpating the thoracic expansion palpate the chest for vocal (Tactile fremitus)
• Percuss for diaphgramatic excursion


  • In percussing the thorax
• In thoracic percussion, it penetrates to a depth of 5-7cm (2-3in), it detects superficial rather than deep lesions
• Percussion sounds:

  • Flat
  • Dull
  • Resonant
  • Hyper resonant
  • Tympanic
• Flat


  • Sound produced by very dense tissue
• Dull


  • Thud like sound produced by dense tissue
• Resonant


  • Hallow sound produced by lungs filled with air
• Hyper Resonant


  • Described as booming sound
• Tympanic


  • Drum like sound produced from air filled stomach
• Lowest point of resonance is at the diaphragm
• Percussion on a rib normally elicits dullness
• Vesicular


  • Soft, low pitched sighing sounds created by air moving through the bronchioles and alveoli heard over lung periphery
• Bronchovesicular


  • Moderate intensity "Blowing sound created by air passing through the bronchi heard between the scapula and lateral sternum
• Bronchial


  • Loud and high pitched sound created by air passing through the trachea
• Rhonchi (gurgles)


  • Loud low pitched, coarse sounds heard most often during inspiration and expiration