Lungs and Thorax

• Upper airway structures


  • Nasopharynx
  • Oropharynx
  • Larynx
• Upper airway structures


  • Warms, filter and humidify
  • Helps to make sound
  • Sends air to lower airways
• Respiratory system


  Functions to enable the exchange of oxygen and carbon dioxide through respiration
• Respiratory system


  1. Begins at the nose

  2. Continues as a series of airways or passages extending to the alveoli where gas exchange takes place
• Mechanical process of respiration

  1. Inspiration

  2. Expiration
• Tactile fremitus


  A sensation felt by a hand placed on a part of the body (as the chest) that vibrates during speech
• Tactile fremitus palpation of the chest

  1. Place the balls of your hands with your fingers hyperextended or the ulnar surface of your hand on the patient's chest

  2. As you move your hand to each area, instruct the client to say "99"

  3. Assess all areas for symmetry and intensity of vibrations
• Normal tactile fremitus


  • Symmetric, easily identified in the upper regions of the lungs
• Abnormal increased tactile fremitus

  • Occurs with conditions causing fluid or exudates in lungs, such as consolidating pneumonia, atelectasis, pulmonary fibrosis, pulmonary edema, or pulmonary infarction
  • May also occur with lung tumor
• Abnormal decreased or absent tactile fremitus


  • Occurs where there is air trapping and decreased air movement
• Bronchial breath sounds


  Characterized by expiration and inspiration producing noise of equal loudness and duration, sounding like blowing through a hollow tube
• Bronchovesicular breath sounds


  Intermediate between bronchial and vesicular breathing, with intermediate intensity and pitch and same duration of inspiratory and expiratory phase, normally heard anteriorly over 1st and 2nd intercostal spaces and between scapulae posteriorly
• Vesicular breath sounds


  Soft, low-pitched sounds heard throughout the lungs, primarily when a person breathes in, may have abnormal sounds like crackles, wheezes, and clicking
• Bronchophony


  Atypical increase in the intensity and clarity of the individual's spoken voice heard when auscultating the lungs with a stethoscope
• Bronchophony


  Ask the client to repeat the phrase "99" or "Blue Moon" while auscultating the chest wall
• Normal bronchophony


  • Voice transmission is soft, muffled, and indistinct, sound of the voice may be heard but the actual phrase cannot be distinguished
• Abnormal bronchophony


  • Words are easily understood and louder over areas of increased density, may indicate consolidation from pneumonia, atelectasis or tumor
• Egophony


  Increased resonance of voice sounds heard when auscultating the lungs
• Egophony


  Ask the client to repeat the letter "E" while you listen over the chest wall
• Normal egophony


  • Voice transmission will be soft and muffled but the letter "E" should be distinguishable
• Abnormal egophony


  • Over areas of consolidation or compression, the sound is louder and sounds like "A"
• Whispered pectoriloquy


  Increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso
• Whispered pectoriloquy


  Ask the client to whisper the word "one-two-three" while you auscultate the chest wall
• Normal whispered pectoriloquy


  • Transmission of sound is very faint and muffled, may be inaudible
• Abnormal whispered pectoriloquy


  • In such areas, it sounds as if clients is whispering directly into the stethoscope
• Normal breath sounds


  • Vesicular (normal)