LUNGS & THORAX ASSESSMENT

• For efficiency, the posterior thorax is examined first, then the anterior thorax
• For posterior thorax and lateral thorax examinations, the client is uncovered to the waist and in a sitting position.
• The sitting position is preferred because it maximizes the thorax expansion.
• Good lighting is essential, especially for thorax inspection.
• Anteroposterior to transverse diameter in ratio of 1:2
• Inspect the spinal alignment for deformities if the client can stand. From a lateral position, observe the three normal curvatures: cervical, thoracic, and lumbar.
• Spinal column is straight, right and left shoulders and hips are at same height.
• Exaggerated spinal curvatures (kyphosis, lordosis)
• Avoid deep palpation for painful areas, especially if a fractured rib is suspected. In such a case, deep palpation could lead to displacement of the bone fragment against the lungs.
• Place the palms of both your hands over the lower thorax with your thumbs adjacent to the spine and your fingers stretched laterally.
• when the client takes a deep breath, your thumbs should move apart an equal distance and at the same time; normally the thumbs separate 3 to 5 cm [1.2 to 2 in.] during deep inspiration)
• Palpate the thorax for vocal (tactile) fremitus, the faintly perceptible vibration felt through the chest wall when the client speaks.
• Bilateral symmetry of vocal fremitus
• Fremitus is heard most clearly at the apex of the lungs
• Decreased or absent fremitus (associated with pneumothorax)
• Increased fremitus (associated with consolidated lung tissue, as in pneumonia)
• Compare the fremitus on both lungs and between the apex and the base of each lung
• Percussion of the thorax is performed to determine whether underlying lung tissue is filled with air, liquid, or solid material
• Percussion penetrates to a depth of 5 to 7 cm (2 to 3 in.), it detects superficial rather than deep lesions
• Lowest point of resonance is at the diaphragm (i.e., at the level of the 8th to 10th rib posteriorly)
• Percussion on a rib normally elicits dullness.
• Percuss in the intercostal spaces at about 5-cm (2-in.) intervals in a systematic sequence.
• Percuss the lateral thorax every few inches, starting at the axilla and working down to the eighth rib.
• Auscultate the thorax using the flat-disk diaphragm of the stethoscope.
• Use the systematic zigzag procedure used in percussion.
• The diaphragm of the stethoscope is best for transmitting the high-pitched breath sounds.
• Costal angle is less than 90°, and the ribs insert into the spine at approximately a 45° angle
• Costal angle is widened (associated with chronic obstructive pulmonary disease)
• Percuss the anterior thorax systematically.

  • Begin above the clavicles in the supraclavicular space, and proceed downward to the diaphragm.
• Displace female breasts to facilitate percussion of the lungs.
• Percussion notes resonate down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone
• dull on areas over the heart and the liver, and tympanic over the underlying stomach
• Auscultate the anterior thorax. Use the sequence used in percussion 7, be- ginning over the bronchi between the sternum and the clavicles.
• VESICULAR

  Soft-intensity, low-pitched, “gentle sighing” sounds created by air moving through smaller airways (bronchioles and alveoli)
• VESICULAR

  Over peripheral lung; best heard at base of lungs
• VESICULAR

  Best heard on inspiration, which is about 2.5 times longer than the expiratory phase (5:2 ratio)
• BRONCHOVESICULAR

  Moderate-intensity and moderate- pitched “blowing” sounds created by air moving through larger airway (bronchi)
• BRONCHOVESICULAR

  Between the scapulae and lateral to the sternum at the first and second intercostal spaces
• BRONCHOVESICULAR

  Equal inspiratory and expiratory phases (1:1 ratio)
• BRONCHIAL (TUBULAR)

  High-pitched, loud, “harsh” sounds created by air moving through the trachea