HA lec 6

• Assessment of the thorax


  1. Inspect for color

  2. Inspect intercostal spaces

  3. Inspect chest symmetry

  4. Inspect respiratory patterns

  5. Inspect anterior-posterior to lateral diameter

  6. Inspect shape of sternum

  7. Inspect position of sternum

  8. Inspect position of trachea

  9. Inspect chest expansion
• Palpation of the chest

  1. Drape anterior chest

  2. Use finger pads of palms to palpate posterior chest
• Positioning the client

  1. Client folds arms across anterior chest

  2. Client leans forward to increase area of lungs
• Examination of the lungs and thorax

  1. First palpate, percuss, and auscultate posterior lungs and thorax while client is sitting

  2. Then palpate, percuss and auscultate lateral lungs and thorax while client is in supine position
• Heart

  Hollow, muscular, four-chambered organ located in the middle of the thoracic cavity between the lungs in the space called the mediastinum
• Heart


  • About the size of a clenched fist
  • Weighs approximately 255g (9 oz) in women
  • Weighs approximately 310g (10.9 oz) in men
• Location of the heart


  • Extends vertically from the second to fifth intercostal space (ICS)
  • Extends horizontally from the right edge of the sternum to the left midclavicular line (MCL)
  • Upper portion near the second ICS is the base
  • Lower portion near the fifth ICS and the left MCL is the apex
• Assessment of the heart

  1. Inspect the chest to identify landmarks

  2. Check for visibility of the point of maximal impulse (PMI) and any abnormal pulsations

  3. Client should be lying down

  4. Palpate using the fingertips and palmar surfaces of fingers in an organized fashion, beginning in the aortic area and moving down the chest toward the tricuspid area

  5. Percussion may be done to define cardiac borders by identifying areas of dullness, but it is generally unreliable

  6. Size of the heart can be more accurately determined by a chest x-ray

  7. Auscultate in an orderly, systemic fashion beginning with the aortic area, moving across then down the chest, focusing on one sound at a time

  8. Auscultate each area with the stethoscope diaphragm applied firmly to the chest

  9. Repeat the sequence using the stethoscope bell applied lightly to the chest

  10. Auscultate with the client in the supine position

  11. Listen specifically over the apex with the bell while the client is in the left lateral position

  12. Assist the client to a sitting position, and auscultate the pericardium with the diaphragm

  13. Have the client lean forward and exhale while you listen over the aortic area with the diaphragm