Health Asses: SEMI

• Posterior chest assessment

  1. Sit patient, observe for symmetry, palpate vertebrae

  2. Assess for scoliosis, kyphosis, lordosis

  3. Observe respiratory movement, assess fremitus

  4. Assess for atelectasis, chest expansion
• Normal chest


  • Slight retraction of intercostal spaces
  • AP diameter 1:2
• Barrel chest


  • AP diameter 2:2
• Funnel chest


  • Repression of the lower portion of sternum
• Pigeon chest


  • Sternum protrudes outward
• Tactile fremitus assessment

  1. Palpate thorax, ask patient to say 99 or blue moon

  2. Equal vibration in left and right lungs

  3. Decreased fremitus = obstruction

  4. Increased fremitus = fluid presence
• Pleural effusion


  Pleural space has fluid
• Hemothorax


  Pleural space has blood
• Hydrothorax

  Pleural space has water
• Pneumothorax


  Pleural space has air
• Emphysema


  Over inflation of lungs
• Percussion

  1. Determine if underlying tissue is filled with air or solid materials

  2. Start with shoulder

  3. Resonance = normal air

  4. Hyper-resonance = too much air

  5. Flatness/dull = fluid or solid
• Costovertebral angle (CVA) percussion

  Percuss 12th rib, no pain or tenderness
• Diaphragmatic excursion


  Movement of thoracic movement during breathing, normal 3-5 cm
• Anterior chest assessment

  1. Auscultate breath sounds from superior to inferior, left to right

  2. Assess for adventitious sounds
• Bronchial breath sounds


  Hollow, high-pitch, expiration slightly longer than inspiration
• Vesicular breath sounds


  Soft, low-pitched, inspiration greater than expiration
• Bronchovesicular breath sounds


  Mixed, inspiration and expiration equal
• Abnormal adventitious breath sounds

  • Polyphonic (sibilant) wheeze/rhonchi
  • Monophonic (sonorous) wheeze/rhonchi
  • Stridor
  • Coarse crackles/rales
  • Fine crackles/rales
  • Pleural friction rub
• Crackles indicate presence of secretions or excess fluids in the lungs
• Cervical curve

  C7, Concave
• Thoracic curve

  T12, convex
• Lumbar curve


  L5, concave
• Sacral curve


  S1, convex
• Lordosis


  super concave, normal only in pregnancy

  
• scoliosis

  abnormal spine alignment, used of milwaukee.
• Thoracic expansion 


  normal 3-5 on T10
• Resonance


  drun like when percussion (normal air)
• Flatness/dull


  fluid or solid, pleural eddusion, pneumonia or tumor.
• Bronchial 


  TRachea & bronchi, hollow and only dound in anterior, hgih-pitch, inspiration lsighty shorter than expiration. (ie= 1:3 or 1<E)
• vesicular


  lung field, soft and low, heard through peripheral lung fields, inspiration is greater than expiration (IE= 3:1 or I>E)
• Broncho vesicular


  mixed (betweeen 1st and 2nd intercoustal spaces), isnpiration and expiration are equal, in anterior between 1st and 2nd intercostal spaces and posterior are between scapula.
• Wheezes


  obstruction/narrowing airway.
• crackles


  secretion or excess fluids
• self-examination 


  stand in mirror, put hand in the head, hips and lean forward (do it once a month) examine fibrous tissue and mammary gland after 7 days of menstrual period
• axilla


  where breast cancer of men is located (only 1%)
• anthropic

  tissue getting smaller) that makes the breast shallow common for old people.
• skin dumpling


  breast have a dimple or part that hollow considered normal

  
• Discharge


  assesment of breast that common for creast cancer.
• peau D'orange


  found in inflammatory breast cancer.