Assessment of the thorax and lungs

• Ratio of the AP diameter to the transverse diameter is app. 1:2 to 5:7
• Normal thorax is slightly elliptical in shape.
• For infants a barrel chest is normal.
• PECTUS EXCAVATUM OR CONCAVE CHEST WALL - Depressed sternum or breast bone.
• PECTUS CARINATUM or Protruding Sternum - Difficulty in exhaling the air in the lungs which restricts gas exchange and causes short and fast breathing and reduced exercise tolerance.
• Pott’s disease or caries of the spine - Chest falls forward and its anteroposterior diameter is increased. Pushthe sternum and lower ribs forward.
• scapulae project like wings it is called "alar" or "pterygoid chest".
• Costal angle is less than 90 deg. During exhalation and rest.
• The ribs articulate at a 45 deg.angle with the sternum
• CHEYNE- STOKES - occur in crescendo and decrescendo patterns
• BIOT RESPIRATION OR ATAXIC RESPIRATION - irregularly irregular respiratory pattern
• APNEUSTIC RESPIRATION - characterized by prolonged gasping during inspiration followed by a very short, inefficient expiration. These pauses can last 30 – 60 seconds.
• AGONAL RESPIRATIONS - irregularly irregular respirations. They are of varying depths and pattern.
• HYPERPNEA - the breath that is greater in volume
• KUSSMAUL’S RESPIRATION - characterized by extreme depth and rate of respirations.
• ORTHOPNEA - is a difficulty breathing in positions other than upright.
• Sputum - Color is light yellow or clear. Odorless. Thick or thin depending on the hydration status of the patient
• Mucoid - Tracheobronchitis, asthma, coryza
• Yellow or green - Bacterial infection
• Rust or blood- - Pneumonia, pulmonary tinged infarction, TB, lung cancer
• Black - Black lung disease
• Pink - Pulmonary edema
• TACTILE OR VOCAL FREMITUS - Is the palpable vibration of the chest wall that is produced by the spoken word.

  The technique is useful in assessing the underlying lung tissue and pleura.
• DIAPHRAGMATIC EXCURSION - Provides information on the patient’s depth of ventilation. measuring the distance the diaphragm moves during inspiration and expiration.
• The level of the diaphragm on inspiration is T12 and T10 on expiration. The right side is slightly higher than the left.
• BRONCHIAL (TUBULAR) I < E
• BRONCHOVESICULAR I = E
• VESICULAR I > E
• VESICULAR I > E
• BRONCHIAL (TUBULAR) I < E
• BRONCHIAL LUNG SOUNDS - heard on the chest at sites which are close to large airways. louder in expiration than inspiration. They may also be heard in the axillae. It has a "tubular" quality - it has been compared to the sound of air blowing through a cardboard tube.
• VESICULAR LUNG SOUNDS - sound heard over the chest at a distance from large airways. It is a "soft" sound that has been compared to the sound of wind blowing through the leaves of a tree.
• BRONCHOVESICULAR SOUNDS - Over the major bronchi – posterior

  Between the scapula. Around the upper sternum in the first and second intercostal spaces – anterior
• FINE CRACKLES (rales) - These are “discontinuous” i.e. intermittent, “explosive” sounds. Laennec described them as sounding like the crackling noise made when salt is heated on a frying pan. They are caused by airway opening.
• COARSE CRACKLES - These are intermittent "bubbling" sound. sound of water being poured from a bottle. They are caused by airway opening and secretions in airways.
• WHEEZES (ronchi) - These are high pitched, whistling or sibilant sounds. Musical and continuous. They are caused by airway narrowing, secretions
• Anterior chest - midsternal, right and left midclavicular lines
• Posterior thorax - vertebral line, right and left scapular lines
• Tripod position seen in COPD - Client leans forward. Uses arms to support weight. Lifts chest to increase breathing capacity
• Agonal - Irregularly irregular respirations that signal impending death or compression of the respiratory center.