? Lung & Thorax Assessment

? Lung & Thorax Assessment
? Dr. Sahar Adham
? 2016- 2017
? Lung Examination
Objectives:
At the end of this lab, the students will be able to:
1. Demonstrate the ability to safely & accurately complete thorax & lung assessment.
2. Demonstrate the ability to accurately document thorax & lung assessment data in organized
manner.
Equipment Needed
1. Stethoscope
2. Small ruler, marked in centimeters
3. Marking pen
4. Alcohol swab
Preparation
1. Ask the client to sit upright & the male to disrobe to the waist.
2. For female, leave the gown on & open at the back.
3. When examining the anterior chest, lift up the gown & drape it on her shoulders rather than
removing it completely.
4. For farther comfort: a warm room, a warm diaphragm end piece.
5. Private examination time with no interruption.
Subjective data:
? Cough
? Past history of respiratory infections
? Self-care behaviors
? Shortness of breath
? Smoking history
? Chest pain with breathing
? Environmental exposure
? Chest Landmarks
Anterior : Right anterior axillary line ,
Right midclavicular line ,
Mid sternum line
left midclavicular line ,
left anterior axillary line
Mid axillary line
Posterior: L . posterior axillary line , L .mid scapular line ,mid spinal line , R. mid scapular line and R. posterior axillary line ,
Inspect anterior, posterior, & lateral thorax for the following:
Color : Pink
Intercostals spaces : Even
Chest symmetry: Equal
Rib slope : Less than 90 degree downward
Respiration (rate, depth, rhythm) ,Even, 12-20/min, unlabored
Anterior-posterior to lateral diameter 1 : 2 ratio
Shape & position of sternum : level with ribs
Position of trachea Midline
? Breathing Pattern
Eupnea: Normal breathing is relaxed, effortless, and regular at 14-16 breath\minute
Tachypnea: Rapid shallow breathing is a rate above 20 breaths per minute, associated with increased activity or a disease process
? Bradypnea: slow breathing is a rate blow 12 breath per minute with normal depth and rhythm , associated with Sedation , anesthesia
Hypoventilation : Shallow irregular breathing hypercapnia and hypoxemia such as in COPD
Hyperventilation increased depth and rate of breathing (kussmaul ‘s respiration caused by diabetic ketoacidosis
? Apnea is the absence of respirations.
? Cheyne-Stokes is the term for cycles of breathing characterized by deep, rapid breaths for about 30 seconds, followed by absence of respirations for 10 to 30 seconds. Cheyne-Stokes respirations constitute a serious symptom and precedes death in cerebral hemorrhage, uremia, or heart disease

Biot s respiration
rapid, short breathing with pauses of several seconds, indicating increased intracranial pressure.
? Inspection
Normal chest
Slight retraction of intercostal spaces
2x as wide as deep
Anterior/posterior diameter
1:2
? Inspection
Barrel chest
The anterior-posterior diameter
2:2
Pigeon chest
Sternum protrudes outward
anterior-posterior diameter
?
Scoliosis
Lateral curvature of thoracic spine
Shoulders elevated Complications
Lung & heart damage Back problems
Body image
? Kyphosis
? Abnormal curvature of the thoracic spine

? Lordosis
? Sway-back
? Abnormal curvature of the lumbar spine
? Uniform expansion of the chest
Pneumonia
Pleural effusion
Pneumothorax
Bulging intercostal spaces
Obstruction
Emphysema
Palpate thorax at three levels for the following:
Sensation : no pain or tenderness
Vocal fremitus ( tactius) as client says 99Use either the palm base (the ball) of fingers, or the ulnar edge of one hand.
- Touch the client s chest- Ask the client to repeat a resonant phrases that generate strong vibration
Like 99.
- Start over the lung apices & palpate from side to another.- Avoid palpating over the scapulae.
- Vibration decreased over periphery of lungs & increased over major airways .
- Palpate chest expansion :
Posterior : placing your warmed hand on the poster lateral chest wall
- The thumbs should be at level of T9 or T10.
- Slide your hands medially to pinch up a small fold between your thumbs.
- Ask the client to take deep breath.
- Your thumb should move with respiration.
Anterior: placing your warmed hand on the anterolateral wall.
- Thumbs should be along the costal margins & pointing toward the xiphoid process. - Ask the client to take deep breath.
- Watch your thumbs move with respiration.
? 2 to 3-inch symmetrical thoracic expansion.
Symmetrical expansion (thumbs move apart equal distance in both directions).
Percussion (Diaphragmatic Excursion)
Posteriorely :
ask the client to exhale & hold it.
- Percuss down the scapular line until the sound changes from resonant to dull each side.
- Mark the level where the sound changed to dull.
- Ask the client to take deep breath & hold it. - Continue percussion from the mark down ward.
- Mark the level the sound changed to dull on deep inspiration.
- Normal Finding :
It should be equal bilaterally, & measure about 3-5cm in adult, although it may be up to 7-8cm.
.
? Auscultation
Purpose
Asses normal and abnormal air flow through bronchial tree by using
Diaphragm of stethoscope
Compare R to L
? Auscultation: normal lung sound
Bronchial : Trachea , high , inspiration shorter than expiration

Bronchovesicular :
Moderate , Between scapulae
Side of sternum intercostal space , inspiration equal with expiration
Vesicular : Lung field , inspiration longer than expiration is it soft and low
? Adventitious breath sound
Crackles (fine): high, short, popping sound heard during inspiration not clear with cough
Caused by: inhaled air sudden open of the small deflated air passage with sticky with exudates , can be associated with pneumonia , congestive heart failure or bronchitis and asthma
Coarse crackles low pitch bubbling , moist sound that may persist from early inspiration to early expiration air comes into contact with secretions in the large bronchi and trachea may indicated pneumonia , pulmonary edema client with COPD
Wheeze(sibilant): high in pitch ,musical sound heard in expiration or may be inspiration ,air pass through constricted passage as secretion or tumor heard asthma or emphysema
Wheeze (sonorous): low pitch snoring or moaning sound heard during expiration clear with cough , heard in bronchitis , sleeping apnea .
Stridor: harsh honking wheeze heard with broncholaryngo spasm as in croup
Pleural friction rub: low pitch grating sound superficial occur during I&E result of rubbing of two inflamed pleural surface as pleuritis
Best heard anterior, Lower, lateral area