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Physical Assessments
Thorax and Lungs-Lower Respiratory
Question | Answer |
---|---|
REVIEW OF SYSTEMS THORAX AND LUNGS | Do you wheeze? Do you have difficulty breathing/feel short of breath? (if yes, onset at rest or/exertion) Do you have a cough? If yes, sputum production/color/consistency?) Have you noticed any weight loss, fever or night sweats? Do you smoke? |
INITIAL SURVEY OF RESPIRATION AND THORAX | Inspect chest front, side,back observing: inspir/expir/chest movement"symmetry"/audible breath sounds ie stridor,wheezing Observes and reports the rate, rhythm,depth of breathing "normal 14-20 bs/min" Observe and reports the AP D. "barrel chest" |
POSTERIOR CHEST-INSPECTION Patient position upright with arms folded | ID Landmarks: scapular line/vetebral line RP: condn. of skin for cyanosis RP: deform. of thoracic spine RP: respir. movement of the chest wall RP: inspir. movement ie retraction "Sym.No delays noted" RP: expir. movement, i.e., bulging INSP/RP:access. |
INSPECTION - ANTERIOR CHEST Ask patient to lay in supine position | Identify landmarks: a.suprasternal notch b.sternal angle c.costal angle d.mid-sternal line e.mid-clavicular line f.anterior axillary line g.mid-axillary line h.posterior axilliary line Reports condition of skin "No cyanosis noted" |
INSPECTION - ANTERIOR CHEST | Reports use of: a.accessory muscles & nasal flare b.deformities or asymmetry c.retraction d.supraclavicular retraction e.bulging "No deformities noted on inspection" |
PALPATION - ANTERIOR CHEST | Ppts tenderness, masses and sinus tracts (3 ars anter, 2 ars lat) Test chest expansion: Pinch hands @ stomach, tell pt to take a deep breath. "Lungs are symmetrical no delays noted." Hands should be equidistant. Ppt for tactile fremitus (same ars) |
PERCUSSION - ANTERIOR CHEST | a.Tympany/Gastric Bubble b.Hyperresonance/Not Heardc.Resonance/Throughout d.Dullness/Liver Percusses 5 ars bilaterally, & 2 posterior axillary line bilat cpr R:L |
AUSCULTATION - ANTERIOR CHEST | Specific and complete instruction to pt for breathing Auscultate in both complete inspiration and expiration (deeper then usual) States in all the following areas the breath sounds as: a.Vesicular b.Bronchovesicular c.Bronchial |