Assessing the Thorax, Lungs, and Breasts

Question 1

steps

Answer 1

1) ppe/hand hygiene
2) ID Patient
3) close curtains explain reason for visit
4) help patient undress, put on gown
5) use blanket to cover, assess overall skin
6) Inspect the posterior thorax. Examine the skin (Figure 1), bones, and muscles of the spine, shoulder blades, and back as well as symmetry of expansion and accessory muscle use during respirations
7) .Assess the anteroposterior (AP) and lateral diameters of the thorax.
8) Palpate over the spine and posterior thorax. Use the dorsal surface of the hand to palpate for temperature. Use the palmar surface of the hand to palpate in a sequential pattern for tenderness, muscle development, and masses
9) Assess thoracic expansion by standing behind the patient and placing both thumbs on either side of the patient’s spine at the level of T9 or T10 (Figure 3A). Ask the patient to take a deep breath and note movement of your hands
10) As the patient breathes slowly and deeply through the mouth, auscultate the lungs across and down the posterior thorax to the bases of lungs in a sequential pattern, comparing sides
11) Inspect the anterior thorax. With the patient sitting, rearrange the gown so the anterior chest is exposed. Inspect the skin, bones, and muscles, as well as symmetry of lung expansion and accessory muscle use.
12) Palpate the anterior thorax across and down the anterior thorax to the bases of lungs in a sequential pattern (Figure 5). Use the palmar surface of the hand to palpate for temperature, tenderness, muscle development, and masses.
13) As the patient breathes slowly and deeply through the mouth, auscultate the lungs across and down the anterior thorax to the bases of lungs in a sequential pattern, comparing sides
14) If assessment of the breasts is required, inspect the breasts.
15) Palpate the axillae with the patient’s arms resting against the side of the body. If any nodes are palpable, assess their location, size, shape, consistency, tenderness, and mobility
16) Assist the patient into a supine position. Place a small pillow or towel under the patient’s back and ask the patient to place a hand on the side being examined under the head
17) Wear gloves if there is any discharge from the nipples or if a lesion is present. Palpate each quadrant of each breast in a systematic method, using either the circular, wedge, or vertical strip technique
18) PPE/hand hygiene