Physical Assessment- Chest & Thorax Flashcards
What is in the respiratory upper tract?
– Nose
– Pharynx
– Larynx
– Upper trachea
What is in the respiratory lower tract?
– Lower trachea
– lungs
What are the lung borders in the thoracic cavity?
– apex, highest point of lung
tissue, above mid clavicles.
– Base, rests on diaphragm
The lungs are composed of?
– 3 lobes on right
– 2 lobes on left
What is a Pleurae?
forms an envelope between lungs & chest wall
What is a Visceral pleurae?
lines outside of lungs dipping into fissures.
What is breathing?
• Air rushes into lungs as chest size increases – Inspiration (active) • Air expelled from lungs as chest recoils – Expiration (passive)
What is a health history in thorax assessment?
– Common chief complaints:
Dyspnoea, cough, sputum, chest pain
What is a past history in thorax assessment?
– Medical: Asthma, bronchitis, emphysema, pneumonia, PE, CF, TB
– Surgical: bronchoscopy, lobectomy, pneumonectomy, chest trauma
– Medications : bronchodilators, cough suppressants, oxygen, steroids
What is family history in thorax assessment?
Cystic fibrosis, Asthma, bronchitis, TB
What is social history in thorax assessment?
– Diet: alcohol
– Environment: smoker, stress, bird keeper, scuba diving, asbestos,
– Home: passive smoker
What equipment do you need for thorax examination?
– Stethoscope – Tape measure – Watch (with second hand) – Pen light – Washable marker
What to inspect in a thorax examination?
– Skin, colour & condition: scars – Shape & configuration – Respiratory rate, rhythm, depth, audibility, symmetry, position, mode – Presence of superficial veins
How to palpate the chest?
Using fingers palpate entire chest wall anterior & posterior – Note areas of tenderness, lumps or masses – Skin temp, moisture & lesions
How to do symmetrical expansion?
– Place clean warm hands outstretched – Posteriolateral chest wall – Thumbs at level of T9/T10 either side of vertebral column – Slide hands medially – Ask patient to take a deep breath in and out – Observe movement of thumbs bilaterally 3-5cm
How to palpate the fremitus?
– Palpable vibration of chest wall during speech
– Assess anterior, posterior and lateral chest for fremitus
– Can use 3 different aspects of the hand:
• Palmar base of fingers
• Ulnar aspect of hand
• Ulnar aspect of closed fist
– Follow sequence as indicated, asking patient to say “99”, with same
intensity each time you place your hand
– Compare bilateral sides, symmetry most important
How to percuss the chest?
• Sit patient upright
• Percuss 2-3 strikes each time
• Move from right to left then down
every second intercostal space and percuss again
• Start along right lung apex and
continue until entire lung has been percussed
What is Diaphragmatic excursion?
Measures depth of ventilation
In diaphragmatic excursion, instruct the patient to?
– inhale as deeply as possible
– Exhale fully and hold exhale, instruct ‘hold it’
– Percuss right lung, below scapula (scapular line) to where resonance
changes to dullness
– Mark this point and tell patient to breathe normally
After instructing the patient?
• Patient inhale as deeply as possible and hold breath.
– ‘take a deep breath and hold it’
– Continue percussion from marked point downward to where sound
changes to dull on deep inspiration
– Mark this point
• Using a ruler measure the difference between 2 marks: 3-5cm