The document discusses the anatomy and physiology of the thorax and lungs. It covers topics like the structures of the thorax, the process of ventilation and respiration, and how to assess the thorax and lungs through inspection, palpation, percussion, and auscultation. The assessment involves examining the shape and symmetry of the chest, breathing sounds and patterns, thoracic expansion, tactile fremitus, and lung sounds. Normal findings for each assessment technique are provided.
The document discusses the anatomy and physiology of the thorax and lungs. It covers topics like the structures of the thorax, the process of ventilation and respiration, and how to assess the thorax and lungs through inspection, palpation, percussion, and auscultation. The assessment involves examining the shape and symmetry of the chest, breathing sounds and patterns, thoracic expansion, tactile fremitus, and lung sounds. Normal findings for each assessment technique are provided.
The document discusses the anatomy and physiology of the thorax and lungs. It covers topics like the structures of the thorax, the process of ventilation and respiration, and how to assess the thorax and lungs through inspection, palpation, percussion, and auscultation. The assessment involves examining the shape and symmetry of the chest, breathing sounds and patterns, thoracic expansion, tactile fremitus, and lung sounds. Normal findings for each assessment technique are provided.
The document discusses the anatomy and physiology of the thorax and lungs. It covers topics like the structures of the thorax, the process of ventilation and respiration, and how to assess the thorax and lungs through inspection, palpation, percussion, and auscultation. The assessment involves examining the shape and symmetry of the chest, breathing sounds and patterns, thoracic expansion, tactile fremitus, and lung sounds. Normal findings for each assessment technique are provided.
Approach to thorax and lung assessment Greet and explain the assessment techniques to the PT The examination room should be warm Use a quite room to avoid interruptions Place the patient in a sitting position Expose the entire area being assessed Ask the female patient to lift the breast when examining Always compare the left to the right Use systematic approach Equipment Stethoscope Centimetre ruler or tape measure Washable marker Watch with a second hand Modalities Inspection Palpation Auscultation Percussion Inspection Area Normal findings Shape of the thorax Ratio Stand in front of the patient of the transverse Estimate the transverse diameter to the AP diameter is of the thorax approximately 1:2 Move to either side of the patient Estimate the width of the anteroposterial diameter of the thorax Estimate and compare the two visualizations Symmetry of the chest wall The shoulders should Note the shoulder height be at the same height Nor any differences between The scapula should be the two sides of the chest wall Move to the back and inspect the same height the right and left posterior bilaterally thoraxes comparing right and There should be no left sides Note the position of the masses scapula • Inspect the arterial thorax for the presence of dilated superficial veins Presence of superficial veins • In adults dilated superficial veins are not seen
• No retractions or budging Intercostal space
• No accessory muscles should be used during breathing
Muscle of respirations
• 12 to 20 breaths in adults Respirations
• Normal breathing are regular and even in rhythm
Pattern of breathing
• Effortless, non exergerated
Depth
• The thorax rises and falls in unison in the respiratory cycle . There is no paradoxical Symmetry movements Audibility • A persons respirations are normally heard by unaided ear a few centimetrers from the patients nose or mouth
Patients • The health adult breathes comfortably in a supine, prone, or upright position
position Palpation Anterior Stand in front of the patient Place the finger pads of the dominant hand on the apex of the right lung ( above the clavicle) Move the finger pads down to the clavicle and palpate Proceed with the palpation moving down to each rib and ICS of the right anterior thorax. Palpate the area of tenderness last Repeat the procedure on the left anterior thrax Posterior Stand behind the patient Place the finger tips of the dominiant hand on the apex of the right lung ( approximately at the level of T1) Using light palpation, assess the intergument of the thorax in that area Move the fingers pads down to the first thoracic vertabrae and palpate. Continue moving down to palpate the thoracic vertabrae and ICS of the right posteriol thorax Repeat the procedure on the other side Lateral Stand at patients right side Ask the patient to lift the arms overhead Place the finger pads of the dominant hand beneath the axillary folds Assess the integument Then move the finger pads down to the first rib beneath the axillary fold, then each rib and ICS of the right lateral thorax Repeat on the other side What to look for when palpating Pulsations – no pulsations should be present Masses _ no masses should be present Thoracic tenderness- no thoracic tenderness should be present Crepitus – should be absent Thoracic expansion Assess the extent of chest expansion and symmetry of the chest wall expansion Anterior chest expansion Stand directly in front of the patient Place thumbs of both hands on the coastal margin, pointing the xiphoid process Gather a small fold of skin between the fold to assist in visualisation of the expansions Lay the outstretched palms on the anterior lateral thorax Instruct patient to take a deep breath Observe the movements of the thumbs, both in direction and distance Ask the patient to exhale Observe the movement of the thumb as they return to the midline Anterior Chest Expansion Posterior thorax expansion Stand directly behind the patient. Place the thumbs of both hands at the level of the 10th spinal vertebra Gather a small fold of skin between the fold to assist in visualisation of the expansions Lay the outstretched palms on the anterior lateral thorax Instruct patient to take a deep breath Observe the movements of the thumbs, both in direction and distance Ask the patient to exhale Observe the movement of the thumb as they return to the midline The normal distance is 3 to 5 CM Tactile fremitus Palpable vibrations of the chest wall produced by a spoken word Useful in assessing the underlying lung tissue and pleura. The palmer base of the fingers, the ulnar aspect of the hand and the ulnar aspect of closed fist can be used Locations for feeling fremitus How to feel the fremitus Firmly place your hands on the the fremitus points Your hand should be on the ICS to avoid bonny structures Instruct patient to say “99” or 1,2,3 with the same intensity. Pt to speak loudly Feel any vibration on your hand Compare the vibrations on the right and left aspects Normal fremitus is felt as Buzzing on the ulnar sulface of the hand. More pronounced near the major bronchi and the trachea less palpable in the peripheral of the lungs Tracheal position Also palpate the position of the trachea The trachea is usually midline Percussion Use your fingers
The aim is to detect abnormalities in the underlying
tissues
Percussthe anterior, posterior and lateral chest, again
comparing all the sides.
Patient should be in an upright position
Percussion sites anteriorly Five percussion notes Notes Relative Relative pitch Relative Example intensity duration Flatness Soft High Soft Thigh
Dullness Medium Medium Medium Liver
Resonance Loud Low Long Normal lung
Hyper Very loud Lower Longer Emphysema of
resonance the lungs
Tympanic Very loud Lower Longer Emphysema of
the lungs Auscultation To detect breath sounds and air flow Procedure for anterior site Place patient in upright sitting position Instruct the patient to breath using the mouth Listen to one complete cycle Note the sounds ausculted Repeat on all sites moving down 5 cm or every other ICS Auscultation of the posterior thoracic Patient in upright sitting position- slight tilt forward, - head bent down – arms folded in front of the waist Instruct the patient to breath using the mouth Listen to one complete cycle Note the sounds auscultated Repeat on all sites moving down 5 cm or every other ICS Lateral thoracic auscultation Upright sitting position with arms and hands directly overhead Instruct the patient to breath using the mouth Listen to one complete cycle Note the sounds auscultated Repeat on all sites moving down 5 cm or every other ICS Breath sounds Three types Bronchial Bronchiovesicular Vesicular
Breaths sounds that are not normal are divided into two Abnormal breaths sounds – decreased or absent breath sounds Adventitious breath sounds – superimposed sounds on the normal sounds Characteristics of normal breaths sounds Breath sound Pitch Intensity Quality Relative Location duration of inspiratory and expiratory phase
Bronchial High Loud Blowing/hallo I<E Trachea
w Bronchovesicular Moderate Moderate Combination I=E Between of bronchial scapulae, and vesicular first and second ICS to the sternum
Vesicular Low Soft Gently I>E Peripheral
rustling/ lung Adventitious sounds Fine Crackles – inspiration.
