Doña Remedios Trinidad Romualdez Medical Foundation

College of Nursing

PERFORMANCE EVALUATION CHECKLIST

THORAX AND LUNGS ASSESSMENT

Name: ______________________________________________ Year: ________

Semester/Term: ________________________________ School Year: ________

Date of Performance: ___________________________

PROCEDURE DONE NOT DONE REMARKS

1. Introduces self and verifies
the client’s identity.
Explains to the client what
you’re going to do, and
why it is necessary and how
the client can cooperate.
2. Performs hand hygiene and
observes other appropriate
infection control
procedures.
3. Provides client’s privacy.
4. Inquires if the client has
history of the following:
 Family history of
illness, including
cancer
 Allergies
 Tuberculosis
 Lifestyle habits such
as smoking and
occupational hazards
 Any medications
being taken
 Current problems
such as swelling,
coughs, wheezing
and pain
Assessment
Posterior Thorax
5. Inspects the shape and
symmetry of the thorax
from posterior and lateral
views. Compares the
anteroposterior diameter
to the transverse diameter.
6. Inspects the spinal
alignment for deformities.
a. Asks the client to stand.
(From a lateral
positions) observes
three normal
curvatures: cervical,
thoracic and lumbar.
b. (To assess for lateral
deviation of the spine)
observes the standing
client from the rear.
Asks the client to bend
forward at the waist and
observes from behind.
7. Palpates the posterior
thorax.
a. For clients who have no
respiratory complaints,
rapidly assesses the
temperature and
integrity of chest skin.
b. For clients who have
respiratory complaints,
palpates and chest
areas for bulges,
tenderness or abnormal
movements. Avoid deep
palpation for painful
areas, especially if a
fractured rib is
suspected.
8. Palpates the posterior
chest for respiratory
excursion.
a. Places the palms of both
hands over the lower
thorax, with the thumbs
adjacent to the spine
and the fingers
stretched laterally. Asks
the client to take a deep
breath while observing
the movement of the
hands and any lag in
movement.
9. Palpates the chest for vocal
(tactile) fremitus.
a. Places the palmar
surfaces of the
fingertips or the ulnar
aspects of the hand or
closed fist on the
posterior chest, starting
near the apex of the
lungs.
b. Asks the client to repeat
such word as “blue
moon” or “one” “two”
“three”.
c. Repeats the two steps,
moving the hands
sequentially to the base
of the lungs.

d. Compares the fremitus

 on both lungs and
between the apex and
base of each lung, either
1) using one hand and
moving it from one side
of the client to the
corresponding area on
the other side 2) using
two hands that are
placed simultaneously
on the corresponding
areas of each side of the
chest.
10. Percusses the thorax.
11. Percusses the
diaphragmatic excursion.
12. Auscultates the chest using
flat-disc diaphragm of the
stethoscope.
a. Uses the systematic
zigzag procedure used
in percussion.
b. Asks the client to take
slow, deep breaths
through the mouth.
Listens at each point to
the breath sounds
during a complete
inspiration and
expiration.
c. Compares findings at
each point with the
corresponding point on
the opposite side of the
chest.

Anterior Thorax
 13. Inspects breathing
patterns.
14. Inspects the costal angle
and the angle at which the
ribs enter the spine.
15. Palpates the anterior
chest.
16. Palpates the anterior chest
for respiratory excursion.
a. Places the palms of both
hands on the lower
thorax, with the fingers
laterally along the lower
rib cage and the thumbs
along the costal
margins.
b. Asks the client to take a
deep breath while
observing the
movement of the hands.
17. Palpates tactile fremitus in
the same manner as for the
posterior chest.
18. Percusses the anterior
chest systematically.
a. Compares one side of
the lung to the other.
b. Displaces female breasts
for proper examination.
19. Auscultates the trachea.
20. Auscultates the anterior
chest.
21.Documents findings in the
client record.
TOTAL

Name and Signature of Clinical Instructor: ___________________________________________