ASSESSING

THORAX AND
LUNGS

Presented by:

ALMA CECILIA R. MALAZARTE

Looking
back……

◦ THORAX - portion of the body extending from the base of the

neck superiorly to the level of the diaphragm inferiorly.
◦ The lungs, distal portion of the trachea, and the bronchi are
located in the thorax and constitute the lower respiratory
system.
◦ THORACIC CAGE -outer structure of the thorax
◦ THORACIC CAVITY contains the respiratory components.
(mediastinum and the lungs, and is lined by the pleural
membranes)
◦MEDIASTINUM - a
central area in the
thoracic cavity that
contains the trachea,
bronchi, esophagus,
heart, and great
vessels.
 Thoracic Cage
◦sternum,
◦12 pairs of ribs,
◦12 thoracic vertebrae,
◦ muscles, and
◦ cartilage.
 Anterior
Thoracic Cage
 Posterior
Thoracic Cage
Anterior Vertical Lines
(imaginary landmarks)
Posterior Vertical Lines
(imaginary landmarks)
Lateral Vertical Lines
(imaginary landmarks)
The bronchi and trachea
represent “dead space” in
the respiratory system

where air is transported but

no gas exchange takes
place.

- Both function primarily as a

passageway for both
inspired and expired air.
Are both lungs symmetric?
Both are divided
into lobes by
fissures.
- right lung is
made up of
three lobes;
- left lung
contains only two
lobes.
FYI!
◦ In a healthy adult:
- during deep inspiration the lungs
extend down to about the
eighth intercostal space
anteriorly and the twelfth
intercostal space posteriorly.

- on expiration, the lungs rise to

the fifth or sixth intercostal space
anteriorly and tenth posteriorly.
 ASSESSMENT :
OBJECTIVE DATA
Preparing the Client
◦Have the client remove all clothing from the waist up
and put on an examination gown or drape. ( the
gown should open down the back, and is used to
limit exposure)
◦Explain the procedures before initiating the
examination, to ease client anxiety
◦Ask the client to sit in an upright position with arms
relaxed at the sides.
Preparing the Client

◦Provide privacy for the client.

◦Keep your hands warm to promote the client’s comfort

during examination.

◦Remain nonjudgmental regarding the client’s habits

and lifestyle, particularly smoking. At the same time,
educate and inform aboutrisks, such as lung cancer
and chronic obstructive pulmonary disease (COPD),
related to habits.
 Equipment
◦Examination gown and drape
◦Gloves
◦Stethoscope
◦Light source
◦Mask
◦Skin marker
◦Metric ruler
 NORMAL FINDING ABNORMAL FINDING
Inspect for None Nasal flaring is seen with labored
nasal flaring Abdomen and lower respirations ( as seen in hypoxia)
and pursed lip ribs expands on Pursed lip breathing is seen in asthma,
breathing inspiration and returns emphysema or CHF – a physiologic
to resting position on response to help slow down expiration
expiration and keep alveoli open longer
Observe color Evenly colored skin Ruddy purple complexion seen in clients
of face, lips tone without unusual with COPD or CHF as a result of
and chest or prominent polycythemia.
discoloration Cyanosis is seen if client is cold or hypoxic
Inspect color Pink tones in nailbeds Pale, cyanotic nails may indicate hypoxia.
and shape of 160-degree angle Early clubbing (180-degree angle) and
nails between nail base late clubbing ( >180-degree angle ) can
and the skin. occur in hypoxia
INSPECTION
Posterior Thorax
Inspect configuration.
While client sits with arms at the
sides, stand behind the client
and observe the position of the
scapulae and the shape and
configuration of the chest wall.
NORMAL FINDING ABNORMAL FINDING
Scapulae are symmetric Spinous processes deviate laterally
and non-protruding. in the thoracic area ( as seen in
Shoulders and scapulae are scoliosis)
at equal horizontal positions.

Some clinicians prefer to inspect the entire thorax

first , followed by palpation of the anterior and
posterior thorax then percussion and auscultation of
the anterior and posterior thorax
Normal chest configuration

Barrel chest
 NORMAL FINDING ABNORMAL FINDING
Observe use of No use of accessory Client leans forward and uses arms to
accessory muscles (trapezius/ support weight and lift ches to increase
muscles. shoulder) to assist in breathing capacity (TRIPOD POSITION).
Watch as the breathing -often seen in COPD
client breathes
and note use
of muscles
PALPATION
NORMAL FINDING ABNORMAL FINDING
Palpate for tenderness and NO tenderness, pain or Muscle soreness from exercise of
sensation. unusual sensations . the excessive work of breathing (as
1. With one or both hands, use Temperature should be in COPD) may be palpated as
fingers to palpate for equal bilaterally. tenderness.
tenderness, warmth, pain or Increased warmth may be related
other sensations. to local infection.
2. Start toward the midline at
the level of the left scapula
(over the apex of the left
lung) and move your hand
left to right, comparing
findings bilaterally.
3. Move systematically
downward and out to cover
the lateral portions of the
lungs at the bases.
PALPATION
NORMAL ABNORMAL FINDING
FINDING
1. Palpate for CREPITUS ( subcutaneous No palpable Crepitus is palpated.
emphysema) crepitus
- A crackling sensation (like bones or hairs
rubbing against each other) that occurs when
air passes through fluid or exudate.
 Crepitus. Fremitus
Crepitus can be palpated if air escapes from the lung or other airways
into the subQ tissue as occurs after an open thoracic injury , around a
chest tube , or tracheostomy.
- also in areas of extreme congestion or consolidation
- If noted, Mark margins and monitor to note any decrease or increase
in the crepitant area

Fremitus
– vibration of air in the bronchial tubes transmitted to the chest wall
- Symmetric and can easily be identified in the upper regions of the
lungs
PALPATION
NORMAL ABNORMAL FINDING
FINDING
1. Palpate for surface characteristics Skin and
- Put on gloves and use fingers to palpate subQ tissue
any lesions that you noticed during are free of
inspection. masses and
- feel for any unusual masses lesions. Unequal fremitus is usually the
result of consolidation (increased
2. Palpate for fremitus. fremitus) or bronchial obstruction,
- Use the ball or ulnar edge of one hand to air trapping in emphysema ,
assess for fremitus( follow the sequence pleural effusion or
described previously) . pneumothorax(which all decrease
- ask the client to say “Ninety – nine” fremitus)
- assess all areas for symmetry and intensity of
vibration Diminished fremitus even with a
loud voice may indicate
obstruction of the
tracheobronchial tree