ASSESSING THORAX AND LUNGS AND BREAST
• Good morning, Sir! I’m a student nurse Charles Nathaniel Lozada from
Jose Rizal University, I will be your nurse for today and I’m here today
to assess you.
● Alright, I have already read your medical records. Allow me to double
check some pieces of information for verification. Will that be okay sir?
● What’s your name? Your age and birthday?
● How are you doing?
● Before I start the assessment may I ask po how should I address you
po? And what language do you prefer to use po? Is it Tagalog po ba or
English?
● That’s good to hear, Sir. So, to inform you, I will be assessing your
thorax, lungs, as well as your breast. By means of assessing this it can
offer significant clues related to issues associated with the body's ability
to obtain adequate oxygen to perform daily functions. And, if there is any
presence of lumps, masses and lesions in your breast and thorax area.
In performing the assessment I will inspect, palpate, percuss, and
auscultate some of the parts of your body.
● So, I would like to ask you if it’s okay with you that I touch some parts of
your body? In that way, you can participate in the assessment.
● Reassured that all information that will be documented after every
assessment will remain confidential between me and the attending
physician that I will be going to refer to you. So, to inform you I will be
asking you some questions about your history so that I will be able to
know. Also please be informed that all your considerations that involve
your ethnicity, religion, age, race, and psychological development will be
considered so please let me know if you have restrictions in any of the
following.
● Before proceeding to the assessment, I’ll wash my hands first to prevent
the spread of microbes while assessing you. And I will close the curtain
so that you will not be uncomfortable displaying your body, and when
someone sees or hears you while doing the assessment.
● I’ll be also asking you some questions before performing the
assessment:
- Do you have any family history of cancer, allergies, or
tuberculosis?
- Have you been exposed to any environmental hazards? Like
radiation?
- Do you smoke?
- Do you take any medications?
- Are there any current problems that are present? Like coughing
or swelling?
● Prior to assessment I already gather the supplies and materials that we
will be using in the following procedure I have here the:
 SKILLS - INSPECTING: POSTERIOR THORAX
● First, I’ll be inspecting your posterior thorax which is your back. I’ll
just inspect the symmetry, shape, and your posture from the
posterior and lateral view to inspect if there are any deformities.
- So, as I inspect, I observed that you have a Symmetrical
posterior thorax, no thorax deformities, no skin
discoloration, anteroposterior to transverse diameter 1:2.
• Next, I’ll be inspecting your spinal alignment, so sir please stand
up po as I inspect po your spinal alignment.
- So, as I inspect, I observed that you have a spinous process
in a straight line and vertically aligned, your spinal column
is straight, and your shoulder and hips are at the same
height which is all normal po.
SKILLS - PALPATE: POSTERIOR THORAX
● For the next procedure, I’ll be palpating po your posterior thorax to
identify if there is presence of lesions and masses. Tell me if you
feel any tenderness upon palpation.
- Upon assessing, your skin is intact
and there is no
swelling, tenderness, no lesions or
masses or any unusual sensation that
is present. The temperature is also
bilateral.
● For the next part, I’ll be placing my palm and thumb on your T9-T10
to see if the degree and symmetry of respiratory movement are
equal. So, take a deep breath and exhale.
- While also assessing the respiratory, the expansion of your thorax is full
and symmetric, and the movement of thumbs are equal at the same time
and move 5 to 10 cm apart symmetrically. So, it is normal.
• Then I’ll be placing the palmar part of my hand to palpate the chest for
vocal tactile fremitus, this is for the detection of the resulting vibration
on the chest wall by touch. Each time po that I will put my hands on your
back I will instruct you po to say, “Blue Moon”.
- Upon the assessment, the
fremitus is symmetric and
easily identified in the upper
regions of the lungs. I could
feel the vibration and there was
no presence of an obstruction
of the tracheobronchial tree.
 SKILLS – PERCUSS: POSTERIOR THORAX
● For the next part, I’ll be percussing your posterior thorax to
determine whether underlying tissues are filled with air, fluid, or
solid material. Sir, please sit comfortably po so that I can assess
you po.
- Upon assessing, I have observed that
resonance is the percussion tone that
elicited over normal lung tissue. There
is no presence of hyperresonance in
cases of trapped air such as in
emphysema or pneumothorax.
● Next is, I’m going to do a diaphragmatic excursion to see if your
muscle strength reflects and functions accurately. Like what I did
earlier I am going to percuss it and measure it. Is it okay if I use a
marker on your skin?
- Upon the assessment I could see that
the Excursion is equally bilateral, and
it measures about 3–5 cm. There is no
presence of dullness or fluid or solid
tissue that replaces air in the lung or
occupies the pleural space, such as in
lobar pneumonia, pleural effusion, or
tumor.
SKILLS – AUSCULTATE: POSTERIOR THORAX
● For the next part I’ll be auscultating your posterior thorax to assess
the flow of air through the bronchial tree and in evaluating the
presence of fluid or solid obstruction in the lung structures. I’ll
auscultate for normal breath sounds, adventitious sounds, and
voice sounds. Can you slowly take a deep breath using your
mouth? so that I can hear po your inspiratory and expiratory
sounds.
▪ Bronchophony: Ask the client to repeat the phrase “ninety-nine”
while you auscultate the chest wall.
▪ Egophony: Ask the client to repeat the letter “E” while you listen
over the chest wall.
▪ Whispered pectoriloquy: Ask the client to whisper the phrase
“one–two–three” while you auscultate the chest wall.
- Upon the assessment, there are no
adventitious sounds, such as
crackles (discrete and discontinuous
sounds) or wheezes (musical and
continuous), are auscultated.
- Voice transmission is soft, muffled,
and indistinct. The sound of the voice
may be heard but the actual phrase
cannot be distinguished.
● DOCUMENT THE FINDINGS
 SKILLS - INSPECTING: ANTERIOR THORAX
● I’ll be inspecting po your anterior thorax which is your front. I’ll
just inspect the symmetry, shape, and your posture from the
posterior and lateral view to inspect if there are any deformities.
Relax and breathe normally.
- Upon assessing it I could see that your sternum is positioned
at midline and straight. There is no presence of sternal
retractions with severely labored breathing. Ribs are slope
downward with symmetric intercostal spaces. Respirations
are relaxed, effortless, and quiet and there are no retractions
or bulging of intercostal spaces are noted. There is also no
usage of any accessory muscles.
• Next is I’ll be inspecting your costal angle which is formed at the
intersection of the costal margins and the angle which the ribs
enter the spine.
- Upon assessing it I could see that your costal angle is less
than 90 degrees, and your ribs insert into the spine at
approximately 45 degrees angle.
SKILLS – PALPATING: ANTERIOR
THORAX
● For the next procedure, I’ll be palpating your anterior chest to
identify if there is presence of lesions and masses. Tell me if you
feel any tenderness upon palpation.
- Upon assessment, there is no
tenderness or pain that is palpated
over the lung area with respirations.
There is no presence of extreme
congestion or consolidation, crepitus.
Also, there are no unusual surface
masses or lesions that are palpated.
-
● For the next part, I’ll be placing my palm and thumb on your T9-T10
to see if the degree and symmetry of respiratory movement are
equal. So, take a deep breath and exhale.
- While also assessing the respiratory
movement, I observed that the expansion
of your thorax is full and symmetric, and
the movement of thumbs are equal at the
same time and move 5 to 10 cm apart
symmetrically. So, it is normal.
-
• Next is I’ll be Palpating your tactile fremitus in the same manner SKILLS – AUSCALTATE: ANTERIOR
as the posterior chest. Each time po that I put my hands on your
chest I will instruct you po to say, “Blue Moon”. THORAX
- Upon assessment, Fremitus is
symmetric bilateral and easily ● Next, I will be auscultating your trachea and your anterior thorax to
identified in the upper regions of assess the flow of air through the bronchial tree and in evaluating
the lungs. A decreased intensity of the presence of fluid or solid obstruction in the lung structures. I’ll
fremitus is expected toward the auscultate for normal breath sounds. Can you slowly take a deep
base of the lungs. breath using your mouth? so that I can hear po your inspiratory
and expiratory sounds.
- Upon the assessment, Bronchial and
Tubular breathe sounds are present
in your trachea, and
Bronchovesicular and vesicular
SKILLS – PERCUSSION: ANTERIOR THORAX breath sounds are present in your
● Like in the posterior area, I’ll be percussing your anterior thorax to anterior chest. Also, there are no
determine whether underlying tissues are filled with air, fluid, or adventitious sounds, such as
solid material. Sir, please sit comfortably po so that I can assess crackles or wheezes are heard when
you po. auscultating.

- Upon assessment, percussion

notes resonate down to the sixth
rib at the level of diaphragm, flat
notes over the heavy muscles area,
• Document the findings.
dull notes on organs, and tympanic
over the underlying stomach,
which is all normal po.
● Before I start po the assessment, I’ll be also asking you some questions: SKILLS - INSPECTING: BREAST
- Does your breast have masses? If have what was done about
• First, I’ll be inspecting the size, shape, symmetry, contour, of your
them?
breast. So, sir, please relax and sit comfortably and place your
- Do you feel any tenderness or pain in your breast?
hands po in hanging freely position po as I am inspecting po your
- Any discharge on nipples?
breast.
- Do you take medication or pills like steroids, digitalis or diuretics
- Upon the assessment I observed that your breast is even on
that can cause nipple discharge?
the chest wall, they are slightly unequal and generally
- Did you have estrogen replacement therapy that may be associated
symmetric which is normal po.
with the development of cysts or cancer?
- Did anyone in your family has history of breast cancer?
• Next, I’ll be inspecting the skin of your breast and to check if your
- Alcohol Consumption? High fat diet? Obesity? That may be factors
breast has localized discolorations or hyperpigmentation,
associated with the development of cysts or breast cancer.
retraction, or dimpling, localized hyper vascular areas, swelling or
edema.
• In assessing po your breast it includes inspecting and palpating it, So, I
- Skin is uniform in color same to the abdomen, the skin is also
would like to ask you if it’s okay with you that I will be inspecting and
smooth and intact, and there is not any hyperpigmentation,
touching po your breast?
dimpling, unilateral or localized hyper vascular areas and
swelling or edema present on your breast.

• Allow me po to wear clean examination gloves as I am going po to

palpate some parts of your breast later po.
• Next, I’ll be inspecting the retraction of your breast, so sir I will SKILLS - PALPATION: BREAST
instruct you po to do the followings:
▪ First is to raise your arms above your head, --- So now I will be wearing gloves as I will now palpate some parts of
▪ Next is to push the hands together, with your elbow being your breast and your axillae po.
flexed,
▪ Last, is to press your hands down on your hips.
• So now I will be palpating your lymph nodes on your breast and
axillae to check if there are any tenderness, masses, or nodules
that are present on your breast. So, sir relax and sit comfortably
lang po as I am using the flat surface of my fingers in palpating po
your breast. Please tell me po if you feel any pain or discomfort
while I palpate your breast.
- Upon the assessment, there are no
presence of tenderness, masses,
and nodules on your breast which
- As I observed, your breast rises symmetrically with no signs
is all normal po.
of dimpling or retraction.
• Next, I’ll be inspecting the size, shape, symmetry, color, surface,
and characteristic and inspect also if there any masses or lesions
are present in your areola area.
- As I observed, your areola area is round or oval shape, with
dark-brown color which is normal po.

• Next, I’ll be inspecting the size, shape, position, color of your

nipples and if there is presence of discharge and lesions on your
nipples.
- As I observed, your nipples are round, everted, and equal in
size, soft and smooth, and your nipples are pointing out and
point in same direction. There is no presence of lesions and
discharge on your nipples which is normal po.
• Next, I’ll be palpating your breast to check if there are masses,
tenderness, or lesions, and discharge present on your nipples. So,
sir higa po tayo on a supine position po which is nakaharap po
sakin.
- Upon the assessment, there are no tenderness, lesions,
masses, and discharge present on your nipples which is good
and normal po.

• So, Sir please put your hands po on the back of your head as I will
palpate your breast to check if there is any presence of
tenderness, masses, nodules, and discharge on your nipples. I will
be using the palmar part of my fingers as I palpate your breast and
make rotary motion using “Concentric Circle (Circular) Pattern”. I
will start the palpation on your tail spence going to your areola and
compress nipples to ensure that all the surface of breast are
assessed.
- Upon the assessment, there are no tenderness, lesions,
masses on your breast and no discharge present on your
nipples which is good and normal po.

• Document the findings.