physical

examination
THE THORAX AND LUNGS
Chest landmarks
Location of the anterior and posterior
ribs
 Chest shape and size
• In adults thorax is
oval
• Its Anterioposterior
diameter is half its
transverse
diameter.
• The overall shape
of thorax is
elliptical.
 Thorax and lungs
Techniques
Assessment  Inspection
includes  Palpation
 Posterior thorax  Percussion
 Anterior thorax  Auscultation

Equipments
 Stethoscope
 Skin marker
/pencil
 Centimeter ruler
 Posterior thorax
• Inspect shape and
symmetry
• Inspect spinal alignment
for deformities
Deformities of chest
 Posterior thorax
• Palpate the posterior thorax
• Palpate the posterior chest
for respiratory excursion
(thoracic expansion)
• Palpate the chest for
vocal
(tactile )fremitus ,the
faintly perceptible
vibration felt through the
chest wall when the client
speaks
 Posterior thorax

Chest expansion Tactile fremitus

 Posterior thorax
• Percuss the thorax
• Percuss for
diaphragmatic
excursion ( movement of
the diaphragm during
maximal inspiration and
expiration )
Posterior thorax

Diaphragmatic excursion
Posterior thorax
• Auscultate the chest
using the flat disc
diaphragm of the
stethoscope
 Anterior thorax
• Inspect breathing
patterns
• Insect the costal angle
(angle formed by the
intersection of the costal
margins <90 degree)
and the angle at which
the ribs enter the spine
( appx; 45 degree
angle )
 Anterior thorax
• Palpate the anterior chest
• Palpate the anterior
chest for respiratory
excursion
• Palpate the tactile
fremitus
 Anterior thorax
• Percuss the anterior
chest systematically
 Anterior thorax
• Auscultate the
trachea
• Auscultate the
anterior thorax
Normal Breath sounds
Adventitious breath sounds
Adventitious breath sounds
THE CARDIOVASCULAR AND
PERIPHERAL VASCULAR
SYSTEMS
 HEART
Techniques
•Inspection
•Palpation
•Auscultation
Assessment includes,
Equipments,
• Heart
• Stethoscope
• Central vessels
• Centimeter
• Peripheral vascular
ruler
system
Heart
 HEART

Anatomic sites of the precordium

 HEART
• Simultaneously inspect and palpate the precordium for
the presence of abnormal pulsations, lifts, or heaves .
 HEART
• Auscultate the heart in all four anatomic
sites
Normal heart sounds
Normal heart sound
CENTRAL VESSELS
 CAROTID ARTERIES
• Palpate the carotid artery, using extreme
caution
• Auscultate the carotid artery
 JUGULAR VEINS
• Inspect the jugular vein for distension
• If jugular distension is present , assess the jugular
venous pressure
 PERIPHERAL VASCULAR SYSTEM
• Peripheral pulses
• Peripheral veins
• Peripheral perfusion
– Buerger’s test (arterial adequacy test):Buerger's test
is used to assess the adequacy of the arterial supply to
the leg.
– Capillary refill test
BREAST AND AXILLAE
 BREAST AND AXILLAE
• Inspect the breasts for size symmetry and contour or
shape
• Inspect the skin of the breast
• Inspect the areola
• Inspect the nipple
• Palpate the Axillary ,subclavicular , supraclavicular
lymph nodes.
• Palpate the breast for masses , tenderness and
any discharges from the nipples