Lungs and Thorax Assessment - PPTX RAHEEM KHAN

THORAX AND LUNGS
ASSESSMENT
Raheem khan Lecturer

Objectives
By the end of this unit, the learners will be able to:
Describe the components of health history that
should be elicited during assessment of
respiratory system.
Assess the respiratory system including
inspection, palpation, percussion and
auscultation.
Document findings.
List the changes in respiratory system that are
characteristics of aging process.
Significant History Of
Respiratory System
Significant History Of
Respiratory System
Cough
Dyspnea
Sputum
Respiratory Infections
Smoking
Environmental Exposure
Allergies
Economic Status
Family health history
Drug use
Dyspnea
Quantity Associated Aggravating Alleviating Factors
Manifestations Factors
The number of Palpitations, Smoking, Pillow, position

steps that can faintness, anxiety, exercise, poor the patient,
be climbed fatigue, cough, ventilated provide fresh and
before sputum, room, patient adequate air,
shortness of wheezing, position. supplemental
breath occur; diaphoresis, oxygen, resting
distance that cyanosis.
can be walked;
number of
pillows needed
to sleep
comfortably
Cough
Quality Associated Aggravating Alleviating
Manifestations Factors Factors
Dry, wet, Shortness of exposure to Medications,

congested, breath, wheezing, allergen stimuli, remove the
forceful. sputum, pleuritic infection allergen
pain, chest pain,
fever, hemoptysis,
anxiety, diaphoresis
Sputum
Quality Quantity Associated Aggravating Alleviating
manifestations factors factors
White or Small, Cough, fever, Exposure to Medications

clear, moderate, dyspnea allergens,
purulent, copious smoking,
blood tinged, (60 to infection
yellow or 90ml)
green,
mucoid, rust,
black, pink
Consistency:
thick, thin.
Thoracic Landmarks
Reference Lines
Anterior Chest
Midsternal line
Midclavicular line
Anterior axillary line
Posterior Chest
Vertebral line / midspinal
Scapular line
Posterior axillary line
Anterior Chest
Posterior Chest
Lateral Chest
Anterior Axillary line
Mid–axillary line
Posterior Axillary line
Lateral Chest
Lobes of Lungs
Right Lung
3 lobes, upper, middle , lower
Left Lung
LUL = Left Upper
and Lower
( 2 lobes)
Inspection
Inspection
Shape of thorax
Symmetry of chest wall
Presence of superficial veins
Intercostal spaces
Muscles of respiration
Respiration
Sputum
Chest Shape
Normal chest shape
•Aprox : 1:2 AP to transverse
ratio
•Slightly elliptical
Barrel Chest
•Aprox AP to transverse ratio
1:1
•Normal in infants &
sometimes in older adults
Pectus Carinatum (Pigeon)
•Sternum protrusion
•Congenital
Pectus Excavatum (Funnel)
•Depression in body of
sternum
•Congenital anomaly
SCOLIOSIS
•Lateral curvature
of thorax or lumber
vertebrae
Kyphosis
Or
Humpback
•Extreme curving
of thoracic spine
Symmetry of Chest Wall
Inspect & note for
Shoulder height
Position of scapula
Observe any differences e.g. presence of
masses
shoulders = same height bilaterally
Scapula = same height bilaterally
There should be no masses
Respirations
Respiration: (Inspiration & Expiration)
Rate
Pattern/rhythm
Depth
Symmetry
Audibility
Patient position
Mode of breathing
Rate
Count the breaths/ minute by watching the
rising and falling of chest
Do not let the patient know
1 respiration = 1 inspiration + 1 expiration
In resting adult, normal respiratory is 12-20
breaths/ minute, called eupnea
> 20 = tachypnea
< 12 = bradypnea
Pattern
Stand in front
While counting the respiratory rate note the
rhythm for regularity
Normal respirations are
regular in rhythm
Depth
Observe the relative depth of inspiration
The normal depth of inspiration is effortless
Hyperpnea
COPD = forced expiration due to difficulty
with exhaling
Audibility
• Listen breath sounds
• Normally patient’s breath sounds are audible
by unaided ears few cm away from mouth &
nose
• Hearing audible sounds few feet away is
abnormal
• Air hunger
Palpation
Palpation
General palpation
Thoracic expansion
Tactile fremitus
Tracheal position
General Palpation
Pulsation
Masses
Thoracic tenderness
Thoracic Expansion
• Assess the extend of chest expansion and the

symmetry of wall expansion
Anterior Thoracic Expansion
Posterior Thoracic Expansion
.
Tactile
Fremitus
Tracheal Position
• Place the finger pad of index finger on
trachea in suprasternal notch
• Palpate for the position of trachea
• Trachea is midline in suprasternal
notch
• Tracheal deviation is abnormal
Percussion
Examination of the lungs:
Percussion
• Compare the percussion notes on both sides at
the same intercostal space level
• Percussion is done from the apex to the base of
the lungs
• Normal lung fields are resonant on percussion
• Dullness on percussion: Consolidation due to
pneumonia/fluid in the lungs
• Hyper resonance on percussion: Excess air in
pneumothorax
Characteristics of Percussion Sounds
SOUND INTENSITY NORMAL
LOCATION Pathological
Flatness Soft Muscles (thigh) or bone
Pleural Effusion
Dullness Moderate Organs (liver, heart)

Lobar Pneumonia
Resonanc Loud Normal lungs
e Normal Lung
Hyper- Very loud Normal lungs in

resonance children Emphysema
Pneumothorax
Tympany Loud Gastric air bubble Large
Pneumothorax
Auscultation
Auscultation
Place the patient with upright position with
shoulder back
Ask the patient to breath in and out slowly
and deeply through the mouth.
Place the stethoscope on the apex of the
right lung and listen for one complete
respiratory cycle
Begin at the apex of each lung and zigzag
downward between intercostal spaces .
Listen with the diaphragm portion of the
Cont….
One full respiration
Directly over chest wall – displace female
breast tissue
Breath Sounds
There are three distinct type of normal breath
sounds during inspiration and expiration
 Bronchial
 Bronchovesicular
 Vesicular
Adventitious Sounds
• Fine crackle
• Coarse crackle
• Sonorous wheeze
• Sibilant wheeze
• Stridor
Video
https://www.youtube.com/watch?v=TlgP8MzlM
aw
Characteristics of Adventitious
Breath Sounds
Breath Sounds Description Condition
Fine Crackle Dry, High pitched, crackling, short COPD, Pulmonary fibrosis,
duration Atelectasis
Coarse Crackle Moist, low pitch, crackling, Pneumonia, pulmonary

gurgling, long duration edema, bronchitis,
atelectasis
Sonorous Wheeze Low pitch, snoring Asthma, bronchitis, airway

edema, tumor, bronchiolar
spasm, foreign body
obstruction
Cont….
Breath Sounds Description Condition
Sibilant wheeze High pitched, musical Asthma, chronic

bronchitis, emphysema,
tumor, foreign body
obstruction
Stridor Crowing Croup, large airway tumor,
foreign body obstruction
Documentation of
Findings
Inspection
• Shape of thorax: AP diameter/transverse
equal, no barrel chest/pectus
carinatum/pectus excavatum/scliosis
Symmetry of chest wall (movement of chest
wall)
Respiration (rate, rhythm)
Sputum
Palpation
General palpation (pulsation, tenderness,
masses)
Thoracic expansion (anterior and posterior
expansion)
Tactile fremitus ( throughout the lungs +ve or
–ve)
Tracheal position (midline or deviated)
Percussion
General percussion (resonant on both lungs,
dullness at Rt. 5th ICS and Lt. 3rd ICS)
Diaphragmatic excursion
Auscultation
Breath sounds (vesicular, bronchial or
bronchovesicular)
Adventitious sounds (Fine crackle, Coarse

crackle, Sonorous wheeze, Sibilant wheeze,
Plural friction rub, Stridor )
References
• Ellen, M. (2010). “Health Assessment and
Physical Examination” 4th Edition, USA.
Delmar
“Goodness is the only investment that never
fails.”
( Henry David, 1854)

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THORAX AND LUNGS

Raheem khan Lecturer

The number of Palpitations, Smoking, Pillow, position

Dry, wet, Shortness of exposure to Medications,

White or Small, Cough, fever, Exposure to Medications

• Assess the extend of chest expansion and the

Dullness Moderate Organs (liver, heart)

Hyper- Very loud Normal lungs in

Coarse Crackle Moist, low pitch, crackling, Pneumonia, pulmonary

Sonorous Wheeze Low pitch, snoring Asthma, bronchitis, airway

Sibilant wheeze High pitched, musical Asthma, chronic

Adventitious sounds (Fine crackle, Coarse

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