Thorax and Lungs assessment
1. Inspect posterior thorax
a. Notice the chest wall shape and configuration
b. AP diameter < transverse diameter
c. The spinous processes should be aligned and the THORAX should be
symmetrical with NO deformities.
Note: In different culture thoracic sizes may differ. Whites have the
largest chest volume followed by black, Asians, and native American.
d. Observe the position the person takes to breathe. It should be relaxed
and supports their weight with their arm resting on their sides or their
lap.
e. Assess their skin color and condition, there should be NO cyanosis,
pallor, abnormal pigmentation or lesions.
2. Palpate the posterior thorax
a. Place hands on their posterolateral chest wall with your thumbs at T9
or T10, slide your hand towards each other to pinch up a small fold of
skin and ask the patient to take a deep breathe normally.
,b. As they inhale your thumb should move apart symmetrically
c. Palpate and confirm the patient’s chest expansion if it’s symmetrical
d. Palpate for tactile fremitus:
i. Using the palm of your hands palpate the back while the
patient’s repeats a resonant phrase such as “99 or blue moon”
ii. Follow a consistent pattern.
, iii. Palpate systematically, move from one side to the other. Avoid
the scapula.
iv. Vibration should feel the same in corresponding areas on each
sides
v. Right side may feel stronger between the scapula because that
side is closer to the tracheal
e. Palpate the chest wall:
i. Gently palpate the (chest wall) back and tell the patient to let
you know if they feel pain or tenderness at each palpation.
ii. Skin should feel warm and dry. Should detect no tenderness,
masses, or lesions
3. Percuss the posterior thorax
a. Follow the percussion patter systematically.
b. Start at the apices and percuss at the top of both shoulders.
c. Note the intensity, pitch and duration of the percussion notes.
d. They should match side to side
e. Over the lungs, percussion should produce resonance
1. Inspect posterior thorax
a. Notice the chest wall shape and configuration
b. AP diameter < transverse diameter
c. The spinous processes should be aligned and the THORAX should be
symmetrical with NO deformities.
Note: In different culture thoracic sizes may differ. Whites have the
largest chest volume followed by black, Asians, and native American.
d. Observe the position the person takes to breathe. It should be relaxed
and supports their weight with their arm resting on their sides or their
lap.
e. Assess their skin color and condition, there should be NO cyanosis,
pallor, abnormal pigmentation or lesions.
2. Palpate the posterior thorax
a. Place hands on their posterolateral chest wall with your thumbs at T9
or T10, slide your hand towards each other to pinch up a small fold of
skin and ask the patient to take a deep breathe normally.
,b. As they inhale your thumb should move apart symmetrically
c. Palpate and confirm the patient’s chest expansion if it’s symmetrical
d. Palpate for tactile fremitus:
i. Using the palm of your hands palpate the back while the
patient’s repeats a resonant phrase such as “99 or blue moon”
ii. Follow a consistent pattern.
, iii. Palpate systematically, move from one side to the other. Avoid
the scapula.
iv. Vibration should feel the same in corresponding areas on each
sides
v. Right side may feel stronger between the scapula because that
side is closer to the tracheal
e. Palpate the chest wall:
i. Gently palpate the (chest wall) back and tell the patient to let
you know if they feel pain or tenderness at each palpation.
ii. Skin should feel warm and dry. Should detect no tenderness,
masses, or lesions
3. Percuss the posterior thorax
a. Follow the percussion patter systematically.
b. Start at the apices and percuss at the top of both shoulders.
c. Note the intensity, pitch and duration of the percussion notes.
d. They should match side to side
e. Over the lungs, percussion should produce resonance
