Prof Dr.
Salma Khadim Jehad
Dr. Ali Faris Al-Saadi
Dr. Noor Mohammed
[Link] Hassanain Mohammed
Lecture -6-
Lung Examination
Objectives:
At the end of this lab, the students will be able to:
1. Demonstrate the ability to safely & accurately complete thorax
& lung assessment.
2. Demonstrate the ability to accurately document thorax & lung
assessment data in organized
manner.
Equipment Needed
1. Stethoscope
2. Small ruler, marked in centimeters
3. Marking pen
4. Alcohol swab
Preparation
1. Ask the client to sit upright & the male to disrobe to
the waist.
2. For female, leave the gown on & open at the back.
3. When examining the anterior chest, lift up the gown &
drape it on her shoulders rather than
removing it completely.
4. For farther comfort: a warm room, a warm diaphragm
end piece.
5. Private examination time with no interruption.
Subjective data:
Cough ✓
Past history of respiratory infections ✓
Self-care behaviors ✓
Shortness of breath✓
Smoking history✓
Chest pain with breathing ✓
Environmental exposure✓
Chest Landmarks
Anterior : Right anterior axillary line ,
Right midclavicular line ,
Mid sternum line
left midclavicular line ,
left anterior axillary line
Mid axillary line
Posterior: L . posterior axillary line , L .mid
scapular line ,mid spinal line , R. mid scapular
line and R. posterior axillary line ,
Inspect anterior, posterior, & lateral thorax for the following:
Color : Pink
Intercostals spaces : Even
Chest symmetry: Equal
Rib slope : Less than 90 degree downward
Respiration (rate, depth, rhythm) ,Even, 12-20/min,
unlabored
Anterior-posterior to lateral diameter 1 : 2 ratio
Shape & position of sternum : level with ribs
Position of trachea Midline
Breathing Pattern
1-Eupnea: Normal 3-Tachypnea: Rapid
breathing is relaxed, shallow breathing is a
effortless, and regular at rate above 20 breaths
per minute, associated
14-16 breath\minute with increased
activity or a disease
process
4-Bradypnea: slow breathing is a rate
blow 12 breath per minute with normal
depth and rhythm , associated with
Sedation , anesthesia
5-Hypoventilation : Shallow irregular
breathing hypercapnia and hypoxemia
such as in COPD
6-Hyperventilation increased depth and
rate of breathing (kussmaul ‘s
respiration caused by diabetic
ketoacidosis
7-Cheyne-Stokes is the term
for cycles of breathing
8- Biot's respiration
characterized by deep, rapid
breaths for about 30 seconds, rapid, short breathing
with pauses of
followed by absence of
several seconds,
respirations for 10 to 30
indicating increased
seconds. Cheyne-Stokes intracranial pressure.
respirations constitute a
serious symptom and
precedes death in cerebral
hemorrhage, uremia, or heart
disease
Inspection
Normal chest
Slight retraction of
intercostal spaces
2x as wide as deep
Anterior/posterior
diameter
1:2
Inspection
Barrel chest
anterior-posterior
diameter
2:2
Inspection
Pigeon chest
Sternum protrudes
outward
anterior-posterior
diameter
Pigeon Chest
Inspection
Scoliosis
Lateral curvature of
thoracic spine
Assessment
Shoulders elevated?
Complications
Lung & heart damage
Back problems
Body image
Scoliosis
Inspection
Kyphosis
Abnormal
curvature of the
thoracic spine
Kyphosis
Inspection
Lordosis
Sway-back
Abnormal curvature
of the lumbar spine
Lordosis
Inspection
Uniform expansion of
the chest
Pneumonia
Pleural effusion
Pneumothorax
Bulging intercostal
spaces
Obstruction
Emphysema
Palpate thorax at three levels for the following:
Sensation : no pain or tenderness
Vocal fremitus ( tactius) as client says 99Use either the
palm base (the ball) of fingers, or the ulnar edge of one
hand.
- Touch the client's chest- Ask the client to repeat a resonant
phrases that generate strong vibration
Like 99.
Start over the lung apices & palpate from side to another.- -
Avoid palpating over the scapulae.
Vibration decreased over periphery of lungs & increased -
over major airways .
- Palpate chest expansion :
Posterior : placing your warmed hand on the poster lateral
chest wall
- The thumbs should be at level of T9 or T10.
- Slide your hands medially to pinch up a small fold between
your thumbs.
- Ask the client to take deep breath.
- Your thumb should move with respiration.
Anterior: placing your warmed hand on the anterolateral wall.
- Thumbs should be along the costal margins & pointing toward
the xiphoid process. - Ask the client to take deep breath.
- Watch your thumbs move with respiration.
2 to 3-inch symmetrical thoracic expansion.
Symmetrical expansion (thumbs move apart equal
distance in both directions).
Percussion (Diaphragmatic Excursion)
Posteriorely :
ask the client to exhale & hold it.
- Percuss down the scapular line until the sound changes from
resonant to dull each side.
- Mark the level where the sound changed to dull.
- Ask the client to take deep breath & hold it. - Continue
percussion from the mark down ward.
Mark the level the sound changed to dull on deep inspiration. -
Normal Finding : -
It should be equal bilaterally, & measure about 3-5cm in adult,
although it may be up to 7-8cm.
.
Auscultation
Purpose
Asses normal and
abnormal air flow
through bronchial tree
by using
Diaphragm of
stethoscope
Compare R to L
Auscultation: normal lung sound
1-Bronchial : Trachea , high , inspiration
shorter than expiration
2-Bronchovesicular :
Moderate , Between scapulae
Side of sternum intercostals space ,
inspiration equal with expiration
3-Vesicular : Lung field , inspiration
longer than expiration is it soft and
low
Abnormal Lung sound
1-Crackles (fine): high, short, popping sound heard
during inspiration not clear with cough
Caused by: inhaled air sudden open of the small
deflated air passage with sticky with exudates , can be
associated with pneumonia , congestive heart failure
or bronchitis and asthma
2-Coarse crackles low pitch bubbling , moist sound
that may persist from early inspiration to early
expiration air comes into contact with secretions in the
large bronchi and trachea may indicated pneumonia ,
pulmonary edema client with COPD
3-Wheeze(sibilant): high in pitch ,musical sound heard in
expiration or may be inspiration ,air pass through
constricted passage as secretion or tumor heard asthma or
emphysema
4-Wheeze (sonorous): low pitch snoring or moaning sound
heard during expiration clear with cough , heard in
bronchitis , sleeping apnea .
5-Stridor: harsh honking wheeze heard with
broncholaryngospasm as in croup
6-Pleural friction rub: low
pitch grating sound
superficial occur during I&E
result of rubbing of two
inflamed pleural surface as
pleuritis
Best heard anterior, Lower,
lateral area