Health assessment on the chest and lungs examination

1. PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY,ASELLA,ETHIOPIA,
SOUTH EAST AFRICA.

2.  The chest, or thorax, is the bony cage that
protects the
 heart,
 lungs,
 and great vessels.

3.  The ribs,
 sternum,
 and vertebrae form the chest.
 Be systematic in your assessment:

4.  Always assess the areas of the chest and
lungs in the same order.

5.  Anterior chest—
 Identify positions vertically on the anterior
chest in relation to the ribs.
 For example, the space between the 5th and
6th ribs is known as the 5th intercostal space
(5th ICS).

7.  You can easily palpate the ribs and count the
spaces if you remember that the 1st rib is
tucked up next to the clavicle.

8.  Anterior chest—
 Use a series of imaginary vertical lines with the
rib spaces to further aid In identifying locations
on the anterior chest.

9.  For instance, the apex of the heart is usually
located in the 5th intercostal space at left
midclavicular line (5th ICS MCL).

10.  Posterior chest—
 Identify positions vertically in relation to the
vertebra .
 The prominent vertebra at the base of the neck
is the 7th cervical vertebra (C7).

12.  The next one down is T1 (1st thoracic).
 Counting down to about T9 should be
adequate.

13.  Lateral and posterior chest—
 Use imaginary lines on the lateral and
posterior chest as well.

14.  Notice that the anterior axillary line can be
used to locate sounds on both the anterior
and lateral chest.

17.  The normal adult chest is symmetrical and
rises and falls with respirations.

19.  The chest diameter expands up to 3 inches
(7.6 cm) with deep inspiration.

20.  This is written as AP: Lateral = 1:2).
 In young children, the chest is apple-shaped.

21.  This change is also seen, regardless of age, in
clients who have chronic obstructive pulmonary
disease (COPD),
 a disorder associated with long-term smoking.

22.  kyphosis (excessive curvature of the thoracic
spine).
 scoliosis (lateral curvature of the spine) alter the
shape of the thoracic cage.

25. Osteoporosis,
 a common disorder associated with aging,
 is associated with increased porosity of the
vertebrae.

27. As a result,
 vertebrae may compress or collapse,
 shortening the length of the spine
 and pushing the ribs forward and downward.

29.  Listen to breath sounds in a quiet room by
auscultating one full respiratory cycle at each
site.

30.  Directly apply the stethoscope to the client’s
skin.
 Compare breath sounds bilaterally.
 Three types of breath sounds are heard.

31. Bronchial breath sounds are
 loud, high-pitched,
 tubular sounds;
 expiration is of longer duration than inspiration.

32.  Air moving through the trachea produces these
sounds,
 which you will hear best over the trachea on the
anterior chest and
 below the nape of the neck on the posterior
chest.

33.  Bronchovesicular breath sounds are medium
pitched with
 an equal inspiratory and expiratory phase.

34.  Air moving through the large airways of the
bronchi produces these sounds,
 which you will hear best over the 1st and 2nd
ICS adjacent to the sternum on the anterior
chest and between the scapula on the posterior
chest.

35.  Vesicular breath sounds are soft, low-pitched,
breezy sounds with a lengthy inspiratory phase
and a short expiratory phase.

36.  Air moving through the smaller airways produces
these sounds,
 which you will hear best over the lung fields.

37.  Breath sounds that differ from those above are
abnormal.

38.  Diminished breath sounds are
 heard with poor inspiratory effort,
 in the very muscular or obese,
 or with restricted airflow.

39.  Misplaced breath sounds
 (e.g., bronchial breath sounds heard over the
lung fields) indicate constriction of flow.

40.  Adventitious breath sounds, such as
 wheezes,
 rhonchi, and
 rales, are sounds heard over normal breath
sounds.

41.  If an abnormal sound is heard,
 have the client cough and listen again.

42. Other abnormal findings include
 bronchophony,
 whispered pectoriloquy,
 and egophony.
 These are abnormal voice sounds that result
from consolidation of lung tissue.