health assessment of the thorax and lung

1. ASSESSING THORAX
AND LUNGS

2. • 1. PREPARE THE CLIENT
• Have the client remove all clothing from the waist up and
• put on an examination gown or drape.
• The gown should open down the back, and is used to limit exposure.
Examination of a female client’s chest may create anxiety because of
embarrassment related to breast exposure.
• Explain that exposure of the entire chest is necessary during some parts of
the examination. To further ease client anxiety.
• Ask the client to sit in an upright position with arms relaxed at the sides.

3. • 2. Equipment
• Examination gown and drape
• Gloves
• Stethoscope
• Light source
• Mask
• Skin marker
• Metric ruler

4. 3. During examination of the client, remember these key points:
• Provide privacy
• Keep your hands warm
• Remain nonjudgmental regarding the client’s habits and lifestyle
particularly smoking. At the same time educate and inform about
risks such as lung CA, COPD and related habits

5. INSPECTION
• Inspect for nasal flaring and pursed lip breathing
• Nasal flaring is seen with labored respirations (especially in small children)
and is indicative of hypoxia.
• Pursed lip breathing may be seen in asthma, emphysema, or CHF as a
physiologic response to help slow down expiration and keep alveoli
open longer
• Pursed lip breathing - slowly inhale through your nose and gently
exhale through pursed lips.

6. • Observe color of face, lips, and chest
• The client has evenly colored skin tone, without unusual or prominent
discoloration
• Ruddy to purple complexion may be seen in clients with COPD or CHF
as a result of polycythemia. Cyanosis may be seen if client is cold or
hypoxic.
• Inspect color and shape of nails.
• Pink tones should be seen in the nailbeds.
• There is normally a 160-degree angle
• between the nail base and the skin.

7. • Inspect configuration. While the client sits with arms at the sides,
stand behind the client and observe the position of scapulae and the
shape and configuration of the chest wall
• Scapulae are symmetric and nonprotruding.
• Shoulders and scapulae are at equal horizontal positions. The ratio of
anteroposterior to transverse diameter is 1:2.
• Spinous processes appear straight, and thorax appears symmetric,
with ribs sloping downward at approximately a 45-degree angle in
relation to the spine

8. • Observe use of accessory muscles. Watch as the client breathes and
note use of muscles
• The size of the thorax, which affects pulmonary function, differs by
race. Compared with African Americans, Asians and Native
Americans, adult Caucasians have a larger thorax and greater lung
capacity
• The client does not use accessory (trapezius/shoulder) muscles to
assist breathing. The diaphragm is the major muscle at work. This is
evidenced by expansion of the lower chest during inspiration

9. • Inspect the client’s positioning. Note the client’s posture and ability to
support weight while breathing comfortably
• Client should be sitting up and relaxed, breathing easily with arms at
sides or in lap.

10. PALPATION
• Palpate for tenderness and sensation. Palpation may be performed with
one or both hands, but the sequence of palpation is established.
• Use your fingers to palpate for tenderness, warmth, pain, or other
sensations.
• Start toward the midline
at the level of the left scapula (over the apex
of the left lung) and move your hand left to
right, comparing findings bilaterally. Move
systematically downward and out to cover
the lateral portions of the lungs at the bases.

11. • Palpate for crepitus. Crepitus, also called subcutaneous emphysema,
is a crackling sensation (like bones or hairs rubbing against each
other) that occurs when air passes through fluid or exudate.

15. ASSESSING THE PERIPHERAL-VASCULAR SYSTEM

16. 1. Inspection :
• Observe skin over extremities for:
 color
 pallor
 rubor ( redness)
 hair distribution
• Inspect the arms for any superficial vessels.
Normal findings:
Extremities symmetrical, even in color
Skin is warm and moist

17. UPPER EXTREMITIES
Palpation
• Note temperature of skin over
extremities, comparing one side to
the other.
• Palpate pulses- radial then brachial
for :
 Symmetry
• Test ROM
 Full ROM
 normal muscle strength
 Arms symmetric in size

18. NORMAL FINDINGS:
 Radial pulses on both arms present and equal.
 Normal pulse rate per minute :
 60 to 100 beats per minute
Qualities of pulse
Amplitude( force) of pulses
 3+ increased, full, bounding
 2+ normal(regular rhythm , equal intervals between pulsations)
 1+ weak
 0 absent

19. ASSESSING THE PULSE
Methods in assessing the pulse
 Palpation. The three fingers are
used to assess all peripheral
sites except the apical pulse.
 Auscultation. Health care
provider uses a Doppler
Ultrasound Stethoscope. DUS
is used for pulses that are
difficult to assess.

20. Data Collected when Assessing the Pulse
1. Pulse Rate
2. Pulse Rhythm
3. Pulse Volume
- Full or Bounding Pulse
- Weak, feeble or thready Pulse
4. Elasticity of the arterial wall
5. Presence or absence of bilateral equality

21. PERIPHERAL PULSES : SITES IN ASSESSING THE PULSE
 Determine symmetry of pulse
volume
1. Femoral (groin),
2. Popliteal (back of the knee),
3. Posterior tibial (ankle),
4. Dorsalis pedis (foot) areas.
- Other pulses
5. Radial (wrist),
6. Brachial (forearm)

22. ABNORMAL FINDINGS: UPPER EXTREMITIES
 Cold, clammy and pale hands and arms.
 Indicate vasoconstriction and decreased cardiac
output.
 Edema of upper extremities,
 indicate poor venous return or obstruction of
lymphatic drainage.
 Full, bounding pulse (3+)..
 can occur with exercise, anxiety, fever. Anemia,
hyperthyroidism.
 Weak, thready pulse.
 Occurs with shock and peripheral disease.

23. LOWER EXTREMITIES
 Inspection
Expose legs, in supine position,
keep genitalia covered.
Inspect both legs, note skin
color, hair distribution,
temperature, venous pattern,
size (swelling or
muscle atrophy)
 Measure calf circumference with
tape measure
( if lower leg appear
asymmetrical)
 Normal findings ;
Hair covers the legs.
Venous pattern in legs normally
flat and barely visible.
Legs symmetric in size, no
swelling or atrophy.

24. ABNORMAL FINDINGS
 Legs appear pale ( vasoconstriction ), reddish with
vasodilation; cyanotic( poor oxygenation ).
 Skin thin, pallor, cold, loss of hair, ulcers, gangrene
in legs ( arterial insufficiency)
 Bilateral edema in legs ( deep vein thrombosis)
may indicate systemic illnesses affecting heart or
kidneys.
 Acute, unilateral painful swelling in the legs
indicate deep vein thrombosis.
 Brown discoloration in legs * chronic venous stasis
due to hemosiderin deposits( a protein compound
that stores iron in tissues) from red blood cell
degradation.
 Venous ulcers ( poor venous return)
 Arterial ulcers on tip of toes, metatarsal heads and

25. LOWER EXTREMITIES
 Palpate peripheral pulses
To determine symmetry of
pulse volume
1. Femoral (groin),
2. Popliteal (back of the knee),
3. Posterior tibial (ankle),
4. Dorsalis pedis (foot) areas
 Normal findings
 Symmetric pulse volumes
 Full pulsations

26. Deviations from normal:
Asymmetric volumes
Absence of pulsation
Decreased ,weak, thready pulsations
( impaired cardiac output)
Thready pulse( a scarcely perceptible
and rapid pulse that feels like a fine
mobile thread under a palpating
finger).
Increased pulse volume( hypertension,
high CO, circulatory overload)

27.  Inspect the peripheral veins in
the arms and legs for:
 presence / appearance of
superficial veins when limbs are
dependent and when limbs are
elevated.
Normal findings :
 Dependent position:
presence of distention and
nodular bulges at calves
 Limbs elevated: veins collapse

28. PERIPHERAL VEINS
Abnormal findings
Distended veins
Tenderness on palpation
Pain in calf muscles with forceful
dorsiflexion (positive Homan’s
sign)
Warm and redness over vein
( phlebitis)
Swelling of one calf or leg

29.  Inadequate perfusion to the
extremities refers
to decreased arterial blood flow
to the extremities.
 Inspect the skin of the hands and
feet for color, temperature,
edema, and skin changes.
Normal findings :
 Skin color pink
 Skin temperature not excessively
warm
 No edema
Deviations from normal:
Cyanotic ( venous
insufficiency)
Pallor that increases with
limb elevation
Dusky red color when limb is
lowered( arterial
insufficiency)
Skin cool ( arterial
insufficiency}
Marked edema
Delayed color return

30. Assess the adequacy of arterial flow
if arterial insufficiency is suspected.
Normal findings: skin color pink
 Buerger's test : original color
returns in 10 seconds; veins in
feet or hands fill in about 15
seconds.
 Capillary refill test: immediate
return of color

31. Deviations from normal:
Delayed color return or
mottled appearance; delayed
venous filling; marked redness
of arms or legs
(indicates arterial insufficiency)

32. ASSESSING THE BREAST

33. ASSESSING THE BREAST
PREPARING THE CLIENT
• The actual hands-on physical examination of the breast may create client
anxiety.
• The client may be embarrassed about exposing his or her breasts and may be
anxious. Explain in detail what is happening throughout the assessment.
• Provide the client with as much privacy as possible during the examination.
• Prepare for the breast examination by having the client sit in an upright
position. Explain that it will be necessary to expose both breasts to compare for
symmetry during inspection.
• One breast may be draped while the other breast is palpated. Be sensitive to the
fact that many women may feel embarrassed to have their breasts examined.
• The breasts are first inspected in the sitting position while the client is asked to
hold arms in different positions. The breasts are then palpated while the client
assumes a supine position

34. ASSESSING THE BREAST
• The final part of the examination involves:
• teaching clients how to perform BSE and asking them to demonstrate then
ask the client to demonstrate how is it done.

35. ASSESSING THE BREAST
EQUIPMENT:
• Centimeter ruler
• Small pillow
• Gloves
• Client handout for BSE
• Slide for specimen

36. Key points for physical assessment include the following:
• Explain to the client what the steps of the examination and the rationale.
• Warm your hands.
• Observe and inspect breast skin, areolas, and nipples for size, shape,
rashes, dimpling, swelling, discoloration, retraction, asymmetry and
other unusual findings.
• Palpate breasts and axillary lymph nodes for swelling, lumps, masses,
warmth or inflammation, tenderness, and other abnormalities.
• Remember it is important to carefully perform the breast examination on
male as well as female clients.

59. ABDOMINAL ASSESSMENT
IAPePa
alter the frequency of bowel
sounds and make your findings less
accurate.
dorsal recumbent position