The document describes the process for examining the anterior chest, heart, breasts, axillae, and abdomen. It includes inspecting, percussing, auscultating, and palpating each area. Normal findings are described along with common abnormal findings. The anterior chest is examined for breathing patterns and lesions. The heart is examined for pulsations, sounds, and murmurs. Breasts are inspected and palpated for masses or abnormalities. Abdominal examination involves inspection, auscultation, percussion, and palpation of the four quadrants to check for organ enlargement, tenderness, or other issues.

1. Examination of Anterior chest
and Heart
Mrs Melba R Lobo
Asst Professor
YNC
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2. Anterior thorax
• Inspect the breathing pattern
• Palpate the anterior chest for temperature ,
lesions
• Palpate anterior chest for respiratory
excursion
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3. Anterior chest
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4. Chest excursion
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5. • Percuss the anterior chest –begin above the
clavicles in the supraclavicular space and
proceed downward to the diaphragm
- Percussion notes are resonate till sixth rib , flat
over areas of heavy muscle and bones , dull
over heart and liver , tympany over underlying
stomach
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6. Sequence for anterior chest
percussion
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7. • Auscultation of anterior chest
- Auscultate the trachea
- Auscultate the anterior chest wall in the
sequence used for percussion
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8. 4/24/2023 9:42 AM (NAME) 8

9. Normal Breath sounds in
Auscultation
Type Description Location Characteristics
Vesicular Low intensity ,
soft pitched
sounds created
by air moving
through
smaller
airways
Over the
peripheral
lungs , best
heard at the
base of lungs
Best heard on
inspiration
,which is
about 2.5
times longer
than
expiratory
phase
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10. Type Description Location Characterist
ics
Bronchovesic
ular
Moderate
intensity and
moderate
pitched
blowing
sounds
created by air
moving
through
larger airway
Between the
scapulae and
lateral
sternum at
the first and
second
intercostal
spaces
Equal
inspiratory
and
expiratory
phases
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11. Type Description Location Characteris
tics
Bronchial (
tubular )
High pitched
, loud sound
created by
air moving
through the
trachea
Anteriorly
over the
trachea
Louder than
vesicular
sounds ,
have short
inspiratory
and long
expiratory
phase
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13. Adventitious or abnormal breath
sounds
• Abnormal breath sounds occur when air passe
through narrowed airways or airways filled
with fluid or mucus or when pleural linings are
inflamed
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14. Type Description Causes Characteris
tics
Crackles
( rales )
Fine , short ,
interrupted
crackling sounds
( sound can be
simualted by
rolling a lock of
hair near the ear )
Air passing
through fluid
or mucus in
any air
passage
Most
commonly
heard in the
bases of
lower lung
lobes
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15. Type Description Causes Characteristic
s
Ronchi
(gurgles)
Continuous , low
pitched gurgling
, harsh louder
sounds with a
moaning or
snoring quality ,
best heard on
expiration
Air passing
through
narrow air
passages as
a result of
secretions ,
swelling ,
tumors
Loud sounds
can be heard
over most lung
areas but
predominate
over trachea
and bronchi
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16. Type Description Causes Characteristi
cs
Friction
rub
Superficial
gratin or
creaking
sounds heard
during
inspiration and
expiration
Rubbing
together of
inflamed
pleural
surfaces
Heard most
often in areas
of greatest
thoracic
expansion
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17. Type Description Causes Location
Wheeze Continuous ,
high pitched
sqeaky
musical
sounds , best
heard on
expiration
Air passing
through
constricted
bronchus
Heard over
all lung
fields
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18. Heart
• Nurses assess heart through inspection ,
palpation and auscultation in the sequence
• Precordium is inspected for abnormal
pulsation , lifts or heaves ( it refers to rising
along the sternal border with each heart beat
)
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20. • Auscultate for the heart sounds
- S1 – Dull low pitched , “lub” sound occurs
when A- V valves close
- S2 – high pitched “ dub”sound heard when
semilunar valves close
- Audible anywhere on precordial area , but
best heard over aortic , pulmonic , tricuspid ,
apical area
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22. Breasts and axillae
• Breast of both men and wpmen must be
inspected and palpated
• Men have smaller glandular tissue beneath
the nipple , mature women have glandular
tissue throughout the breast
• Provide privacy during examination
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24. • Inspect the breast for size , symmetry ,
contour , shape while client is in sitting
position
- Normally rounded shape , slightly unequal size
and generally symmetric in females
- In males breast are even with chest wall
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25. • Inspect the skin of the breast for localized
discoloration or hyperpigmentation ,
retractions or dimpling , localized
hypervascular areas , swelling or edema
- Usually skin is uniform in color , smooth and
intact , streth marks may be visible
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26. • Inspect the areola area for size , shape ,
symmetry , color , masses or lesions
- Normally round or oval with color variation
from light pink to dark brown
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27. • Inspect the nipples for size , shape , position ,
color, discharge and lesions
- Normally nipples are round, everted and equal
in size , similar in color , soft and smooth , no
discharges( except pregnant and breast
feeding women )
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29. • Palpate the axillae for axillary , subclavicular ,
supraclavicular lymphnodes , check for
tenderness, masses or nodules
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30. • Palpate the breast for masses , tenderness and
any discharge from nipples , the client must
sleep in supine position with abducted arm
and hands placed behind the head
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31. 3 patterns of breast palpation
• circular
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32. • Wedge pattern
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33. • Vertical strips pattern
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34. • If any mass is detected note
A. Location
B. Size: lenth , width
C. Shape: oval/ round/lobulated
D. Consistency : hard/ soft
E. Mobility : movable / fixed
F. Skin over the lump: reddened/dimpled / retracted
G. Nipple: displaced or retracted
H. Tenderness
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37. • Palpate the areola and the nipples for masses
• Compress each nipple to determine presence
of discharge
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38. Abdomen
• Assessment of abdomen involves all four
methods of examination
• Client must be supine position
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39. Abdomen
Quadrants of abdomen
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41. 9 regions of
abdomen
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42. • Inspect the abdomen for skin integrity , color
• Check for rashes or other lesions
- Normally uniform color and intact skin will be
present
- Silver white striae( stretch marks or surgical
scars may be present
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• Striae

44. • Dilated veins
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45. • Ascites: accumulation of fluid in the peritoneal
cavity
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46. • Inspect the abdomen contour and symmetry
- Normally flat , rounded or concave shape
- Check for distended abdomen , evidence of
enlargement of liver or spleen
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47. • Observe abdominal movements associated
with respiration , peristalsis or aortic pulsation
- Normally symmetric movements caused by
respiration , visible peristalsis in lean clients ,
aortic pulsation in thin clients
- https://www.youtube.com/watch?v=Og5xAdC
8EUI
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48. • Auscultate the abdomen for bowel sounds
- Place the diaphragm in each of the four
quadrants of abdomen
- Listen for active bowel sounds – irregular
gurgling sound about every 5-20 seconds
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50. - Hypoactive sounds indicate decresed motility(
surgery , inflammation , bowel obstruction )
- Hyperactive sounds( borborygmi) indicate
increased intestinal motility ( diarrhoea, use of
laxatives )
- True absence of sound( none in 3-5 minutes
)indicates cessation of intestinal motility
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51. • Percuss several areas in each of four
quadrants
- Normally tympany over the stomach and gas
filled bowel , dullness over liver , spleen and
full bladder
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52. • Palpation of the abdomen
- Perform light palpation first to detect areas of
tenderness
- Systematically explore four quadrants
- Ensure appropriate position
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53. • Light palpation
- Hold the palm of the hand slightly above the
clients abdomen with fingers parallel to the
abdomen
- Depress the abdominal wall lightly about 1 cm
with finger pads
- Move finger pads in a slight circular motion
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55. - Note areas of tenderness or superficial pain ,
masses and muscle guarding
- Palpate the area above pubic symhysis if the
client has the history of urinary retention (
distended and palpable as smooth , round ,
tense mass indicates urinary retention )
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57. Summary
• Auscultation of the chest must be done in a
zig zag manner
• Differentiate the normal and abnormal sounds
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