Thorax and Lungs Assessment Notes

Introduction

• Assessment of thorax and lungs due to reported shortness of breath.
• Examination includes inspection, palpation, percussion, and auscultation.

Posterior Thorax Assessment

Inspection

• Chest Shape: Elliptical/conical with downward sloping ribs.
• Spinous Process: Straight.
• Thorax Symmetry: Symmetrical thorax as evidenced by scapula base.
• Neck Muscles: Normally developed.
• Anterior Posterior (AP) Diameter: Normal at 1:2.
• Skin Color: Uniform, no redness, no cyanosis.

Palpation

• Findings: No pain, tenderness, masses, or lesions; skin warm to touch.

Symmetrical Chest Expansion

• Landmarking at the ninth to tenth vertebrae.
• Findings: Symmetrical expansion with no lag.

Tactile Fremitus

• Using ulnar aspect of hand, have patient say "99".
• Findings: Equal vibrations throughout five areas.

Percussion

• Percuss nine areas from C7-T1 down between scapula and vertebrae.
• Findings: Resonance throughout, which is normal.

Auscultation

• Using stethoscope over nine areas during deep breathing.
• Findings: Clear breath sounds, no adventitious sounds. Bronchovesicular sounds between scapula, vesicular sounds peripherally.

Anterior Thorax Assessment

Inspection

• Symmetry: Thorax symmetrical.
• Muscle Development: Normal abdominal muscles.
• Rib Angle: Downward sloping, costal margin at 90 degrees.
• Skin and Lips: Uniform color, no redness or cyanosis, lips pink.
• Capillary Refill & Clubbing: Refill < 3 seconds, no clubbing (angle 160 degrees).
• Facial Expression & Respiration: Calm, relaxed, respirations silent and effortless.

Palpation

• Same findings as posterior: No pain, tenderness, masses, bulges, or lesions; skin warm, dry.

Tactile Fremitus

• Conducted down midclavicular line in five areas.
• Findings: Equal vibrations throughout.

Percussion

• Percuss five areas above clavicle and downward, adjusting for breast tissue.
• Findings: Resonance throughout, liver dullness, potential cardiac dullness, splenic dullness, tympany over stomach.

Auscultation

• Using diaphragm of stethoscope over same five areas.
• Findings: Bilateral breath sounds clear, no adventitious sounds. Tracheal sounds near throat, bronchial sounds mid-chest, vesicular sounds peripherally.

Conclusion

• Completed thorax and lungs assessment.
• No questions from the patient.