Chest Assessment in Nursing

Introduction

Hand Hygiene: Perform before beginning the assessment.
Patient Privacy: Ensure the patient is comfortable and understands the procedure.
Equipment: Stethoscope needed for auscultation.

Visual Check: Look for lesions, wounds, and any abnormalities.
Breathing Effort: Observe if breathing is labored or if accessory muscles are used.
Anterior Posterior Diameter: Check for barrel chest, common in patients with COPD.

Mnemonic: "All Patients Effectively Take Medicine"
- A: Aortic valve
- P: Pulmonic valve
- E: Erb's Point
- T: Tricuspid valve
- M: Mitral valve
Aortic Valve
- Location: Right sternal border, second intercostal space
- Sound: S1, S2 (Dub louder)
Pulmonic Valve
- Location: Left sternal border, second intercostal space
- Sound: S1, S2 (Dub louder)
Erb's Point
- Location: Third intercostal space
- Note: No specific valve, listen for S1, S2
Tricuspid Valve
- Location: Fourth intercostal space
- Sound: S1 loudest
Mitral Valve
- Location: Fifth intercostal space, midclavicular line
- Note: Point of Maximal Impulse, Apical Pulse
- Normal Rate: 60-100 bpm (e.g., 63 bpm during this demonstration)
Use of Bell: Listen for heart murmurs (swishing/blowing sounds)

Abnormal Sounds: Crackles, wheezes, friction rub, stridor
Anterior Auscultation
- Start at lung apex and compare sides, moving down to assess all lobes
- Right Lung: 3 lobes
- Left Lung: 2 lobes
Posterior Auscultation
- Avoid scapula, listen between spine and scapula
- Begin at apex, compare sides
- C7 to T3: Between shoulder blades, assess right and left upper lobes
- T3 to T10: Assess right and left lower lobes