this is cereth registered nurse orient home and in this video i'm going to demonstrate how to assess the chest and if you would like to watch a complete nursing head-to-toe assessment you can access this card up here in the corner or in the youtube description below now to do this skill what you'll need to do is you'll need to perform hand hygiene provide privacy to the patient and tell them what you will be doing and you'll need to grab your stethoscope so let's get started we're going to inspect the chest we're looking for any abnormalities like lesions or any wounds anything like that we're also inspecting the patient's effort of breathing is it really labored are they using those accessory muscles to breathe also we're looking at that anterior posterior diameter so turn to the side like that and you're looking for that barrel chest and can will be increased in patients with like COPD they will have what's called the barrel chest and now what we're going to do is we're going to listen to heart sounds and then we're going to listen to lung sounds so first let's auscultate heart sounds and we're going to do this in five locations and they're based on where the valves are located and I like to remember the mnemonic all patients effectively take medicine and the first letter of each word represents the valve except for effectively so a would be a or tick p and patients would be pulmonic effectively would be herbs point and this is just the halfway point between the base of the heart and the apex of the heart and there's no valve location there and then t is for tricuspid and then n is for medicine so again using the diaphragm we're going to listen at the right of the sternal border at the second intercostal space and that's going to be the aortic valve so to find that second intercostal space find the sternal notch go down to the angle of Luis and then just go a little bit to the right and you're in the second intercostal space and this will be the aortic and we're just listening lub-dub lub-dub s1 s2 and s2 the dub is going to be louder in this location then we're going to go a little bit over to where the pulmonic valve is found that's on the left of the sternal border at the second intercostal space so we were just right across Kandace listening to love dub lub dub and s2 dub is going to be louder in this location then we're going to go a little bit down to the third intercostal space and this is herb's point and again and here love dub that there's no specific valve here then we're going to go down to the fourth intercostal space and this is where the tricuspid valve is and love s1 is going to be the loudest at this location then we're going to go to the fifth intercostal space midclavicular line and we're going to listen to the mitral valve and again s1 is going to be loud us hear dub and there's something special about this site this is the point of maximal impulse this is where you're going to listen for the apical pulse so we're gonna set here and we're gonna counter it for one full minute and a normal apical pulse an adult should be 60 to 100 beats per minute and his apical pulse was 63 then we're going to switch over with the Bell of our stethoscope and we're just going to repeat in those locations and we're specifically listening for heart murmur so that's swishing blowing sound so that's what we're going to listen to with that and I did not hear any now let's listen to lung sounds now when you're listening to lung sounds you're listening for abnormal sounds and here are some samples of some abnormal sounds that you may hear crackles wheezes a friction rub or Strider first we're going to listen and tearily and what we're gonna do is we're gonna listen with the diaphragm over stethoscope and we're gonna start at the apex of the lungs and we're gonna always compare sides and just enter way downward and assess all the lobes of that right and left lung so first let's start up here okay and we don't want you take good deep breath in and out so here we go apex okay we're gonna come here sides then we're going to move down to the second intercostal space and this is going to help us assess the right upper lobe and the left upper lobe so another deep breath then we're going to go down to the fourth intercostal space and we're going to assess where our right middle lobe is and our left upper lobe because remember the right lung has three lobes and the left lung has two lobes so let's listen to our left upper lobe a little bit more then we're gonna go mid-axillary at the six six intercostal space and we're gonna listen to the right and left lower lobe so you just want to turn to the side right there okay other side okay now let's listen post eerily again using the diaphragm here the stethoscope you're going to start listening at the apex and work your way down and one thing to keep in mind when you're listening back here you have the scapula and you don't want to listen over those because you won't be able to hear the sound so you're gonna listen in between where the scapula and the spine are so down in these regions right here again we're just going to compare sides and you can do this part at the end if you wanted to whenever you turn your patient over to look at their back side but we're just going to go ahead and do it now so we're gonna start and the apex compared sides then we're going to find c7 which is that vertebral prominence it's the big ball right there you can't miss it and go down to about t3 and you'll be in between the shoulder blades and go a little bit in between the shoulder blades and the spine right in there and you're gonna assess the right and left upper lobes then from t3 to t10 we're just going to inch around and we're going to listen to the right and left lower lobes okay so that is how you assess the chest and don't forget to watch that video on a complete head-to-toe nursing assessment thank you so much for watching and don't forget to subscribe 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