Anterior and Posterior Thorax Assessment

Overview

• The assessment involves inspecting, palpating, and auscultating the anterior and posterior thorax.
• The patient is provided with a drape during the process.

Inspection

Anterior Thorax

• Check for signs of labored breathing:
  • Use of trapezius or neck muscles.
  • Inspect lips for cyanosis.
  • Assess color of chest skin.
  • Observe use of intercostal muscles.
• Evaluate the way the patient is breathing; note if it's normal.
• Inspect the anterior-posterior ratio:
  • Normal ratio: 1:2.
  • Abnormal ratio (e.g., barrel chest): 2:2.

Palpation

Anterior Thorax

• Sanitization of hands before touching the patient.
• Check for crepitus or visible masses:
  • No crepitus or masses noted.
• Assess chest expansion:
  • Equal and symmetrical chest expansion observed.

Vocal Fremitus Test

• Place palm on various chest areas; patient says "99."
• Normal tactile fremitus noted.

Auscultation

• Use diaphragm of stethoscope on various chest areas.
• Instruct patient to take deep breaths; inform them to alert if dizzy.
• Good air entry to bases bilaterally; no adventitious sounds (crackles/wheezing).

Posterior Thorax Assessment

Inspection and Palpation

• Inspect for signs of labored breathing; patient sitting properly.
• Check for masses:
  • No masses noted.
• Evaluate chest expansion:
  • Symmetrical chest expansion observed.

Vocal Fremitus Test

• Repeat "99" test on back; normal tactile fremitus.

Auscultation

• Landmark identification:
  • Locate C7, then T1 for apex of lungs.
• Instruct patient to take deep breaths during stethoscope movement.
• Good air entry to lungs, bilaterally equal; no adventitious sounds.

Conclusion and Feedback

• Conclude assessment by asking for patient questions.
• Feedback from Professor Anagil:
  • Avoid placing stethoscope on bony or muscular areas for better lung sound accuracy.
• Positive feedback on sequencing and execution.