Lung and Thorax Examination

Introduction

• Presenter: Deidre, Nurse Practitioner
• Purpose: Demonstration of lung and thorax examination
• Pre-requisite: Wash hands before starting

Initial Inspection

• Focus on:
  • Use of accessory muscles
  • Retractions
  • Nasal flaring
  • Circumoral cyanosis
  • Audible wheezing
  • Presence of cough

Auscultation of Anterior Chest

• Procedure:
  • Alternate between left and right sides
  • Examine two areas: the apices and the upper anterior chest
  • Note: Lungs extend slightly above the clavicles
• Stethoscope Preparation:
  • Ensure earpieces face towards eyes
  • Use the diaphragm for auscultation
• Patient Instructions:
  • Breathe deeply through the mouth
  • Complete full inhalation and exhalation before moving stethoscope
  • Avoid rushing the patient

Inspection of Posterior Chest

• Focus on:
  • Skin abnormalities such as nevus, skin cancer, or rashes

Chest Expansion Examination

• Technique:
  • Place palms against the patient’s back, fingers spread, thumbs touching
  • Ask the patient to take a deep breath
  • Observe for symmetrical movement of hands
• Purpose:
  • Check for space-occupying lesions or symmetry issues

Percussion of Posterior Lungs and Thorax

• Instruction:
  • Follow explanation in the book (page 322)
• Expected Findings:
  • Resonance in healthy lung tissue
  • Dullness indicates potential issues (fluid, pneumonia, pleural effusion)
  • Hyperresonance could indicate COPD, asthma, pneumothorax, or air-filled bulla
• Patient Position:
  • Arms crossed in front
• Technique:
  • Percuss at least 3-4 areas on each side
  • Alternate left to right
  • Use finger percussion or reflex hammer

Auscultation of Posterior Lungs and Thorax

• Areas to Examine:
  • Above the scapula
  • Right and left posterior, superior, middle, and inferior lung fields
• Instruction:
  • Alternate sides
  • No arm crossing needed for auscultation

Auscultation of Lateral Lung Fields

• Procedure:
  • Examine two areas on each side

Review and Reminders

• Checklist:
  • Do not rush the patient
  • Ensure full inhalation and exhalation before moving the stethoscope
  • Anterior chest: listen to two areas
  • Lateral chest: listen to two areas
  • Posterior chest: auscultate and percuss four areas

This guide serves as a comprehensive overview of the proper procedure and techniques for a lung and thorax examination.