Welcome to the lung and thorax examination video. Hi, my name is Deidre. I'll be your nurse practitioner today.
Is it okay to do your exam? Yes. Thank you. Always remember, wash your hands. As with every examination, remember that we begin with inspection.
We've talked about this a lot. So as we're paying particular attention to the lung and thorax today, my inspection, I'm going to begin with inspection, is going to begin with just taking a good look at my patient. I'm looking for any signs of use of accessory muscles, any retractions, any other signs of distress such as nasal flaring, any circumoral cyanosis, any audible wheezing that would indicate that my patient is having respiratory distress and as you can see he does have a cough today.
You'll start by auscultating the upper anterior chest To perform this exam, you will alternate left to right, examining two areas on each side, the apices and the upper anterior chest. So one thing I want you to know... When you're getting ready, as you prepare to auscultate the anterior chest, if you find the clavicles on your patient, the lungs actually, the ABCs actually go just barely above, so a lot of times.
Sometimes we want to come lower than that, but just remember that the limbs actually go a little bit higher. So as I prepare to do this, and I'm looking at my stethoscope, I'm going to make sure that the ears of my stethoscope are facing my eyes and I have the bell of my stethoscope ready to go. Diaphragm. Excuse me.
And when you're auscultating lung sounds, you're going to ask the patient to breathe in through their mouth and you want to wait for full inhalation and exhalation. exhalation and one area counts as this is one the left and the right so could you inhale through your mouth please Do not rush the patient to breathe too quickly. This is a common mistake. Don't move the stethoscope to the next location before the patient has completed exhalation.
Always use the diaphragm of the stethoscope for lung auscultation. It is not true that applying greater pressure while using the bell of the stethoscope allows it to function as the diaphragm. Always use the diaphragm.
Deeper breathing with the mouth open improves the quality of auscultated sounds. Next you'll move to the back of the patient to inspect the posterior chest. So since we have this patient exposed and this should also be done on the anterior chest too, this is a very good time to be inspecting the skin for abnormal nevus. or skin cancer or potentially rashes.
The first exam on the posterior lung and thorax will be checking chest expansion bilaterally. You'll place your palms against the patient's back, fingers spread apart, thumbs just touching. You'll ask the patient to take a deep breath, keeping your fingertips fixed, but allowing your thumbs to move apart. Take a deep breath please.
There is a thorough explanation of this exam on page 319 of your book. So the purpose of this exam is you're observing to see that both of your hands are moving symmetrically and coming together. and back at the same time together.
If you potentially had a space occupying lesion or pneumo or flat lung, you would notice that one hand could potentially not rise and the other hand rise. So you're looking for a space occupying lesion. symmetry on the rise and the fall of your thumbs.
Remember, with the lung and thorax examination, always do this directly on the patient's skin, not through the exam gown or clothing. The next exam will be to percuss the posterior lungs and thorax. There is a thorough explanation of the percussive notes you may hear during this exam on page 322 of your book. You expect to hear resonance in healthy lung tissue. Dullness indicates fluid, solid tissue, pneumonia, or pleural effusion.
Generalized hyperresonance could indicate COPD or asthma if bilateral, or a large pneumothorax or an air-filled bulla if unilateral. Ask the patient to cross their arms in the front of their body for percussion. Could you cross your arms please? Thank you.
Give yourself a hug. There you go. You'll use correct percussive techniques percussing at least 3 to 4 areas on each side again alternating left to right.
One. Two, three, four. An expert examiner can use a finger percussion technique, but feel free to use a reflex hammer in your own practice.
Next, you're going to auscultate the posterior lungs and thorax. Again, examine both sides, alternating left to right, examining at least four areas on each side. The patient does not need to cross their arms for auscultation.
Asking the patient to breathe. Osculate both posterior upper lung fields above the scapula, right and left posterior, superior, middle, and inferior lung fields. Lastly, you will auscultate the lateral lung fields. Examine both sides, two areas on each side.
So, in review of your checklist, a couple things that I want to point out is to make sure that you don't rush the patient, that you have full inhalation and exhalation before you remove your stethoscope to the next area to be auscultated. Remember on the anterior chest, you want to listen to two areas. On the laterals, you want to listen to two areas.
And on the posterior chest, you want to auscultate four areas. In addition to that, you want to percuss four areas.