[Music] in this video we are going to look at assessment of the thorax and lungs so really we're looking at things that are related to the respiratory system now it's important to note here that when you're assessing the lungs you have to assess them front and back so we're going to show you both the anterior assessment and the posterior assessment and we'll speed it up just a little bit for time's sake so starting with the anterior thorax you want to start with inspection in order to do that you have to move the patient's gowns so make sure that you're protecting their dignity and their privacy at all times start by just watching the patient breathe normally for a few breaths you want to make sure there's no signs of distress that their chest is expanding equally and make note of the general rate and rhythm of their breasts are they rapid shallow deep you also want to look at the shape and symmetry of the thorax the diameter from front to back or the ap diameter should be about half the length of the diameter from left to right if they're closer to being equal that's called a barrel chest we see that a lot in copd and you of course want to look at the skin color and condition on the chest making note of any redness lesions or cyanosis if they have any lines or chest tubes you would assess those at this point as well now you want to palpate over the chest to feel for any crepitus or crackling under the skin this could indicate subcutaneous air sometimes sometimes caused by trauma to the lungs now you can percuss use two fingers from each hand and tap in the intercostal spaces from the apex down moving from left to right you should hear resonance any dullness could indicate fluid in the lungs or you could be over the heart liver or a bone now we can move on to auscultation make sure you listen with a naked ear first to make sure you don't hear any audible wheezes cough or strider then you will use your stethoscope to listen into 10 or 12 places on the front you'll start at the apex and work your way down moving left to right to compare the two sides usually i'll ask the patient to take a deep breath in and out every time they feel my stethoscope move that keeps me from having to say take a deep breath take a deep breath over and over and over again make sure that you also listen in the mid axillary regions so that you can hear uh the middle lobe on the right side especially now that we've finished the anterior we want to move on to posterior now the easiest way to do this is just to have their patients sit up for efficiency's sake you can go ahead and auscultate the posterior while you still have your stethoscope in place you'll use the same technique as the anterior avoiding the shoulder blades and working your way down side to side you should hear bronchial then bronchovascicular then vesicular sounds make sure you make note of any adventitious sounds like crackles or wheezes check out the lung sounds lesson in the respiratory course to learn more about that now we can circle back to inspection we're looking for the same things we did on the anterior symmetry skin color and expansion when we palpate the posterior we're going to feel for crepitus just like on the front but there's a couple other things we feel for as well the first is expansion you want to place your hands on the lower rib cage with your thumbs touching and ask the patient to take a deep breath you should see your thumbs move away and back equally then we're going to check for what's called tactile fremitus it's a vibration in the chest when the patient talks use the palms of your hands to feel in four or five places from the apex downward on both sides while the patient says the word 99. again i usually just tell them to repeat the words whenever they feel my hands move the vibration should be equal on both sides and any decrease could mean there's some fluid consolidation and finally you're going to percuss the posterior thorax in the same way as the anterior listening for resonance and making sure that you avoid the scapula remember that any adventitious sounds could mean that the client is having difficulty breathing or oxygenating so make sure you intervene appropriately and notify the provider if necessary as always check out all of the resources that are attached to this lesson now go out and be your best selves today and as always happy nursing thanks for watching another nursing.com lesson click the link below in the description to watch thousands more lessons over on nursing.com also be sure to hit the subscribe and the little bell to make sure you're reminded when new lessons come out and if you want to just keep watching more lessons go ahead and click this video over here to continue learning like we always say here at nursing.com happy nursing