Auscultation of the Posterior Chest

Study Notes

Assessment of the Respiratory System

To assess the respiratory system, the person should be seated, leaning forward slightly, with arms resting comfortably across the lap.
The person should breathe through the mouth, a little deeper than usual, but stop if they begin to feel dizzy.
The examiner should monitor the breathing throughout the examination and offer times for the person to rest and breathe normally.
The flat diaphragm endpiece of the stethoscope should be cleaned and held firmly on the person's chest wall.
The examiner should listen to the following lung areas:
- Posteriorly from the apices at C7 to the bases (around T10)
- Laterally from the axilla down to the 7th or 8th rib
The examiner should note the normal location of the three types of breath sounds:
- Bronchial (tracheal)
- Bronchovesicular
- Vesicular
The vesicular sound should be heard normally.

Assessment of the Anterior Chest

The examiner should inspect the chest wall, noting:
- Shape and configuration
- Symmetric interspaces
- Costal angle (should be within 90 degrees)
The examiner should assess the person's facial expression, looking for:
- Relaxed appearance
- Effortless breathing
The examiner should assess the level of consciousness, noting if the person is:
- Alert and conscious
The examiner should assess the skin color and condition, looking for:
- No cyanosis or unusual pallor
- Normal lip and nail bed color
The examiner should explore any skin lesions and assess the quality of respirations, noting:
- Normal, relaxed breathing
- Effortless, regular, and not noisy breathing

Assessment of the Peripheral and Lymphatic System

The examiner should measure the calf circumference with a non-stretchable tape measure to identify any edema or atrophy.
The examiner should measure at the widest point and record the findings in centimeters for comparison.
The examiner should palpate for temperature, tenderness, and edema in the legs.
The examiner should palpate the peripheral arteries in both legs, including the femoral, popliteal, dorsalis pedis, and posterior tibialis.
The examiner should depress the skin over the tibia or medial malleolus for 5 seconds and release to detect edema.
The examiner should grade pitting edema if present, using a scale of 1+ to 4+.
The examiner should ask the person to stand up to assess the venous system, noting:
- Any visible, dilated, and tortuous veins
- Varicosities in the saphenous veins
The examiner should perform a manual compression test to identify the beginning and end of the varicose vein.

Pulmonary Function Status

The examiner should ask the person to inhale as deeply as possible and then blow out hard and quickly with the mouth open.
The examiner should listen with a stethoscope over the sternum to assess the pulmonary function.
The normal time for full expiration is 4 seconds or less.

Pulse Oximeter

The examiner should use a pulse oximeter to assess arterial oxygen saturation (SpO2).
The normal range for SpO2 is 97% to 99%.

Heart and Neck Vessel

The examiner should inspect and palpate the carotid artery, noting:
- Contour (should be smooth)
- Amplitude (should be 2+)
- Symmetry (should be equal on both sides)
The examiner should auscultate the carotid artery, noting:
- Any bruits or abnormal sounds
- The character of the bruit (e.g., high-pitched, blowing, or swooshing)
The examiner should inspect the jugular vein, noting:
- Any visible pulsation
- The external jugular vein overlying the sternomastoid muscle
- The internal jugular vein in the area of the supra-sternal notch or around the origin of the sternomastoid muscle
The examiner should inspect the precordium, noting:
- The apical impulse (should be visible at the 4th or 5th intercostal space)
- The location, size, amplitude, and duration of the apical impulse

Learning Objectives

At the end of this lab, the students will be able to:
- Determine normal findings of the heart and neck vessels
- Identify abnormal findings of the heart and neck vessels
- Demonstrate an organized approach in examining the heart and neck vessels
- Consider safety, infection control, and patient dignity during the examination
- Establish a nursing diagnosis related to abnormal findings of the heart and neck vessels

Description

Auscultation is a medical technique used to examine the sounds of the lungs. This quiz assesses your understanding of the procedure to auscultate the posterior chest, including the correct positioning and breathing techniques.