Auscultation of the Posterior Chest

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