Chest and Abdomen Assessment: Thorax and Lungs

Module 6: Chest to Abdomen Assessment

• This section focuses on the external chest and respiratory components within the thoracic cavity for assessing the lower respiratory system.

Thorax and Lungs: Structures and Functions

• The thorax is the body portion between the neck's base superiorly, down to the diaphragm inferiorly.
• The lower respiratory system, specifically the lungs, the trachea, and the bronchi, are present inside the ribcage.
• The thoracic cage is the outer structure of the thorax.
• Thoracic cavity - The thoracic cavity contains respiratory components.

Imaginary Landmarks - Anterior Vertical Lines

• Midsternal line - The midline of the sternum.
• Right and Left midclavicular lines - Lines running down from the midpoint of each clavicle.

Imaginary Landmarks - Posterior Vertical Lines

• Left and Right scapular lines - Lines extend down from the tips of the scapula when arms are at their side.
• Vertebral line - Line runs along the spinous processes of the vertebrae.

Imaginary Landmarks - Lateral Vertical Lines

• Anterior Axilliary line - Runs down vertically from the anterior axilla (armpit).
• Midaxillary line - Runs down vertically from the middle of the axilla.
• Posterior axillary line - Runs down vertically from the posterior axilla.

Major Structures of the Respiratory System

• The major components include the frontal and sphenoidal sinuses, nasal and oral cavities, pharynx (naso-, oro-, and laryngeal), larynx, epiglottis, trachea, lungs, and mediastinum.
• Alveoli are located in the lungs, and are where gas exchange occurs.
• The right lung has three lobes while the left has two.

Assessment of the Posterior Thorax Configuration

• Client should sit with arms at sides while you stand behind, to observe scapulae and chest wall shape.
• Symmetric scapulae that are non-protruding along with horizontal positions of both shoulders and scapulae are considered normal
• Ratio of anteroposterior to transverse diameter is 1:2.
• Deviating spinous processes may indicate scoliosis.
• Horizontal ribs at an angle greater than 45 degrees to the spine may indicate barrel chest, often seen in emphysema.

Assessment of the Use of Accessory Muscles to Breath

• Watch client breathe, noting muscle use
• Normally, the client doesn't use accessory shoulder/neck muscles to breathe and the expansion of the lower chest indicates the diaphragm major activity.
• Client leaning forward and using arms to support weight and lift chest may indicate COPD called tripoding

Assessment of Client Positioning

• Observe the client's posture and ability to support their weight while breathing comfortably
• Client sitting upright and relaxed & breathing easily with arms at sides/lap is normal; Tendor or painful areas may indicate inflamed fibrous connective tissue; Rib pain, especially at junctions may indicate fractures.

Palpating for Tenderness and Sensation

• One or both hands can be used for palpation, but the sequence must be consistent, using fingers to feel for tenderness, temperature, pain, or sensations.
• Start at the level of the left scapula midline, move left to right for comparing findings bilaterally, and move systematically to cover lung’s lateral portions.
• Clients reporting no tenderness, pain, or unusual sensations with equal temperatures is considered normal.
• Muscle soreness from breathing exertion or increased warmth may be palpated as tenderness or a local infection.

Palpate for Crepitus

• Crepitus, or subcutaneous emphysema, feels like crackling when air passes through fluid/exudate.
• Use your fingers and use the established sequence when palpating for crepitus.
• It is normal to have no crepitus.
• Crepitus palpated if air escapes from lung or airways like open thoracic injury, around chest tube, or tracheostomy; Mark margins and monitor any decrease/increase

Palpate Surface Characteristics

• Wear gloves and use your fingers to palpate any surface lesions.
• Feel for any unusual masses.
• Normal characteristics find both skin and subcutaneous tissue are free of lesions and masses.
• Unusual palpable mass should be evaluated by a professional.

Palpate for Fremitus

• Fremitus from vibrations of air in bronchial tubes transmitted to the chest wall.
• Follow the established palpation sequence using palm or ulnar edge of hand; As you move, ask client to say "ninety-nine," assessing for the intensity and symmetry of vibrations.
• Fremitus is normally symmetric and easily identified mostly in the upper lungs.
• Diminished fremitus suggest obstruction or air trapping; those with a loud voice may mean tracheobronchial tree obstruction.

Assess Chest Excursion

• Place hands on posterior chest with thumbs at T9 or T10 and small skin fold between; Observe movement of thumbs as client deep breaths. Norm: Thumbs should move apart 5-10 cm symmetrically
• Unequal chest expansion can happen from severe atelectasis (collapsed/incomplete expansion, pneumonia, chest trauma, or pneumothorax.

Percuss Tone

• Start at scapulae apices and percuss across the tops of both shoulders then the intercostal spaces across and down comparing sides to lateral lung bases by contrasting sides
• Resonance normal tone over the tissue over the lungs but flatness should be above the scapula.
• Hypersonance is hyperinflated like emphysema or pheumothorax.

Percuss for Diaphragmatic Excursion

• Diaphragmatic excursion: Assessed by asking the client to exhale forcefully and hold their breath; Begin to percuss at scapular line downwards right posterior ribcase, and intercoastal until resonance to dullness.
• Next ask client to inhale deeply repeat marks and mesure, then preform both sides.
• Normal excursion ranges from 3-5 cm in adults with evenness bilaterally.
• Dullness signals solid tissue occupying pleural space like pneumonia or tumors Diaphragmatic movement is limited with atelectasis
• Diaphragmatic remains low, low inspiration, and expiration.

Asucultate for Breath Sounds

• Place the warm diaphragm of the stethoscope firmly to avoid breathing interferences, on side
• Ask client to breathe deeply thru the mouth. Alert for clients comfort as you alternate positions There is three types of breath sounds are bronchial, bronchovesicular, vesicular over normal. Diminished or absent breath can indicate no air area , Emphysema is hyper inflated, Lungs elasticity loss -result diminished.

Assess Three Types of Breath Sounds

• Bronchial - high pitch, harsh/hollow quality, amplitude- loud, short inspiration, & long during expiration heard and location over the trachea and thorax.
• Bronchovesicular - moderate pitch and amplitude mixed wuality w/same duration insp & expiration heard around the upper sternum one and 2 nd areas
• Vesicular - low pitch Breezy sound with location at lungs pereriphary with amp soft and long inspiration
• Sounds that can be heart adveious like super imposin

Auscultate for Discontinous Sounds

• Discontinous sounds which the crackles are high-pitched, short and non clear are are not cleared with coughing Inhaled air suddenly small or deflected the airways coated stick with exudate restictive disessea like Heart failure/
• Crackles may indicate pneumia, congested failure early inspiration /associoted obstruve e.g, bronkitis.

Wheezes

• High pitched musical sound like wheezing or tumoring /
• Air passes through the restricted passages Sonorous: low which like bronchitis is or like sleep apnea like Snorning /
• Croup / Honking /
• Pleural friction rub like scratching or in pleuits like coughs/
• Superficial only/

Ausculate Voice Sounds

• Bronchophany -The client repeated ninety nine while you ascultate the cheat walls for understanding
• Ephony- Ascultaed E - repeat ascultate it - clear indication of sounds that heard
• Compression
• Whipser Pectoriloquy - one two three - Clear indication that ascultted

Thoracic Deformaties and Configurations

• Normal chest configuration
• Barrel chest- Emphysema /
• Perctus escantum - Fannell
• Perctus Carinatum -Pigeon chest * Scoilios- Uneven side -
• Watch fore Strenanal Retraction
• Normally - Not Observed
• Abornal -
• Stern - not noted seveiy labored breathing spect slope or ribs

Assess Slope of Ribs

• Normal : Ribas slope down with symmetric, and not 90 degree
• Barrel Chese Configuration Reust in 90 degree high ribs

Observe Quality / Pattern of Breathing

• Normal - 12 respiratations relaxed/ Effort with normal dept - Tachypnea & Bradypnea Breathg sounds
• Discription- Normal Beathing - Description : 12 / 20 breath -More than (Taky) 24 shallow / more than (Brady)- 10 breaht- Kussmaul- High - rapid labor - Hyperventilation - Diabetic Ketoacidois // Apnea Bito - Irregular / Damage /

Inspect intercostal space

Check Client Breate intercostal spaces - Normal intercostal should be no butging or retrtaction

Observe accessory use

• Normal Use Assessory like Rectals and Sterniod -
• Abornoml - Muscle use, Faciltate inspirations

Pulpat Tender /Sensation

• Fingertips P / and sensation -
• Abnormal Muscler S - May from Breathing / may warm -local infection

Palpate Cutinous

The sensation with fingered sequence may not exist in tissue

• Normal - no cutinous

Palpate Fremitis

• Vibration of air - bronchial walls tranamit in Chst W.

Breast & Lymphatic Structure and Function

• Breasts are paired mammary glands over muscles of the anterior wall to 2 and 6 rib in the second one is for noarshment Males is similary
• The breast is located into four quatrants

Palpate Aorla Area

• Ask chent lie down- support with your hand
• Feel it

Inspect Size &Symetity and the Skin

• Clients must do the robs . /
• Abnormal if Brest one-recent
• with arms hanging , during assess symet /

Inspects Venious

• Normal. -Vein that will indicate over increaes

Innpect Areious

• The cilor

IInpect nipple

• Note the size and D of both the chest and Dry or dischas

Inspect retraction and diampling ,

1-

• Arms up -2 over head

Ask client leans forward - -

• Support large or Pendulos ones

MALE BREASTS

• Assessment can be done - for any S or Mass. In those area. Look no swllimg like gymencomata
• A smooth frm mobile is pubity and temper

Assessment for neck Vessels

• jugular one inspect both sides
• Distended sign may indicated central, in a stroke

Heart and Neack vessels.

Structures and functins

• Cardivascualr is complex that accurate data is done Jug Venous Pres
• 30, 4% , and

Asculature for heart

• Assess the mid and cluiculare note carioated during stoke. S1 lub/ d
• Assess the apical - Impulsee

Assucltate S1 and S2

• Ascultate sound . with sound
• Hear areo - check what are
• Murmers are rare to be heart-

Palpate for vessels

• Hear where sounds be

Ascultate /

• Murmer over those area . which are bad-

Assess Skin colorations

• Check in abdomen with that area- -
• Purple or discoloation check - With abornial swelling - with

Assess contour

• Assesses size an contour A, B, C
• with mass, is that one

Aborenalities on Note

D/ B/ A/ C

ABODMINAL

-Distention

• Assess those like and -Palpating

Assess

Inspection and Pulption

Asses all the Qutrents Like Ascitis or the hernia

Perform test appendix

• Test for Pain. Where , The Right
• Assess - The Test Like Pso, Obturator , or other signs. In any area and follow guidelines. Follow this guide with those instructions.

An overview of the external chest, respiratory components, and thoracic cavity for assessing the lower respiratory system. Key structures include the lungs, trachea, bronchi, and ribcage. Important imaginary landmarks such as the midsternal, midclavicular, scapular, and vertebral lines are defined.