Chest and Lung Examination Lab

Chest and Lung Examination

• Determine normal chest and lung examination
• Determine abnormal chest and lung examination
• Determine other systematic diseases based on assessment of chest and lung examination
• Demonstrate organized approach in examining the chest
• Demonstrate approach reflecting safety, infection control, and patient dignity

Preparation

• Ask the person to sit upright
• Ask a man to disrobe to the waist, and a woman to leave the gown on and open at the back
• Equipment needed: Stethoscope, alcohol wipe, and Pulse Oximeter

Inspection

• Inspect the posterior chest: thoracic cage
  • Note the shape and configuration of the chest wall
  • The spinous processes should appear in a straight line
  • The thorax is symmetric
• Inspect the anterior chest
  • Lift up the gown and drape it on her shoulders rather than removing it completely

Palpation

• Palpate the posterior chest
  • Symmetric expansion: place warmed hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10
  • Palpate for tenderness, skin temperature and moisture, superficial lumps or masses, and skin lesions
• Palpate using the fingers, gently palpate the entire chest wall
• Tactile fremitus: use either the palmar base or the ulnar edge of one hand and touch the person's chest
  • Ask the person to repeat the words “ninety-nine” or “blue moon”
  • Start over the lung apices and palpate from one side to the other, avoiding the scapulae

Percussion

• Percuss the posterior chest
  • Determine the predominant note over the lung fields
  • Start at the apices and percuss the band of normally resonant tissue across the tops of both shoulders
  • Percuss in the interspaces, making a side-to-side comparison all the way down the lung region
  • Avoid damping resonance and the effect of the scapulae and ribs

Additional Assessments

• Measure the calf circumference with a non-stretchable tape measure
  • To identify any edema or atrophy
• Palpate for temperature, tenderness
• Palpate peripheral arteries in both legs
• Depress the skin over the tibia or the medial malleolus to detect edema
• Ask the person to stand up to assess the venous system
  • Note any visible, dilated, and tortuous veins
• Perform a manual compression test

Pulmonary Function Status

• Measure pulmonary function status
  • Ask the person to inhale as deeply as possible and then blow all out hard, as quickly as possible
  • Listen with a stethoscope over the sternum
  • Normal time for full expiration is 4 seconds or less
• Use Pulse Oximeter to assess arterial oxygen saturation (SpO2)
  • Normally SpO2 is 97% to 99%

Heart and Neck Vessel Examination

Preparation

• Ask the person to sit upright
• Ask a man to disrobe to the waist, and a woman to leave the gown on and open at the back
• Environmental preparations:
  • Room temperature should be about 22° C (72° F) and draft less to prevent vasodilation or vasoconstriction
• Equipment:
  • Marking pen
  • Paper tape measure
  • Stethoscope with diaphragm and bell end pieces
  • Doppler ultrasonic probe

Inspection and Palpation

• Inspect and palpate the arms
  • Lift both person hands in your hands
  • Inspect the palms of hands for size and shape
  • Turn hands and inspect, then inspect for skin color, nail beds, texture, turgor of skin presence of lesion, edema, clubbing, profile sign

This lab teaches students to examine chests and lungs, identifying normal and abnormal conditions, as well as systematic diseases. Students will learn a safe and dignified approach to examination.