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Questions and Answers
What is the normal time for full expiration during pulmonary function measurement?
What is the normal range for SpO2 measurement?
What is the primary objective of assessing heart and neck vessels?
What does it mean when a node is enlarged, tender, or fixed in area?
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How should a woman be prepared for a chest examination?
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Why is it important to measure the calf circumference?
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Where should the assessment of the chest begin?
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What is the purpose of palpating for temperature and tenderness?
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What is an important consideration during the examination?
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Why is it important to measure the other leg in exactly the same place?
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What is the purpose of depressing the skin over the tibia or medial malleolus?
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How is pitting edema graded?
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Why is it important to ask the person to stand up?
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What is the purpose of the manual compression test?
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What is the primary objective of the chest and lung examination?
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How should a woman be prepared for the examination?
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What is the correct ratio of anteroposterior (AP) to transverse diameter in adults?
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What is the first step in the examination process?
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What is the purpose of inspecting the posterior chest?
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What is the purpose of noting the position of the person's arms during the assessment?
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What equipment is needed to perform the examination?
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What should be the color of the person's skin?
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What is the purpose of palpating the posterior chest?
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Why should the patient sit upright during the examination?
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What should be done with the woman's gown when examining the anterior chest?
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What is the correct way to assess symmetric expansion of the chest?
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What is tactile fremitus used to assess?
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What should you avoid when percussing the lung fields?
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What is the characteristic of resonance in the lung fields?
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What is the purpose of asking the person to repeat the words 'ninety-nine' or 'blue moon' during the assessment?
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Why is it important to maintain a room temperature of around 22°C (72°F) during the examination?
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What is the purpose of lifting both of the person's hands in your hands during the examination?
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What is the normal time for color to return to the nail beds after depression and blanching?
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What is the purpose of inspecting the skin for turgor during the examination?
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What equipment is used to measure the circumference of the legs during the examination?
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Why is it important to evaluate the leg veins with the person standing?
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Study Notes
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
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Description
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.
