Question | Answer |
Palpation of the posterior Thorax | Feel for tenderness.Tenderness or pain may indicate inflammation of the tissue, especially over the intercostal spaces due to pleuritis. Muscle pain may indicate increased work of breathing |
Palpation for Crepitus | Crepitus = subcutaneous emphysema, Feels like crackling and results from air or fluid trapped under the skin. Occurs with an open chest injury-think bullet wound, stab wound, chest tube, or tracheostomy
-mark borders and document. |
Plapation for Fremitus | Palpate with ball of hand and follow auscultation sequence. As you palpate, have client say “ninety-nine”
Abnormals= uneven fremitus, indicative of consolidation (mass or pneumonia), pneumothorax
Decreased fremitus= obstruction of tracheobronchial tree |
Posterior Thorax expansion | Place thumbs at T9 have client breath and observe movement of thumbs. Should normally move 5-10 cm symmetrically. Abnormally- unequal movement- could be atelectasis. |
Percussion of posterior Chest | Start at scapula and percuss across top of both shoulders, moving downward to intercostal spaces and to lateral areas of lungs |
Percussion Abnormal: Hyperresonance | Trapped Air- Emphysema, pneumonia |
Percussion Abnormal: Bullness | fluid or solid tissue- pneumonia or tumor |
Auscultation of Posterior Thorax | Listen to bare chest-skin to scope
Use diaphragm
Start at apex C7 and have client breathe through mouth in order to clearly hear inspiration and expiration |
Auscultation Abnormals | Decreased=little or no air movement
Obstruction, secretions, mucus plug, foreign body
Pneumothorax, effusion
Loud sounds=consolidation/tumor, density |
Normal Breath Sounds Bronchial: | Bronchial-high pitch, harsh, hollow, loud, short inspiration, long expiration; over trachea and thorax |
Normal Breath Sounds: Bronchovesicular: | Bronchovesicular-moderate pitch, mixed, moderate sound, inspiration=expiration; heard over major bronchi, posterior between scapulae, anterior around upper sternum at 1-2 intercostal spaces |
Normal Breath Sounds: Vesicular | Vesicular-low pitch, breezy, soft, long inspiration, short expiration; heard at peripheral lung fields |
Abnormal Breath Sounds: Crackles | Crackles-popping sound (think “bubble wrap”)-indicates pneumonia, chf, fluid in lungs, asthma, bronchitis
May be fine or coarse (pulmonary fibrosis) |
Abnormal breath sounds: Pleural Friction Rub | Pleural friction rub-grating, dry, harsh sound-pleuritis-”rubber against rubber |
Abnormal Breath Sounds: Wheeze- sibilant | Wheeze-sibilant=musical, expiration-refers to obstructed or constricted airways-asthma, copd |
Abnormal breath sounds: Wheeze- sonorous- | Wheeze-sonorous-low pitch, expiration or entire respiratory cycle=bronchitis, sleep apnea with snoring |
Abnormal breath sounds: | Stridor-barking, harsh wheeze indicative of bronchospasm/croup |
Voice Sound Auscultation: Bronchophony | Bronchophony-listen with stethoscope to chest as client says “ninety-nine”
Normal is muffled and unclear-cannot understand sound
Abnormal=clearly heard, indicates solid area in lungs or increased density
Tumor, pneumonia, atelectasis |
Voice Sound Auscultation: Egophony | Egophony-Auscultate as client says “E”
Normal=soft, muffled with understandable “E”
Abnormal=sounds like “a” over areas of consolidation |
Voice Sound Auscultation: Whipered Pectroiloquy | Whispered pectoriloquy-Client whispers “1-2-3”
Normal is faint and inaudible
Abnormal=clear sound over areas of consolidation
Sounds as if client is whispering into your stethoscope |
Anterior Thorax abnormal physical findings: Pectus Excavatum | Sunken sternum and cartilage |
Funnel chest | Congenital defect, usually asymptomatic |
Pectus carinatum | Forward protruison of sternum, ribs slope back
restrictive chest motions and decreased lung capacity |
Pigeon chest | restrictive chest motions and decreased lung capacity |