Physical Health Assessment
Thorax and Lungs
Lecturer/ Hanaa Eisa
1) Identify the anatomic landmarks of the thorax.
2) Describe the characteristics of the most common respiratory chief complaints.
3) Perform inspection, palpation, percussion, and
auscultation on a healthy adult and on a
patient with pulmonary pathology.
Learning out come
4) Explain the pathophysiology for abnormal findings.
5) Document respiratory assessment findings.
6) Describe the changes that occur in the lungs with the aging process.
Learning out come
Anatomyanterior thorax
Sternum Clavicles Nipples Suprasternal notch Angle of Louis Costal angle
Anatomy of posterior thorax
1. Vertebra prominence
2. Spine
Anatomy of the lungs
1. Right lung — three lobes
2. Left lung — two lobes
3. Apex
4. Base
5. Mid clavicular line (MCL)
6. Mid axillary line (MAL)
Location of Lobes of Lungs with in
The Thoracic Cavity
Pleurao Parietalo Visceral
Mediastinum or interpleural space
Bronchio Righto Left
Anatomy of the lungs cont’d
Alveoli Diaphragm External intercostals muscles Accessory muscles
Anatomy of the lungs cont’d
Thoracic anatomic topography
1. Anterior axillary line
2. Midspinal (vertebral) line
3. Midsternal line
4. Posterior axillary line
5. Scapular line
Physiology
1. Ventilation
2. External respiration
3. Internal respiration
4. Control of breathing
Health history
Patient profileAge• Children and young adults: cystic fibrosis• Adults and older adults: chronic bronchitis,
emphysema, pneumonia, lung cancero Gendero Race• African ,American
Common chief complaints
1. Dyspnea
2. Cough
3. Sputum
4. Chest pain
Characteristics of chief complaint
1. Quantity
2. Quality
3. Associated manifestations
4. Aggravating factors
5. Alleviating factors
6. Timing
7. Setting
Past health history• Medical
o Respiratory specifico Nonrespiratory specific
• Surgical• Medications• Communicable diseases• Allergies• Special needs• Childhood illnesses
Family health history
o Allergies?o Asthma?o Cystic Fibrosis?o Emphysema?o Cancer?o Bronchiectasis?o TB?
Social history
o Alcohol, drug, or tobacco useo Travel historyo Work and home environmento Stresso Economic status
Health maintenance activities
Sleep Diet Exercise Use of safety devices Health check-ups
Assessment of the thorax and lungs
Equipment• Stethoscope• Centimeter ruler and measuring tape• Washable marker• Watch with second hand
Inspection
Shape of thorax
1. Diameter -Transverse diameter –Anteroposterior Symmetry of chest wall
2. Presence of superficial veins
3. Costal angle
4. Angle of the ribs
5. Intercostals spaces
6. Muscles of respiration
Respirations
1. Rateo Normal in adult 12 – 20 c/mo Tachypnea > 20 c/mo Bradypnea < 12 c/mo Apnea: no respiration for 10 or more
seconds
2. Pattern
3. Depth
o Patient position• Upright• Supine• Orthopnea
o Mode of breathing
Respirations
Sputum
o Coloro Odoro Amounto Consistency
Assessing patients with respiratory assistive devices
Oxygen therapyo Mode of deliveryo Percentage of oxygeno Flow rateo Humidification
Pulse oximeter
Incentive spirometero Frequency of use; volume achieved;
number of repetitions
Endotracheal tubeo Sizeo Nasal or oral insertion
Assessing patients with respiratory assistive devices
o Length of tube as it exits mouth or noseo Cuff inflated or deflated
Tracheostomy tubeo Sizeo Cuffed or cuff lesso How tube is secured to neck
Assessing patients with respiratory assistive devices
Mechanical ventilationo Type of ventilatoro Modeo Peepo Rateo Tidal volumeo Alarms
Assessing patients with respiratory assistive devices
Palpation
o Anterioro Posterioro Lateralo Pulsationso Masses
o Thoracic tendernesso Crepituso Thoracic expansiono Tactile or vocal fremitus
Palpation
Percussion
o Anterioro Posterioro Lateralo Diaphragmatic excursion
Auscultation fields
o Anterioro Posterioro Lateral
Auscultation—breath sounds
o Pitcho Intensityo Qualityo Durationo Location
Normal breath sounds
o Bronchialo Bronchovesicularo Vesicular
Adventitious breath sounds
Crackle or Rateo Fineo Coarse
Wheezeo Sonorous (Rhonchi)o Sibilant
Pleural friction rub Stridor
Voice sounds
Bronchophony Egophony Whispered pectoriloquy
Normal findings
o AP to transverse diameter is 1:2o Elliptical-shaped thoraxo Shoulders and scapula at same height bilaterally
o No masses or superficial veinso Costal angle < 90 degrees during exhalation and
at resto Ribs articulate at a 45-degree angle with the
sternumo Absence of intercostals retractions
Normal findings
o No accessory muscle useo Respiratory rate 12–20 breaths per minuteo Eupneao Respiratory pattern is regular .o Respiratory depth is nonexaggerated and
effortless
Normal findings
o Symmetrical rise and fall of thoraxo Respirations are quiet, unless a few
centimeters from patient’s nose or moutho Able to breath comfortably in supine, prone,
or upright positiono Usually breathe through nose
Normal findings
Normal findings
o Small amount of sputum may be presento Sputum should be odorless and light
yellow to clear in coloro No pulsations, masses, thoracic
tenderness, crepitus presento Thoracic expansion is 3 to 5 cmo Trachea is midline
o Resonant sound on percussion over lung tissue
o Dull sounds over diaphragm and cardiac o Rib sounds are flato Hyperresonance present if adult is thin
Normal findings
o Diaphragmatic excursion is 3 to 5 cmo Bronchial breath sounds over tracheao Bronchovesicular breath sounds over
scapular areao Vesicular breath sounds over peripheral lung
Normal findings
o Increased work of breathingo Limited chest wall expansiono Muscle atrophy
Alveolar gas exchangeo Decreased surface area for diffusion
Anatomic changes
Regulation of ventilationo Decreased sensitivity to changes in carbon
dioxide and oxygen
Lung defense mechanismso Decreased ciliary actiono Diminished cough reflexo Increased susceptibility for infection
Age-related changes
Thank you