THORAX ASSESSMENT

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THORAX ASSESSMENT
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Basic Anatomy and Physiology of the Thorax Systems
UNDERSTAND
DESCRIBE
Proper Assessment Techniques
DEMONSTRATE
Findings
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• LANDMARKS
• Suprasternal notch
• Midsternal line
• Midclavicular lines
• Axillary lines
• Spine

EXTERNAL STRUCTURES

• STRUCTURES
• Skin and Hair Growth
• Breasts nipples, areolas, breast tissue,
• Thoracic cage

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INTERNAL STRUCTURES
SKELETAL sternum, 12 pairs of ribs, intercostal
spaces, vertebrae, clavicles, scapulae. PLEURA
the lungs PLEURAL MEMBRANE linings of the
interior thorax and the lungs. PLEURAL SPACE
potential space between pleural
linings. MEDIASTINUM heart, large blood vessels,
lower trachea, esophagus. DIAPHRAGM
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ASSESSMENTS

• INSPECT PALPATE (Sitting and Supine Position
• Symmetry, color
• Skin color, temperature, texture, turgor,
  moisture, irregularities, lesions, marks
• Contour (spinal curvatures)
• Movements posture
• Breasts placement, symmetry, irregularities,
• Respiratory efforts

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ABNORMAL FINDINGS

• Spinal curvatures
• Lordosis
• Scoliosis
• Kyphosis
• Kyphoscoliosis
• Fail chest
• Pain, tenderness, lumps or nodules
• Cyanosis
• Differences in strength and coordination
• Note any excessive or unusual body odor

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SPINAL CURVATURES
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ABNORMAL FINDINGS

• Pallor, redness, jaundice, bruising or
  pigmentation changes is moles or lesions
• Rashes, edema, lesions, exudate from nipples
• Depression or protrusion of sternum
• Pain, tenderness, lumps or nodules
• Clubbing of fingers
• Asymmetry of chest cavity
• Retractions
• Barrel Chest
• Cyanosis

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CLUBBING OF FINGERS
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FUNCTIONS OF THE THORAX

• SUPPORT AND PROTECT THE LUNGS
• PROTECT THE MEDIALSTINAL PROCESS

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FUNCTIONS OF THE THORAX

• ASSISTS RESPIRTATIONS
• Inspiration and expiration
• Gas exchange through ventilation pulmonary
  perfusion and diffusion
• (at the aveolar/capillary membrane)

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RESPIRATORY ASSESSMENT

• BREATHING METHODS
• Thoracic common, abdominal normal,
• ABNORMAL pursed lip, use of accessory neck
  muscles
• PERCUSSION Over intercostal spaces
• Resonance is normal
• Hyperresonance is usual in children or thin
  adult.
• Dullness over organs

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RESPIRATORY ASSESSMENT

• AUSCULTATION
• Techniques
• Assess breath sounds and detect airflow
• Use diaphragm of stethoscope (bell for infants)
• Patient breath through mouth
• Listen full inhalation/exhalation each spot
• Move side to side, top bottom, front-side-back

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Breath Lung Sound Links
Breath Sounds http//www.med.ucla.edu/wilkes/lung
intro.htm
Rubs, Gallops, and Continuous Murmurs
http//www.med.ucla.edu/wilkes/Rubintro.htm
Diastolic Murmurs http//www.med.ucla.edu/wilkes/D
iastolic.htm
Systolic Murmurs - Aortic Stenosis
http//www.med.ucla.edu/wilkes/Systolic.htm
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ABNORMAL RESPIRATORY
EFFORTS
HYPERPNEA TACHYPNEA BRADYPNEA HYPERVENTILLATION CH
EYNE-STOKES APNEA KUSSMAULS
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DIAGNOSTIC EXAMS
ABG ARTERIAL BLOOD GAS
XRAY
PFT
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AND PHYSIOLOGY
THE ANATOMY
OF THE CIRCULATORY SYSTEM

• HEART (Base at T2 Apex in midclavicular line at
  5th intercostal)
• 4 Chambers (atria, ventricles, major vessels)
• Pericardium (sac)
• Valves (heart and veins)
• CONDUCTION SYSTEM
• Sinoatrial (SA node-pacemaker), Atrioventricular
  (AV node)

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FUNCTIONS OF THE HEART
Cardiac cycle BLOOD FLOW SYSTOLE
contraction DIALSTOLE relaxation
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Blood flows through the left atrium into
the left ventricle.       The left ventricle
pumps the oxygen-rich blood to all parts of the
body.
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BLOOD
FLOW
Pulmonary Artery
Aorta
Superior Vena Cava
Left Atria
Pulmonary Vein
Right Atria
Left Ventricle
Right Ventricle
Inferior Vena Cava
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THE VASCULAR SYSTEM
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ARTERIES carry blood away from the heart.
VEINS returns blood to the heart.
CAPILLARIES gas and nutrient exchange.
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INSPECT
AUSCULTATE
PALPATE
INSPECTION Appearance Vital Signs Deformities
(Clubbing) Color (pallor, cyanosis)
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INSPECT
AUSCULTATE
PALPATE

• AUSCULTATE
• (Over Heart and Pulse Points)
• Lub-dub S1 S2
• S1- systole (Ventricles contract, valves open,
  ventricle empties)
• S2- Diastole (Ventricles relax, valves close,
  ventricles fill)
• Additional sounds (S3, S4, Murmurs, Clicks,
  Swishing

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INSPECT
AUSCULTATE
PALPATE

• PALPATION
• Location
• Duration and presence of any pulsations.
• PERCUSSION
• Estimate cardiac size

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ABNORMAL FINDINGS
IRREGULAR RHYTHMS TACHYCARDIA BRADYCARDIA EXTRA
NOISES OVER HEART BRUITS DURING PREGNANCY BP
elevation gt30SBP AND 15DBP
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palpate points

• PULSES Compare pulse points side to side for
  equality in strength, note rate, regularity of
  rhythm (can auscultate with stethoscope or
  doppler)
• Checked with head to toe assessment.

• Compare side to side for equality in strength.
• Note rate, regularity of rhythm.
• Can auscultate with stethescope or doppler.

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pulse points
TEMPORAL Lateral to eye orbit, anterior to
ear. BRACHIAL Anterior surface of
elbow. POSTERIOR TIBIAL Behind slightly below
malleolus of ankle.
CAROTID Medial to trachea, and below jaw.
Palpate one at a time.
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pulse points
DORSALIS PEDIS Medial dorsum of foot with toes
pointed down. FEMORAL Groin just below midpoint
of inguinal ligament. POPITEAL Fossa behind
knee (flexed).
RADIAL Below thumb, palm surface of wrist.
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NORMAL VITAL SIGN PERAMETERS
IN ADULTS AND PEDS
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Blood Pressure Classification in Adults Category
VITAL SIGNS PARAMETERS ADULT
TPR Temp (po) 98.6-99.5º F Pulse
60-100bpm Respiration 12-20/min
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PEDIATRIC NORMAL VITAL SIGN RANGES