Chest/Pulmonary Exam

1
Chest/Pulmonary Exam

• Inspection, palpation (including tactile
  fremitus), percussion, auscultation of the
  posterior, lateral, and anterior chest.
• Examination of the anterior chest may be
  conducted with the patient supine or sitting
• Examination of the lateral chest may be
  incorporated into examination of the anterior
  and/or posterior chest

2
Anterior Chest
Anterior Chest (lying or sitting or at 30 0) 73.
Inspection For symmetry, fully exposed (in
female patient may cover with gown as in photo)

3
Anterior Chest
74,75. Palpation For tactile fremitus Palpation
Alternates from side to side or may use both
hands simultaneously
4
Anterior Chest Percussion 76-78
Percussion Must be done Bilaterally Symmetrica
lly Good tone Must alternate from side to side

5
Anterior Chest Auscultation

• (Starting above clavicles, 3-4 places, listens
  throughout inspiration and expiration)

• Patient instructed slow, deep breath, mouth open
• Auscultation Alternates from side to side
• Auscultation At least 3-4 areas auscultated on
  each side

6
Posterior Chest
84. Inspection For symmetry
7
Posterior Chest Palpation
A.
B.
A. Place hands on the patients
posterior/lateral chest Apply moderate
pressure-- Move hands up and towards the midline
creating a dimple in the skin between the
thumbs.-
B.Ask the patient to take a deep breath Feel and
visualize the chest expanding Your thumbs will
move apart and the dimple in the skin will go
away
Arrows denote direction of hand movement
8
Posterior chest Palpation

• 86-87Tactile Fremitus
• Start above the scapula
• Use the ulnar aspects of the hands
• May use one hand and alternate from side to side
  or may use both hands moving inferiorly
• Ask the pt to say 99 and feel the vibrations

9
Posterior Chest--Percussion

88-91 Percussion includes percussion,
diaphragmatic excursion, and percussion over the
costovertebral angle

• Percussion--(At level of the diaphragm)
• This is done during normal (tidal) breathing
• Start above the scapula
• Alternate from side to side
• Continue inferiorly until dullness of percussion
  occurs

10
Posterior Chest-Percussion
Percussion 88-91 Diaphragmatic movement

• Once the level of the diaphragm has
• been detected during tidal respiration
• ask the patient to take a deep breath and hold it
• This will move the diaphragm more inferiorly

Begin to percuss moving more inferiorly until
dullness is encountered again

• Begin to percuss moving more inferiorly until
  dullness is encountered again

Repeat this process for the other side
11
Anterior Percussion over costovertebral angle

• Place the ball of one hand firmly over the
  patients costovertebral angle.
• Use the ulnar side of your other hand to strike
  the hand you have placed on the patient.
• Use enough force to cause a perceptible but
  painless jar or thud
• Repeat on the opposite side

12
Posterior Chest Auscultation 92-96

• Patient needs to be in the correct position with
  arms folded and hands on opposite shoulders
• Use the diaphragm of the stethoscope
• Start above the scapula
• Ask the patient to take deep breaths with his/her
  mouth open
• Listen to complete inspiration and expiration
• Move from side to side working your way
  inferiorly
• Listen to at least 3-4 places