Physical examination thorax and lungs

nursing health assessment

1. physical examination

2. THE THORAX AND LUNGS

3. Chest landmarks

4. Location of the anterior and posterior ribs

5. Chest shape and size In adults thorax is oval Its Anterioposterior diameter is half its transverse diameter. The overall shape of thorax is elliptical.

6. Assessment includes Posterior thorax Anterior thorax Thorax and lungs Techniques Inspection Palpation Percussion Auscultation Equipments Stethoscope Skin marker /pencil Centimeter ruler

7. Posterior thorax Inspect shape and symmetry Inspect spinal alignment for deformities

8. Deformities of chest

9. Posterior thorax Palpate the posterior thorax Palpate the posterior chest for respiratory excursion (thoracic expansion) Palpate the chest for vocal (tactile )fremitus , the faintly perceptible vibration felt through the chest wall when the client speaks

10. Posterior thorax Chest expansion Tactile fremitus

11. Percuss the thorax Percuss for diaphragmatic excursion ( movement of the diaphragm during maximal inspiration and expiration ) Posterior thorax

12. Posterior thorax Diaphragmatic excursion

13. Posterior thorax Auscultate the chest using the flat disc diaphragm of the stethoscope

14. Anterior thorax Inspect breathing patterns Insect the costal angle ( angle formed by the intersection of the costal margins <90 degree ) and the angle at which the ribs enter the spine ( appx; 45 degree angle )

15. Palpate the anterior chest Palpate the anterior chest for respiratory excursion Palpate the tactile fremitus Anterior thorax

16. Percuss the anterior chest systematically Anterior thorax

17. Auscultate the trachea Auscultate the anterior thorax Anterior thorax

18. Normal Breath sounds

19. Adventitious breath sounds

20. Adventitious breath sounds

21. THE CARDIOVASCULAR AND PERIPHERAL VASCULAR SYSTEMS

22. HEART Techniques Inspection Palpation Auscultation Equipments , Stethoscope Centimeter ruler Assessment includes, Heart Central vessels Peripheral vascular system

23. Heart

24. HEART Anatomic sites of the precordium

25. HEART Simultaneously inspect and palpate the precordium for the presence of abnormal pulsations, lifts, or heaves .

26. Auscultate the heart in all four anatomic sites HEART

27. Normal heart sounds

28. Normal heart sound

29. CENTRAL VESSELS

30. CAROTID ARTERIES Palpate the carotid artery, using extreme caution Auscultate the carotid artery

31. JUGULAR VEINS Inspect the jugular vein for distension If jugular distension is present , assess the jugular venous pressure

32. Peripheral pulses Peripheral veins Peripheral perfusion Buerger’s test (arterial adequacy test): Buerger's test is used to assess the adequacy of the arterial supply to the leg. Capillary refill test PERIPHERAL VASCULAR SYSTEM

33. BREAST AND AXILLAE

34. BREAST AND AXILLAE Inspect the breasts for size symmetry and contour or shape Inspect the skin of the breast Inspect the areola Inspect the nipple Palpate the Axillary ,subclavicular , supraclavicular lymph nodes. Palpate the breast for masses , tenderness and any discharges from the nipples

35. THANK YOU