1. Physical Health Assessment
Thorax and Lungs
Lecturer/ Hanaa Eisa

2. Learning out come Identify the anatomic landmarks of the thorax.
Describe the characteristics of the most common respiratory chief complaints.
Perform inspection, palpation, percussion, and auscultation on a healthy adult and on a patient with pulmonary pathology.

3. Learning out come Explain the pathophysiology for abnormal findings.
Document respiratory assessment findings.
Describe the changes that occur in the lungs with the aging process.

4. Anatomy anterior thorax
Sternum
Clavicles
Nipples
Suprasternal notch
Angle of Louis
Costal angle

5. Anatomy of posterior thorax
Vertebra prominence
Spine

6. Anatomy of the lungs Right lung — three lobes Left lung — two lobes
Apex
Base
Mid clavicular line (MCL)
Mid axillary line (MAL)

7. Location of Lobes of Lungs with in The Thoracic Cavity

8. Anatomy of the lungs cont’d
Pleura
Parietal
Visceral
Mediastinum or interpleural space
Bronchi
Right
Left

9. Anatomy of the lungs cont’d
Alveoli
Diaphragm
External intercostals muscles
Accessory muscles

10. Thoracic anatomic topography
Anterior axillary line
Midspinal (vertebral) line
Midsternal line
Posterior axillary line
Scapular line

11. Physiology Ventilation External respiration Internal respiration
Control of breathing

12. Health history Age Patient profile
Children and young adults: cystic fibrosis
Adults and older adults: chronic bronchitis, emphysema, pneumonia, lung cancer
Gender
Race
African ,American

13. Common chief complaints
Dyspnea
Cough
Sputum
Chest pain

14. Characteristics of chief complaint
Quantity
Quality
Associated manifestations
Aggravating factors
Alleviating factors
Timing
Setting

15. Past health history Medical Respiratory specific
Nonrespiratory specific
Surgical
Medications
Communicable diseases
Allergies
Special needs
Childhood illnesses

16. Family health history Allergies? Asthma? Cystic Fibrosis? Emphysema?
Cancer?
Bronchiectasis?
TB?

17. Social history Alcohol, drug, or tobacco use Travel history
Work and home environment
Stress
Economic status

18. Health maintenance activities
Sleep
Diet
Exercise
Use of safety devices
Health check-ups

19. Assessment of the thorax and lungs
Equipment
Stethoscope
Centimeter ruler and measuring tape
Washable marker
Watch with second hand

20. Inspection Shape of thorax
Diameter -Transverse diameter –Anteroposterior Symmetry of chest wall
Presence of superficial veins
Costal angle
Angle of the ribs
Intercostals spaces
Muscles of respiration

21. Respirations Pattern Depth Rate Normal in adult 12 – 20 c/m
Tachypnea > c/m
Bradypnea < c/m
Apnea: no respiration for 10 or more seconds
Pattern
Depth

22. Respirations Patient position Upright Supine Orthopnea
Mode of breathing

23. Sputum
Color
Odor
Amount
Consistency

24. Assessing patients with respiratory assistive devices
Oxygen therapy
Mode of delivery
Percentage of oxygen
Flow rate
Humidification
Pulse oximeter

25. Assessing patients with respiratory assistive devices
Incentive spirometer
Frequency of use; volume achieved; number of repetitions
Endotracheal tube
Size
Nasal or oral insertion

26. Assessing patients with respiratory assistive devices
Length of tube as it exits mouth or nose
Cuff inflated or deflated
Tracheostomy tube
Size
Cuffed or cuff less
How tube is secured to neck

27. Assessing patients with respiratory assistive devices
Mechanical ventilation
Type of ventilator
Mode
Peep
Rate
Tidal volume
Alarms

28. Palpation
Anterior
Posterior
Lateral
Pulsations
Masses

29. Palpation Thoracic tenderness Crepitus Thoracic expansion
Tactile or vocal fremitus

30. Percussion
Anterior
Posterior
Lateral
Diaphragmatic excursion

31. Auscultation fields
Anterior
Posterior
Lateral

32. Auscultation—breath sounds
Pitch
Intensity
Quality
Duration
Location

33. Normal breath sounds
Bronchial
Bronchovesicular
Vesicular

34. Adventitious breath sounds
Crackle or Rate
Fine
Coarse
Wheeze
Sonorous (Rhonchi)
Sibilant
Pleural friction rub Stridor

35. Voice sounds
Bronchophony
Egophony
Whispered pectoriloquy

36. Normal findings AP to transverse diameter is 1:2
Elliptical-shaped thorax
Shoulders and scapula at same height bilaterally

37. Normal findings No masses or superficial veins
Costal angle < 90 degrees during exhalation and at rest
Ribs articulate at a 45-degree angle with the sternum
Absence of intercostals retractions

38. Normal findings No accessory muscle use
Respiratory rate 12–20 breaths per minute
Eupnea
Respiratory pattern is regular .
Respiratory depth is nonexaggerated and effortless

39. Normal findings Symmetrical rise and fall of thorax
Respirations are quiet, unless a few centimeters from patient’s nose or mouth
Able to breath comfortably in supine, prone, or upright position
Usually breathe through nose

40. Normal findings Small amount of sputum may be present
Sputum should be odorless and light yellow to clear in color
No pulsations, masses, thoracic tenderness, crepitus present
Thoracic expansion is 3 to 5 cm
Trachea is midline

41. Normal findings Resonant sound on percussion over lung tissue
Dull sounds over diaphragm and cardiac
Rib sounds are flat
Hyperresonance present if adult is thin

42. Normal findings Diaphragmatic excursion is 3 to 5 cm
Bronchial breath sounds over trachea
Bronchovesicular breath sounds over scapular area
Vesicular breath sounds over peripheral lung

43. Anatomic changes Increased work of breathing
Limited chest wall expansion
Muscle atrophy
Alveolar gas exchange
Decreased surface area for diffusion

44. Age-related changes Regulation of ventilation
Decreased sensitivity to changes in carbon dioxide and oxygen
Lung defense mechanisms
Decreased ciliary action
Diminished cough reflex
Increased susceptibility for infection

45. Thank you