Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

PART 2- RLE 2F: Thoracic and Lung Assessment

(Script)

Materials:
- Stethoscope
- Laboratory / Smock Gown (if available)
- Data Recording Sheet
- Ball pen
- Ruler
- Appropriate clothes (for the client)



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 Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

Introduction:
- Good Day, My name is _______ BSN1_ and I will be performing Thoracic and Lung
Assessment. This is my client on which I will be performing this assessment on.
- Maam/Sir can you kindly state your name, age, and relationship to me.
- *Wait for patient’s response*
- Okay Thank you Maam/Sir
- This assessment is done by inspecting, palpating, percussing, and auscultating the client’s
thoracic and lungs.
- The importance of assessing the thorax and lungs is to detect any abnormalities, breathing
difficulties, systemic problems, as well as identifying normal and common abnormal breath
sounds.
- Maam/Sir during this assessment I will be touching your skin. Is this ok with you?
- *Wait for patient’s response*
- Thank you Sir for your consent Maam/Sir
- I will now enumerate the need materials for the procedure: You will need a Stethoscope, a
Laboratory / Smock Gown (if available), Data Recording Sheet, Ball pen, Ruler and
Appropriate clothes (for the client) such as a gown if available.
- I will now place the materials down
- Maam/Sir may place my materials at the bed side table?
- Okay, thank you

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 Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

Inspection:
NURSE: I will now proceed with the assessment Maam/Sir. We will start first with the
inspection of your posterior thorax and lungs
1. Inspect the posterior thorax and lungs
• Inspect for a normal breathing pattern, the position, and how the client is sitting
2. Assess the appearance, symmetry, and body positioning.
• Look for symmetry of the rib cage and breathing pattern
3. After assessment, kindly inform your client about the result.
NURSE: So Maam/Sir everything looks normal or there is an abnormality that I have
observed… Let us proceed to palpation.

Palpation:
1. Inform again the client that you’ll be touching him/her. Ask permission.
• NURSE: Maam/Sir for this part on I will be touching your body is that okay?
• *Wait for patient’s response*
• NURSE: Okay thank you
2. Palpate for any presence of masses over the landmarks of the thorax and lungs. After,
inform the client of the result.
• Place palms on the posterior thorax and lungs
• Assess for some abnormals at the top the lobes then try to feel for some crepitus
over the lung fields. (Sounds like a popping sound)

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 Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

3. Palpate for tactile fremitus. Place the sole of the palm over the intercostal spaces. Instruct
client to say “ninety-nine.” Inform the client of the result.
• NURSE: Maam/Sir kindly say “ninety-nine” as I place my palms on your back
- Feel for vibrations as you move your hands systematically down the lungs
• NURSE: Maam/Sir everything looks and feels fine or there is an abnormality that
I have observed… Let us proceed to percussion.

Percussion:
1. Percuss the lung fields through the intercostal spaces. Inform the client of the findings.
• Use the two finger method in a systematic format percussing all the lobes
• Listen for resonance is a low pitch hollow sound that is heard over the lung fields
2. Assess for diaphragmatic excursion. Instruct client to exhale and hold his/her breath.
Percuss over the lung fields. Stop at the point where dull sound can be assessed and mark
it with a pen. Do not forget to instruct your client to stop holding his/her breath.
• NURSE: Kindly exhale for me and hold your breath
• Percuss starting from the top of the thorax down until you hear a dull sound.
• Once you find the dull sound mark it with the pen
3. Next, instruct the client to inhale and hold his/her breath. From the site marked, continue
percussing until a dull sound can be assessed. Mark the second site. Do not forget to
instruct your client to stop holding his/her breath.
• NURSE: Kindly inhale for me and hold your breath
• Continue percussing down until you hear/feel the dull again. Then mark it with
the pen

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 Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

4. Using a ruler, measure the diaphragmatic excursion from the first marking down to the
second marking.
• Use the ruler to measure the two marks and that will be the diaphragmatic
excursion
• Normal diaphragmatic excursion is three to five centimeters.
• A healthy person may be seven to eight centimeters.
5. Inform the client about the findings.
• NURSE: Maam/Sir everything looks and sounds normal or there is an
abnormality that I have observed… Let us proceed to auscultation

Auscultation:
1. Take out your stethoscope. Use the diaphragm of the stethoscope.
2. Auscultate and assess for sounds over the lung fields.
- *DONE TOGETHER WITH STEP 3*
3. Instruct client to perform one ventilation cycle as you assess for the sound. Move to the
next lung field after one cycle.
- *DONE TOGETHER WITH STEP 2*
• NURSE: Maam/Sir can you kindly take a deep breath in and out
• Push the stethoscope hard up into the skin to leave an imprint that way you
know you're actually listening
• Start from the top lobes and move systematically down and listen for nice
clear sound and hollow pitch
• Adventitious sounds:
• Crackling - sounds like bubbling and that could be related to consolidation
or pneumonia

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 Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

• Wheezing - note if it is on inspiration or expiration, it is common in

people with asthma, COPD, emphysema
4. Next, perform the bronchophony test. Instruct client to say “ninety-nine” as you
auscultate over the lung fields.
• NURSE: Maam/Sir kindly say “ninety-nine” or “blue moon” as I place my
stethoscope on your back
• It should be muffled not clear. If it is clear that could mean that there's a
consolidation or fluid
5. Next, perform the egophony test. Instruct client to say “E” as you auscultate over the
lungs fields.
• NURSE: Maam/Sir kindly say “E” as I place my stethoscope on your back
• It should be muffled . If it comes out as A it could mean things like pneumonia
and pleural effusion
6. Document findings and inform the client.
• NURSE: Maam/Sir everything sounds normal there is no blockage or fluid in the
lungs or there is an abnormality that I have observed…

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 Cebu Doctors’ University

College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclama on, 6014 Mandaue City, Cebu,
Philippines
Tel. No. +63 (32) 238-8333 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudotorsuniversity.edu

Conclusion:
- Okay Maam/Sir we are done with your thoracic and lung assessment. I will quickly
look over my findings jot them down on your chart and I will get back to you with my
findings.
- *Look over/jot down and create a summary of the findings: what are the normal and
abnormal findings. Then prepare your health teachings to the client in order for them to
normalize or to manage those abnormal findings*
- Okay Maam/Sir (Explain Findings)
- That will be it for today Maam/Sir. Thank you very much for your cooperation. Again
my name is _________ if ever you need something just request for me. Thank you
again and have a blessed day!

*** Last step, give your health teaching to your viewers. Any health teaching would do in
relation to the procedure.

*PLEASE NOTE THAT THERE MAY BE SOME PARTS THAT MAY HAVE BEEN LEFT
OUT. KINDLY REWATCH THE PROVIDED VIDEO GIVEN BY SIR LEPITEN ON CELO.”

Prepared by:

Joshua Nuique
Undergraduate Student | BSN1F
College of Nursing
Cebu Doctors' University






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