Manuel S.

Enverga University Foundation

Granted Autonomous Status
CHED CEB Res. 076-2009

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

ASSESSMENT OF THE RESPIRATORY SYSTEM

C.I. Dario V. Sumande PhD, RN
INSPECTION (Anterior Thorax)
1. Position the client
➢ The client should be in setting position with clothing remove except
for an examination gown and drape
2. Instruct the client
➢ Explain that you are going to be looking at the client’s chest
structures. Instruct the client to breath normally.
3. Observe skin color
➢ Skin color varies among individuals. Pink undertones indicate normal
oxygenation
4. Inspect the structure of the thorax
➢ The clavicle should be at the same height. The sternum should be at
the midline.
5. Inspect for symmetry
➢ The structure of the chest and its movement should be symmetrical
6. Inspect chest configuration
➢ The adult transverse diameter should be is approximately twice that
of the antero-posterior diameter.
7. Count the respiratory rate
➢ Normal should be between 12-20
➢ Observe for chest movement
➢ Respiration should be even and smooth
➢ Male adult tends to breath abdominally
➢ Female adult breath more costally

INSPECTION (Posterior Thorax)

1. Instruct the client

➢ Explain to the client that you will be performing several examinations
and tell the client to relax and breath normally.
2. Observe skin color
➢ Skin color of the posterior thorax should be consistent with the rest of
the body
3. Inspect the structures of the posterior thorax
 ➢ The height of the scapula should be even. The vertebrae should be at
the midline.
4. Inspect for symmetry
➢ The structure of the chest and chest movement should be
symmetrical
5. Observe respirations
➢ Respiration should be smooth and even

PALPATION (Posterior Thorax)

1. Instruct the client

➢ Explain that you will be touching the patient’s back to determine if
there are areas of tenderness
2. Lightly palpate the posterior thorax.
➢ Use finger pads to lightly palpate the posterior thorax
➢ Assess for muscle mass
➢ Assess for growth of nodules and masses. Assess for tenderness
➢ The area should be non-tender on palpation

Pattern of Palpation
 3. Palpate and count ribs and intercostal spaces.
➢ Tell the client you will be applying light pressure to the spine and rib
areas. Instruct the client to breath normally and tell you I pain or
discomfort is felt.
4. Palpate for respiratory expansion
➢ Explain the you will be assessing chest movement during breathing.
To do this: place the palmar surface of your hands with thumbs close
to the vertebrae at the level of T10. Pick up some skin between your
thumbs and ask the client to take a deep breath. (Note: the movement
and pressure of the chest against your hand should feel smooth and
even. Your thumbs should move away from the spine and the skin
should move smoothly during inspiration.)

PALPATION FOR RESPIRATORY EXPANSION

5. Palpate for tactile fremitus

➢ It is the palpable vibration on the chest wall when the client speaks
➢ Fremitus is strongest over the trachea, diminish over the bronchi, and
almost non-existent over the alveoli and the lungs.
PERCUSSION (Posterior Thorax).

1. Visualize the landmarks

➢ Observe the posterior thorax and visualize the horizontal and vertical
lines, the level of the diaphragm, and the fissures of the lungs
2. Recall the expected findings
 ➢ The usual sound in the thorax is resonance, a long, low pitch hollow
sound.
3. Instruct the client
➢ Explain to the client that you will be tapping on the chest in a variety
of areas.
➢ Ask the client to breath normally through this examination. Ask the
client to lean forward and round the shoulders.
4. Percuss the lungs.
➢ Percussion will yield dull sounds over solidified or fluid filled areas.
Percussion over bone will yield flat sounds.
➢ Follow this pattern for percussion

PATTERN FOR PERCUSSION OF POSTERIOR THORAX

AUSCULTATION (Posterior Thorax)

1. Instruct the client

➢ Explain that you will be listening to the clients breathing with the
stethoscope. Ask the client to breath deeply through the mouth each
time the stethoscope is place on a new spot.
2. Visualize the landmarks
 ➢ Landmarks are the same with percussion of the posterior thorax

AUSCULTATION PATTERN FOR POSTERIOR THORAX

3. Auscultate for tracheal sounds

➢ Superior to C7 at the vertebral line
4. Auscultate for bronchial sounds
➢ Start at the vertebral line at C7 and move the stethoscope downward
towards T3. The breath sounds will be bronchial.
5. Auscultate for bronchovesicular sounds.
➢ The right and left pulmonary bronchi are located at the level of T3 and
T5. The breath sounds will be bronchovesicular.
 6. Auscultate for vesicular sounds
➢ Auscultate the lungs following the same pattern for percussion. Move
the stethoscope from side to side while comparing the sounds. Start
at the apex and move to the base of the lungs.

PALPATION (Anterior Thorax)

1. Position the client

➢ Usually the client is in supine position for palpation, percussion and
auscultation of the anterior thorax.
➢ Sitting or Fowler’s position ay be use if the patient is experiencing
dyspnea.
2. Instruct the client
➢ Tell the client breath normally and to tell you if pain or discomfort is
felt at any area.
3. Palpate the sternum, ribs, and intercostal spaces
➢ The sternum should be flat, except for the ridge of the sternal angle
and should taper to the xiphoid process. The ribs should fell smooth
and the spacing of ribs and intercostals should be symmetrical.
4. Lightly palpate the anterior thorax
➢ Use the finger pads during palpation. Start at the area above each
clavicle and move from side to side to below the coastal angle and
laterally to the mid-axillary line.
➢ Assess for muscle mass, nodules and tenderness
➢ The chest should be free of lesions or masses. The area should be
non-tender during palpation
 PALPATION PATTERN FOR ANTERIOR THORAX

5. Palpate for respiratory expansion

➢ Explain the you will be assessing chest movement during breathing.
To do this: place the palmar surface of your hands with thumbs close
to the vertebrae at the level of T10. Pick up some skin between your
thumbs and ask the client to take a deep breath. (Note: the movement
and pressure of the chest against your hand should feel smooth and
even. Your thumbs should move away from the spine and the skin
should move smoothly during inspiration.
 PALPATION FOR RESPIRATORY EXPANSION (ANTERIOR VIEW)

6. Palpate for tactile fremitus

➢ Use the ulnar or palmar surface of the hand when palpating for
fremitus. It usually diminishes as you move from large to small
airways and is decreased or absent over the precordium.
 PALPATION PATTERN FOR TACTILE FREMITUS

PERCUSSION (Anterior Thorax)

1. Visualize the landmark

➢ Observe the anterior thorax, and visualize the horizontal and vertical
lines, the level of the diaphragm and the lobes of the lungs.
2. Recall the expected findings
➢ Percussion allows assessment of the underlying structures. The usual
sound in the thorax is resonance
3. Instruct the client
➢ Explain that you will be tapping on the client’s chest in a variety of
areas. Tell the client to breath normally throughout this examination.
4. Percuss the lungs
➢ Begin at the apex of the lungs. Percuss to the bases and laterally to
the mid-axillary line. Follow this pattern
 PERCUSSION PATTERN ANTERIOR THORAX

AUSCULTATION (Anterior Thorax)

1. Instruct the client

➢ Explain that you will be listening to the client’s breathing with the use
of stethoscope. Ask the client to breath deeply through the mouth
each time the stethoscope is place on the chest. Ask the client to let
you know if becoming short of breath.
2. Auscultate the trachea
➢ Follow this pattern
 AUSCULTATORY SOUNDS (ANTERIOR THORAX)

3. Auscultate the apices

➢ Place the stethoscope in the triangular areas just superior to each
clavicle. You will hear the vesicular sounds.
4. Auscultate the bronchi
➢ The bronchi are auscultated at the 2nd and 3rd intercostal spaces at
the left and right sternal border. You will hear bronchovesicular
sounds.
5. Auscultate the lungs following the pattern for percussion. You will hear
vesicular sounds.
6. Evaluate the findings

NORMAL FINDINGS
ADVENTITIOUS SOUNDS