RESPIRATORY

VISUAL INSPECTION
OF POSTERIOR CHEST
INSPECTION

Listen to patient's breathing pattern

Observe pattern of expiration and patient

position

Asses patient's color

Observe for chest symmetry and configuration

 DEFORMITIES

Thoracic Scoliosis Kyphosis

Spine becomes rotated Excessive curve of the
and curved sideways. This spine results in an
curve bends to the right abnormal rounding of the
side of the upper back upper back. The reverse
(thoracic region). C-shaped curve of the
chest (thoracic spine).
 DEFORMITIES

Scapular Winging Thoracoplasty

A rare debilitating Surgical procedure that
condition that leads to allows the reduction of the
limited functional activity thoracic cavity by
of the upper extremity. removing the ribs.
PALPATION
Palpation

Identify tender areas

Assess any visible abnormalities in
the body of the patient
Examination of the Posterior
Chest Wall
Test Chest Exapansion
Place your thumbs at about the level of
the 10th ribs, with your fingers loosely
grasping and parallel to the lateral rib
cage
Ask the patient to inhale deeply
Observe the distance between your
thumbs as they move apart during
inspiration
Feel for the range and symmetry of the
rib cage as it expands and contracts
Examination of the Posterior
Chest Wall
Test Chest Exapansion
Normal chest wall expands symmetrically
during inhalation
Bilateral decrease or delay in chest
expansion means that both lungs are
affected by a certain disease
Unilateral decrease or delay in chest
expansion indicates one lung is affected
Examination of the Posterior
Chest Wall
Feel for tactile fremitus
Fremitus refers to the palpable vibrations
transmitted through the
bronchopulmonary tree to the chest wall
as the patient is speaking
a clinical sign commonly assessed as
part of a routine physical examination of
the lungs
Examination of the Posterior
Chest Wall
Feel for tactile fremitus
To assess tactile fremitus, use either the
ball or the ulnar surface of your hand to
optimize the vibratory sensitivity of the
bones in your hand
Ask the patient to repeat the words
“ninety-nine” or “one-one one.”
Examination of the Posterior
Chest Wall
Feel for tactile fremitus
Palpate and compare symmetric areas of
the lungs in the pattern shown in the
photograph
Identify and locate any areas of
increased, decreased, or absent fremitus
Examination of the Posterior
Chest Wall
Increase or absent tactile fremitus
chest is impeded by a thick chest wall
an obstructed bronchus
COPD
pleural changes from effusion or an
infiltrating tumor

Asymmetrical tactile fremitus

considered to be an unusual finding and
may reflect the presence of an underlying
lung condition
 Four Potential Uses:
PALPATION
OF 1. Identification of tender areas.
2. Assessment of observed abnormalities.
ANTERIOR CHEST WALL 3. Further assessment of chest expansion.
4. Assessment of tactile fremitus.
 PALPATION
OF
ANTERIOR CHEST WALL

1. Identification of tender
areas.
 PALPATION
OF
ANTERIOR CHEST WALL

2. Assessment of observed
abnormalities
 PALPATION
OF
ANTERIOR CHEST WALL

3. Further assessment of
Chest expansion
Place your thumbs along each
costal margin, your hands along the
lateral rib cage.
As you position your hands, slide
them medially a bit to raise loose
skin folds between your thumbs.
 PALPATION
OF
ANTERIOR CHEST WALL

4. Assessment of Tactile
fremitus
Compare both sides of the chest,
using the ball or ulnar surface of
your hand.
Fremitus is usually decreased or
absent over the precordium.
Percussion

percussion

Percussion is one of the most

important techniques of physical
examination.

Percussion helps you establish whether

the underlying tissues are air-filled, fluid-
filled, or solid.
technique of
percussion
Hyperextend the middle finger of your left hand,

known as the pleximeter finger.

Position your right forearm quite close to the surface, with

the hand cocked upward.
 technique of
percussion
With a quick, sharp but relaxed wrist motion, strike the
pleximeter finger with the right middle finger, or plexor

finger.

Strike using the tip of the plexor finger, not the finger pad.
technique of
percussion

Withdraw your striking finger quickly to avoid damping

the vibrations you have created.
percussion notes
PERCUSSION
OF THE
POSTERIOR
CHEST WALL

PERCUSSION
OF THE
POSTERIOR
CHEST WALL

PERCUSSION
OF THE
ANTERIOR
CHEST WALL
PERCUSSION
OF THE
ANTERIOR
CHEST WALL
PERCUSSION
OF THE
ANTERIOR
CHEST WALL
PERCUSSION
OF THE
ANTERIOR
CHEST WALL
Auscultation

 Eartips
Eartube
Tubing

Stem

Diagphragm
Bell
DETECT, DIAGNOSE AND TREAT VARIOUS MEDICAL CONDITIONS.
 AUSCULTATION

(1) LISTENING TO THE SOUNDS GENERATED BY

BREATHING,
(2) LISTENING FOR ANY ADVENTITIOUS (ADDED)
SOUNDS
(3) IF ABNORMALITIES ARE SUSPECTED,
LISTENING TO THE SOUNDS OF THE PATIENT’S
SPOKEN OR WHISPERED VOICE AS THEY ARE
TRANSMITTED THROUGH THE CHEST WALL.
 VESICULAR
most normal ausculted breath sounds
soft. low pitched.
heard through inspiration (all through out)

VESICULAR
Inspiration Expiration
BROCHIOVESICULAR
intermediate
I =
E
detecting differences in pitch and intensity is easier
during expiration (upper third of the chest)

BRONCHIOVESICULAR
BRONCHIAL
hollow and tubular
louder, harsher and higher in pitch.
I ----- EE

BRONCHIAL
 ADVENTITOUS SOUNDS

ADVENTITIOUS (ADDED) SOUNDS. LISTEN FOR ANY ADDED, OR

ADVENTITIOUS,
SOUNDS THAT ARE SUPERIMPOSED ON THE USUAL BREATH SOUNDS.
DETECTION OF
ADVENTITIOUS SOUNDS—CRACKLES (SOMETIMES CALLED RALES),
WHEEZES, AND RHONCHI—IS AN IMPORTANT PART OF YOUR
EXAMINATION, OFTEN LEADING TO DIAGNOSIS OF
CARDIAC AND PULMONARY CONDITIONS.

●SUMMARIZED
LOUDNESS, PITCH, AND DURATION,
AS FINE OR COARSE CRACKLES
●● NUMBER, FEW TO MANY.
TIMING IN THE RESPIRATORY CYCLE
●● LOCATION ON THE CHEST WALL
PERSISTENCE OF THEIR PATTERN FROM
BREATH TO BREATH
●IN ANY CHANGE AFTER A COUGH OR CHANGE
THE PATIENT’S POSITION
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