1.

HISTORY TAKING, interviewed

client (ask if the client smoke, had
xray) FACTORS THAT MAY
INFLUENCE THE ASSESS
Jhaz: May I ask sir if you SMOKE or
UNDERGO X-RAY OR CT SCAN?
2. GATHER EQUIPMENT
 STETHOSCOPE, metric RULER,
GLOVES, CLEAN GOWN, and a
MARKER

3. INTODUCE SELF AND

PROCEDURE
Jhaz: Good morning sir I am Jhaztene
Baniqued, your nurse for today and I am
responsible for your care.
: May I know your name sir? How
would you like me to call you?
Jhaz: Okay, so sir I WILL BE
ASSESING YOUR THORAX & LUNGS,
at some point I will be TOUCHING and
PALPATING your chest and at the back
part, and the same time I WILL ALSO
BE LISTENING TO THE SOUND OF
YOUR LUNGS. Is that okay with you
sir?
4. WEAR THE GOWN (SA PATIENT)

GO AT THE BACK OF THE PATIENT

5. INSPECT the SHAPE AND
CONFIGURATION OF SCAPULA (go
to the back)
FINDINGS:
 As I observe, my patient’s SCAPULA
IS SYMMETRIC HIS SHOULDERS
 ARE ALIGN in a HORIZONTAL
POSITION.
 There is NO WINGING or
PROTRUDING SCAPULA.
 The SPINOUS PROCESS IS IN THE
MIDLINE

6. INSPECT for the ANTERO-

POSTERIOR DIAMETER (gitna ng
side body) and LATERAL DIAMETER
( likod or bukot)
--- The RATIO is ONE IS TO TWO:
means the AP DIAMETER is half of the
LATERAL DIAMETER.
FINDINGS: NORMAL
NOTE: If a patient has THE SAME
DIAMETER of these portion, It indicates
that the patient might be SUFFERING
from COPD or ASTHMA

7. CHECK the ALIGNMENT OF SPINE

(OBSERVE) then….
Jhaz: Sir kindly STAND
FINDINGS: As I was looking at my
patient SPINE, it is ALIGNED and NOT
DEVIATED. The shoulders and hips are
also EQUAL HORIZONTALLY
Jhaz: you can now sit sir

8. INSPECT THE USE OF

ACCESSORY MUSCLES
(CHECK how the diaphragm moves)
FINDINGS: As I was observing the
whole time and until now, my patient
breathes normally.

9. INSPECT THE POSITION OF THE

PATIENT (sitting upright with proper
posture)
FINDINGS: My patient can sit in an
UPRIGHT POSITION IN PROPER
POSTURE WITH NO AID.
NOTE: Patient sitting in a TRIPOD
position may have DIFFICULTY IN
BREATHING

WEAR GLOVES…
10. PALPATE for TENDERNESS
AND SENSATION of the THORAX
 Using a PALPATION SEQUENCE, I
will PALPATE THE POSTERIOR
THORAX (LIKOD/BUKOT) ---
pwedeng sabay na kamay
(PAHINGAIN ang patient WHILE
PALPATING)
Jhaz: Sir, I will be PALPATING you
now. Is that okay with you?
(WHILE PALPATING THE BACK,
TINGNAN ANG PATIENT --- COUNT 8)
use both hands side by side
Jhaz: HINGA PO NG MALALIM sir
Jhaz: Do you feel ANY PAIN ma’am
while I’m doing this?
Patient: None
FINDINGS: There is NO UNUSUAL
SENSATION nor TENDERNESS in my
Client. And the TEMPERATURE that I
have assess is EQUAL BILATERALLY

11. PALPATE for CREPITUS by

USING FINGER TIPS (posterior thorax
likod)
(SA PINAGPALPATETAN MO ULIT—
8 counts)
FINDINGS: There is NO CRACKING
SOUNDS

12. PALPATE for surface

characteristics such as LESIONS and
MASSESS using fingers (sa likod
parin) PALPATION SEQUENCE
FINDINGS: While palpating my patient I
DID NOT FEEL ANY LESSIONS OR
MASSES

13. PALPATE for FREMITUS using

ball of hand or the ULNAR EDGE OF
THE HAND (make client say 99)
Jhaz: Sir kindly say 99 as I touch you
(Palpate ulit yung parang sa 8 counts)
FINDINGS:
 The FREMITUS is SYMMETRIC
 I have felt VIBRATIONS in my hand
and they are EQUAL BILATERALLY

14. ASSESS CHEST EXPANSION by

placing my hands on the POSTERIOR
CHEST wall with my THUMBS at the
level of T9 or T10, and I will observe
for the movements of the thumbs as
the client takes a deep breath.

--- I’ll start in the end of the scapula—

where the T7 is located (then count 8-
10)
(Place the hand in a BUTTERFLY
POSITION on the T10)

Jhaz: Sir I want you to take a deep

breath and then exhale po

AGAIN SIR… inhale, exhale

FINDINGS: As the patient inhale there

is separation of my thumbs
symmetrically, so it is a normal finding
15. PERCUSS the
DIAPHRAGMATIC EXCURSION IN
T7
Jhaz: I’ll be assessing your
DIAPHRAGMATIC EXCURSION,
meaning I’ll be assessing the
EXPANSION of your Lungs
(SA T7 SCAPULA PABBA KA LANG
TAS MARKER)
Jhaz: Sir kindly take a deep breath
INHALE and HOLD IT and then
RELEASE hold and then INHALE and
HOLD IT AGAIN.
-PERCUSS at the end of scapulae
(tap left finger using right finger)
inhale, exhale, hold till its dull sound
-get a marker, mark the dull part and
use paper and then inhale then percuss
-MEASURE the mark (should be around
5-10 cm)
• PERCUSS start from the below of
clavicle (remove gloves)
FINDINGS: The sound is resonant
• AUSCULTATE for breath sounds
(normal, brochial, bronchovesicular and
vesicular)
-use diagphragm of steto then put it in
c7 (basta sa likod) as client is asked to
inhale and exhale
Jhaz: Sir kindly inhale and exhale
•auscultate for adventitous sounds
(crackles, wheezing sound)
•auscultate voice sounds
bronchophony (99) egophony (E) then
ask for whispered (123)

ANTERIOR
•INSPECT the shape and configuration of
anteroposterior diamater to transverse
(symmetry, alignment of shoulder,
transverse diameter is 1:2)
FINDINGS: The ANTERO-POSTERIOR
DIAMETER is symmetric and the
TRANSVERSE DIAMETE RATIO IS 1:2
•INSPECT position of sternum (gitna) in
anterior and lateral(remove clothes) look
for sternal retractions
FINDINGS: The STRENUM is in the MIDLINE
•INSPECT for slopes of the ribs anterior and
lateral viewpoints (downward and
symmetric)
FINDINGS: The slopes of the RIBS in
ANTERIOR and LATERAL viewpoint is
DOWNWARD & SYMMETRIC

•INSPECT for quality and pattern of

respiration (rhythm, rate, depth)
FINDINGS: The RHYTHM is regular as
well as the rate and the depth is not
deep nor shallow, so it is NORMAL
•INSPECT for intercostal spaces (space sa
ribs)
FINDINGS: The intercostal spaces are
distinguishable and it is symmetric
•INSPECT for the use of accessory muscle
(should be effortless, non-labored
breathing)
FINDINGS: As I have observed my patient’s
breathing she does not use his accessory
muscle. He breaths effortless, relaxed, and
non-labored.
•PALPATE for tenderness and sensation
(start at the clavicle, down the clavicle, side,
under boob)
WEAR GLOVES
FINDINGS: There’s no presence of lesions
or masses
•PALPATE crepitus (start with clavicle again)
(should have no popping sound)—use
fingers
FINDINGS: There is no popping sound
•PALPATE surface characteristics for masses
and lesions
FINDINGS: While palpating my patient I
DID NOT FEEL ANY LESSIONS OR
MASSES
•PALPATE for fremitus (use ball of hand)
(99) (should feel vibrations)
FINDINGS:
 The FREMITUS is SYMMETRIC
 I have felt VIBRATIONS in my hand
and they are EQUAL BILATERALLY

•Palpate for chest expansion (put both
hands on sternum) (ask client to inhale and
exhale)(check if your thumb moves
outwards if client inhales) (check both
hands if it moves)--- BUTTERFLY HAND
FINDINGS: As the patient inhale there is
separation of my thumbs symmetrically,
so it is a normal finding

•Percuss for tone above clavicle and below

clavicle then the intercostal space
FINDINGS: The tone is resonant
In the breast part the tone becomes
dull because breast tissues are
present

•Auscultate for breath and adventitious

sounds and voice sounds (same sequence
auscultate) then auscultate ribs (abnormal if
there is crackels)
-- use diaphragm of the stethoscope and
ask the client is asked to inhale and
exhale (warm)
Jhaz: Sir kindly inhale and exhale
FINDINGS: there’s no crackles or
wheezing sound