Name of the Student MAICS ZACHARY.

Section BSN1-A16 Score _______ Name of Clinical Instructor Anne Carmel Sotto Bulawan

ASSESSING THE THORAX AND LUNGS

CRITERIA PROFICIENT APPROACHING DEVELOPING BEGINNING
(4) PROFICIENCY (3) (2) (1)

BEFORE PROCEDURE Independently Performs skills with assistance Perform skills with Perform skills with assistance
Performs all skills frequently of faculty 1-2 times during assistance of faculty 3-4 of faculty greater than 4
and without difficulty simulation times during simulation times during simulation.

1. Identify the patient.

2. Explain the purpose of the respiratory system examination

and answer any questions to the patient.

3. Perform hand hygiene

4. Assist the patient to undress if needed and provide a

patient gown. Assist the patient to a sitting position and
expose the posterior thorax.

ASSESSING THE THORAX AND LUNGS(POSTERIOR)

1. Inspect the posterior thorax. Examine the skin, bones, and

muscles of the spine, shoulder blades and back as well
as symmetry of expansion and accessory muscles use
during respirations.

2. Assess the anteroposterior and lateral diameters of the

thorax.

3. Palpate over the spine and posterior thorax.

A. Use palmar surface of the hand to palpate for temperature,
tenderness, muscle development and masses.
B. Instruct patient to take a deep breath. Assess for tactile fremitus
by using the ball of the hands to palpate over the posterior
thorax and while the patient says “ninety-nine”

4. Assess the thoracic expansion by standing behind the

patient, placing both thumbs on either side of the
patient’s spine at the level of T9 or T10. Ask the patient
to take a deep breath and note movement of examiner’s
hands.
 5. Percuss over the posterior and lateral lung field for tone
using a zig zag pattern , starting above the scapulae to
the bases of the lungs. Note intensity, pitch, duration and
quality of sound produced.

6. Auscultate the lungs across and down the posterior thorax

to the based of lungs as the patient breathes slowly and
deeply through the mouth.

ASSESSING THE THORAX AND LUNGS (ANTERIOR)

1. Examine the anterior thorax. With the patient sitting,

rearrange the gown so the anterior chest. Inspect the
skin, bones, and muscles as well as symmetry of lungs
expansion and accessory muscle use.

2. Palpate the anterior thorax. Palpate for tactile fremitus (as

the patient repeats the word “ninety-nine”)

3. Percuss over the anterior thorax.

4. Auscultate the lungs through the anterior thorax as the

patient breathes slowly and deeply through the mouth.

5. Inspect the breasts and axillae with the patient’s hands

resting on both sides of the body, placed on the hips and
then raised above the head.

6. Palpate the axillae with the patient’s arm resting against

the side of the body. Assist the patient into a supine
position. Place a small pillow or towel under the patient’s
back . Palpate the breast and nipples. Wear gloves if
there is any discharges from the nipples or if a lesion is
present.

AFTER THE PROCEDURE

1. Assist the patient in replacing the gown.

2. Perform hand hygiene

3. Document the findings of the results of the assessments

RATING RATING RATING RATING

Prepared
Christie N. Cellacay, RN.MAN
Clinical Instructor

Noted

Jill Marie C. Hermogenes RN, MAN, Ed.D

Assistant Dean

Approved

Michelle B. Yu RN, MAN, DM

Dean