PA: LUNGS

Assessment
Normal Abnormal
Procedure
Inspection
Inspect for nasal Nasal flaring is Nasal flaring is seen with
flaring and purse not observed. respirations (especially in young
lip breathing children).
Purse lib breathing may be seen
in asthma, emphysema, CHF as a
physiologic response to help slow
down expiration and keep alveoli
open longer
Inspect color and Pink Pale or cyanotic
shape of nails

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: LUNGS
Posterior Normal Abnormal
thorax
Inspect Scapula Spinous process that
configuration symmetric and deviate laterally in
non protruding. the thoracic area
may indicate
scoliosis.
Inspect the Client should be Client leans forward,
client’s sitting up & and uses arms to
positioning relaxed, support weight and
breathing easily lift chest to increase
with arms at breathing capacity –
sides or in lap. tripod position.
Often seen in COPD
clients
JOHN PAUL N. REGANIT, RN, MSN, LPT
CLINICAL INSTRUCTOR
 PA: LUNGS

Palpation Normal Abnormal

Palpate for No tenderness, Tender or painful
tenderness and pain, or unusual areas
sensation sensations. Temp
should be equal
bilaterally
Palpate for No palpable Crepitus can be
crepitus- crackling crepitus palpated if air
sensation like escapes from the
bones or hair lungs or other
rubbing together airways into the
subcutaneous tissue

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 Sequence of PALPATION

1 2

4 3

5 6

8 7

9 10

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: LUNGS
Assessment
Normal Abnormal
Procedure
Palpate surface Free from lesions Any unusual palpable
characteristics and masses mass
Palpate for Fremitus is Unequal fremitus
fremitus symmetric
Asses chest The examiner’s Unequal chest
expansion thumbs should expansion can occur
move 5-10 cm with severe atelectasis
part
Percuss for tone Resonance is the Hyperresonance – in
percussion tone cases of trapped air
elicited over Dullness – when fluid
normal lungs or solid tissues replace
the air in the lungs
JOHN PAUL N. REGANIT, RN, MSN, LPT
CLINICAL INSTRUCTOR
 PA: LUNGS
Assessment Normal Abnormal
Procedure
Auscultate for 3 types of normal Diminished or absent
breath sounds breath sounds:
Bronchial,
bronchovesicular,
vesicular
Normal Breath Sounds
Type Pitch Location
Bronchial High Trachea, thorax
Bronchovesic Moderate Over the major bronchi
ular
Vesicular Low Peripheral lung fields
JOHN PAUL N. REGANIT, RN, MSN, LPT
CLINICAL INSTRUCTOR
 PA: LUNGS
Assessment Normal Abnormal
Procedure
Auscultate for No Presence of adventitious
adventitious adventitious lung sounds
breath sounds sounds
ADVENTITIOUS BREATH SOUNDS
Sound Source Associated conditions
Crackles Air is in -COPD
contact with -pneumonia
fluids -pulmonary edema
Wheezes:
Sibilant – high Air passes -asthma
pitch through -emphysema
Sonorous – low constricted
pitch passages

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: LUNGS

Assessment pro N A
Auscultate
breath sounds :
Bronchopny – Voice Clear
“ninety-nine” transmission is
soft, muffled
and indistinct
Egophony - E Letter E is “A”
distinguishable
Whispered May be Very audible
pectoriloquy – inaudible
whispered one
two three
JOHN PAUL N. REGANIT, RN, MSN, LPT
CLINICAL INSTRUCTOR
 PA: LUNGS

Assessment
NORMAL ABNORMAL
procedure
Anterior Thorax
Palpate for No tenderness Tenderness
tenderness, sensation or pain
or surface masses
Palpate for fremitus Fremitus is Diminished
symmetric vibrations
Palpate anterior chest Thumbs move Unequal chest
expansion outward expansion

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: LUNGS

Assessment pro NORMAL ABNORMAL

Percuss for tone Resonance over Hyperesonance

lungs
Auscultate for Same with Sane with
breath, posterior thorax posterior thorax
adventitious and
voice sounds

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: LUNGS

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: LUNGS

random, sudden
dependent
Crackles re-inflation of
lobes
alveoli fluids

Rhonchi trachea, bronchi fluid, mucus

severely
Wheezes all lung fields narrowed
bronchus

Pleural friction lateral lung

inflamed pleura
rub fields

ABNORMAL BREATH SOUNDS

JOHN PAUL N. REGANIT, RN, MSN, LPT
CLINICAL INSTRUCTOR
 PA: THORAX

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR
 PA: THORAX

LANDMARK OF THE
JOHN PAUL N. REGANIT, RN, MSN, LPT
THORAX
CLINICAL INSTRUCTOR
 PA: THORAX
Elderly: Physical Changes of Thorax and Breathing Patterns
• Kyphosis
• Anteroposterior diameter of
the chest widens
• Breathing rate and rhythm are
unchanged at rest
• Inspiratory muscles become
less powerful, and inspiration
reserve volume decreases.
• Expiration may require the
use of accessory muscles
• Deflation of the lung is
incomplete.

JOHN PAUL N. REGANIT, RN, MSN, LPT

CLINICAL INSTRUCTOR