XAVIER UNIVERSITY

PERFORMANCE RATING SCALE

ASSESSING THE THORAX & LUNGS

SCALE DESCRIPTION INDICATORS

4 Very Good Student performs behaviors/tasks reflecting the highest level of

performance: consistent, independent, effective
3 Good Student performs behaviors/tasks reflecting mastery of performance with
minimal supervision
2 Fair Student performs behaviors/tasks reflecting development and movement
towards mastery of performance with help or direct supervision in some
aspect
1 Needs Student performs behaviors/tasks reflecting beginning level of
Improvement performance; tasks not done properly majority of the time but demonstrate
understanding of concepts involved with tasks

PROCEDURE 4 3 2 1 REMARKS
1. Perform hand hygiene and put on PPE, if indicated.
2. Iden9fy the pa9ent.
3. Explain the procedure to the client and answer any ques9ons.
Mouth: InspecAon & PalpaAon
4. Inspect the lips. Observe lip consistency and color.
5. Inspect the teeth and gums. Ask the client to open the mouth.
Note the number, color, condi9on, and alignment of the teeth. Put on
gloves and retract the client’s lips and cheeks to check gums for color
and consistency.
6.Inspect the buccal mucosa. Use a penlight & tongue depressor to
retract the lips & cheeks to check color & consistency. Also note
Stenson’s ducts (paro9d ducts) located on the buccal mucosa across
from the 2nd upper molars.
7. Inspect & palpate the tongue. Ask client to s9ck out the tongue.
Inspect for color, moisture, size, and texture. Observe for
fascicula9ons (fine tremors), and check for midline protrusion.
Palpate any lesions present for indura9on (hardness).
8. Assess ventral surface of the tongue. Ask client to touch the
tongue to the roof of mouth, & use penlight to inspect ventral surface
of tongue, frenulum, & area under the tongue. Palpate the area. if
you see lesions, if the client is over age 50, or if the client uses
tobacco or alcohol. Note any indura9on. Check also for a short
frenulum that limits tongue mo9on (the origin of “tongue-9ed”).
9. Inspect for Wharton’s ducts— openings from the submandibular
salivary glands—located on either side of the frenulum on the floor
of the mouth.
10. Observe the sides of the tongue; use a square gauze pad to hold
the client’s tongue to each side (Fig. 17-12). Palpate any lesions,
ulcers, or nodules for indura9on.
11. Check the strength of the tongue. Place fingers on the external
surface of the client’s cheek. Ask client to press the tongue’s 9p
against the inside of the cheek to resist pressure from your fingers.
Repeat on the opposite cheek.
12. Check the anterior tongue’s ability to taste by placing drops of
sugar and salty water on the 9p and sides of tongue with a tongue
depressor.
13. Inspect the hard (anterior) and soU (posterior) palates and
uvula. Ask the client to open the mouth wide while you use a
penlight to look at the roof. Observe color and integrity.
14. Note odor. While the mouth is wide open, note any unusual or
foul odor.
 PROCEDURE 4 3 2 1 REMARKS
17. Assess the uvula. Apply a tongue depressor to the tongue
(halfway be- tween the 9p and back of the tongue) and shine a
penlight into the client’s wide- open mouth. Note the characteris9cs
and posi9oning of the uvula. Ask the client to say “aaah” and watch
for the uvula and so^ palate to move.
18. Inspect the tonsils. Using the tongue depressor to keep the
mouth open wide, inspect the tonsils for color, size, and presence of
exudate or lesions. Tonsils should be graded.
19. Inspect the posterior pharyngeal wall. Keeping the tongue
depressor in place, shine the penlight on the back of the throat.
Observe the color of the throat, and note any exudate or lesions.
Before inspec9ng the nose, discard gloves and perform hand hygiene.
Nose: InspecAon & PalpaAon
20. Inspect and palpate the external nose. Note nasal color, shape,
consistency, and tenderness.
21. Check patency of air flow through the nostrils by occluding one
nostril at a 9me and asking client to sniff.
22. Inspect the internal nose. To inspect the internal nose, use an
otoscope with a short wide-9p acachment (or you can also use a
nasal speculum and penlight). Use non-dominant hand to stabilize &
gently 9lt the client’s head back. Insert the short wide 9p of the
otoscope into the client’s nostril without touching the sensi9ve nasal
septum. Slowly direct the otoscope back and up to view the nasal
mucosa, nasal septum, the inferior and middle turbinates, and the
nasal passage (the narrow space between the septum and the
turbinates).
Sinuses: InspecAon & PalpaAon
23. Palpate the sinuses. When an infec9on is suspected, examine
sinuses they palpa9on, percussion, & transillumina9on. Palpate the
frontal sinuses by using your thumbs to press up on the brow on each
side of nose. Palpate the maxillary sinuses by press- ing with thumbs
up on the maxillary sinuses.
24. Percuss the sinuses. Lightly tap (per- cuss) over the frontal
sinuses and over the maxillary sinuses for tenderness.
25. Transilluminate the sinuses. If sinus tenderness was detected
during palpa9on & percussion, transillumina9on will let you see if the
sinuses are filled with fluid or pus. Transilluminate the frontal sinuses
by holding a strong, narrow light source snugly under the eyebrows
(the room should be dark). Use your other hand to shield the light.
Repeat this technique for the other frontal sinus. Transilluminate
maxillary sinuses.
26. Transilluminate the maxillary sinuses by holding a strong, narrow
light source over the maxillary sinus and asking the client to open his
or her mouth. Repeat this technique for the other maxillary sinus.
27. Document findings & refer if necessary.

Actual Score/Total Score x 100

A (92 – 100)
A- (84 – 91.99)
B (76 – 83.99)
B- (68 – 75.99)
C (60 – 67.99)
F (< 60)

Student’s Signature : ________________________

Clinical Instructor’s Signature : ________________________