Assessing The Thorax and Lungs

ASSESSING THE
THORAX AND
LUNGS
Prepared by: Emman M. Parangue, R.N.

ASSESSING THE THORAX AND LUNGS
Structure and Function
The term thorax identifies the
portion of the body extending
from the base of the neck
superiorly to the level of the
diaphragm inferiorly.
✓ The outer structure of the
thorax is referred to as the
thoracic cage.
✓ The thoracic cavity contains

the respiratory components.
Thoracic Cage
• Sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles,

cartilage.
• It provides support and protection for many important

organs, including those of the lower respiratory system.
Sternum and Clavicles
• Sternum/Breastbone- three parts: the manubrium, the

body, and the xiphoid process.
• Manubrium- connects laterally with the clavicles

(collarbones) and the first two pairs of the ribs.
• The clavicle extend from the manubrium to the acromion

of the scapula.
• Suprasternal notch- “u-shaped” indentation located on

the superior border of the manubrium is an important
landmark.
• Sternal Angle- (angle of Louis) is also the location of the

second pair of ribs and becomes a reference point for
counting ribs and intercostal spaces.
RIBS AND THORACIC VERTEBRAE
• 12 pairs of ribs constitute the main structure of the

thoracic cage.
• Anteriorly the first seven pairs articulate with the sternum

by way of costal cartilages.
• The next four pairs of ribs (seven through ten) connect to

the cartilages of the pair lying superior to them rather
than to the sternum.
• Costal angle- formed between the right and left costal

margins meeting at the level of xiphoid process. It is an
important landmark for assessment.
• Costal angle- normally 90 degrees, but may be

increased in instances of long standing hyperinflation of
the lungs, as in emphysema.
• Floating ribs- 11th and 12th pairs of ribs

POSTERIOR RIBS
• Each pair of ribs articulates with its perspective thoracic

vertebra.
• The spinous process of the seventh cervical vertebra

(C7), also called the vertebra prominens.
Vertical Reference Lines
• Anterior chest - midsternal, right and left midclavicular
lines
• Posterior thorax - vertebral line, right and left scapular

lines
• Lateral thorax - midaxillary line, anterior and posterior

axillary lines
Anterior, Posterior & Lateral Vertical Lines
THORACIC CAVITY
• It consists of the
mediastinum and the lungs,
and is lined by the pleural
membranes.
Trachea and Bronchi
• Trachea- is a flexible structure that lies anterior to the

esophagus, begins at the level of the cricoid cartilage
in the neck, and is approximately 10 to 12 cm long in
an adult.
• C-shaped rings of hyaline
cartilage compose the trachea,
they help to maintain its shape
and prevent its collapse during
respiration.
• Bronchi- Right and left bronchus
• The right main bronchus is shorter and more vertical

than the left main bronchus, making aspirated objects
more likely to enter the right lung than the left.
• Trachea and bronchi are lined with mucous membranes
containing cilia.
• These hair-like projections help sweep dust, foreign bodies,

and bacteria that have been trapped by the mucus toward
the mouth for removal.
• Bronchi bifurcates into smaller passageways known as
bronchioles.
• Bronchioles→ alveolar ducts→ alveolar sacs→ alveoli
• Alveolar sacs contain a number of alveoli in a cluster

formation.
QUICK REVIEW
NOSE→ PHARYNX→LARYNX→TRACHEA→ BRONCHI

(L/R)→ BRONCHIOLES→ ALVEOLI
• Mediastinum - central area in the thoracic cavity
• Lungs - two cone-shaped, elastic structures
• Pleura - thin, double-layered serous membrane
lines thoracic cavity

The lungs- the apex of each lung extends slightly
above the clavicle; the base is at the level of the
diaphragm.
- anterior surface lung extends to approximately 6th
rib.
- laterally reaches the level of the 8th rib
Pleural membrane- known as pleura, a thin, double
layer serous membrane.
- parietal pleura- line the chest cavity
- visceral pleura- covers the external
surfaces of the lungs
- pleural space – lies between the 2
pleural layers.
The lubricating serous fluid between the layers

allows movement of the visceral layer over the
parietal layer during ventilation without friction.
Subjective Data Collection
• History of present health concern - COLDSPA
• Past health history
• Family history
• Lifestyle and health practices

Objective Data Collection: Preparation
• Have the client remove all clothing from the waist up
• Explain procedure
• Ask the client to sit in an upright position

Objective Data Collection: Equipment
• Examination gown and drape
• Gloves; stethoscope
• Light source
• Mask; skin marker and metric ruler

Inspection
Position of scapulae and the shape and configuration of the
chest wall
– Scoliosis
– Spinal configurations- respiratory implications

Inspection: Accessory Muscles
• Trapezius, or shoulder muscles - facilitate
inspiration in acute and chronic airway obstruction or

atelectasis
Inspection: Position
Tripod position seen in COPD
– Client leans forward
– Uses arms to support weight
– Lift chest to increase breathing capacity
Palpation
• Tenderness and sensation
• Crepitus- crackling sensation
• Surface characteristics
Palpation: Fremitus and Chest Expansion
• Palpate for fremitus - vibrations of air in the

bronchial tubes transmitted to the chest wall
• Assess chest expansion

Percussion
• Tone - resonance
• Diaphragmatic excursion
Auscultation
• Auscultate for breath sounds
• Three types of normal breath sounds
– Bronchial, bronchovesicular, vesicular
• Breath sounds: considered normal only

in the area specified
POSTERIOR THORAX ANTERIOR THORAX
Bronchovesicular
Auscultation: Adventitious
• Breath sounds, heard elsewhere - considered
abnormal sounds
• Auscultate for adventitious sounds
• Added or superimposed over normal breath
sounds - crackles, wheeze
Monophonic
Low pitched
Wheeze
Wheeze
Polyphonic
Wheeze
Stridor Pleural Friction Rub
Rhonchi Wheeze
Auscultation: Voice Sounds
• Bronchophony: “ninety-nine”
• Egophony: “E”
• Whispered Pectoriloquy: “one–two–three”
Question
Which of the following is an abnormal breath
sound?
a. Bronchial
b. Bronchovesicular
c. Vesicular
d. Adventitious
Question
d. Adventitious
Rationale: Bronchial, bronchovesicular, and
vesicular sounds are normal breath sounds.
Adventitious sounds are sounds added or
superimposed over normal breath sounds
and heard during auscultation.
Anterior Thorax
• Inspection
– Shape and configuration
– Position of the sternum
– Slope of the ribs
Pectus Carinatum (Pigeon Chest)
Is a forward protrusion of the sternum causing

the adjacent ribs to slope backward.
Pectus Carinatum
(Pigeon chest)
Pectus Excavatum (Funnel Chest)
Is a markedly sunken sternum and adjacent
cartilages. It is a congenital malformation
that seldom causes symptoms other than
self-consciousness
Pectus excavatum
(Funnel Chest)
Anterior Thorax: Respirations
• Observe quality and pattern of respiration
• Breathing characteristics - rate, rhythm, and
depth
• Labored and noisy breathing - severe
asthma or chronic bronchitis
Anterior Thorax: Spaces and Muscles
• Inspect intercostal spaces
• Ask the client to breathe normally and

observe the intercostal spaces
• Observe for use of accessory muscles

Palpation
• Palpate for tenderness, sensation, and surface
masses
• Tenderness over thoracic muscles- exercising,
push ups
• Especially in a previously sedentary client
Palpation: Fremitus and Expansion
• Fremitus
– Diminished vibrations - obstruction of the
tracheobronchial tree
– Decreased fremitus - emphysema
• Anterior chest expansion
Percussion
• Tone
• Hyperresonance - emphysema, pneumothorax
• Dullness - consolidation, pleural effusion, tumor

Auscultation
• Auscultate for anterior breath sounds,
adventitious sounds, and voice sounds
• Do not attempt to listen through clothing

or other materials
Thank You.
God Bless ☺
Prepare for a Post-Test and Return
Demonstration ☺

Assessing The Thorax and Lungs

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ASSESSING THE

Prepared by: Emman M. Parangue, R.N.

✓ The thoracic cavity contains

• Sternum, 12 pairs of ribs, 12 thoracic vertebrae, muscles,

• It provides support and protection for many important

Sternum and Clavicles

• Sternum/Breastbone- three parts: the manubrium, the

• Manubrium- connects laterally with the clavicles

• The clavicle extend from the manubrium to the acromion

• Suprasternal notch- “u-shaped” indentation located on

• Sternal Angle- (angle of Louis) is also the location of the

RIBS AND THORACIC VERTEBRAE

• 12 pairs of ribs constitute the main structure of the

• Anteriorly the first seven pairs articulate with the sternum

• The next four pairs of ribs (seven through ten) connect to

• Costal angle- formed between the right and left costal

• Costal angle- normally 90 degrees, but may be

• Floating ribs- 11th and 12th pairs of ribs

• Each pair of ribs articulates with its perspective thoracic

• The spinous process of the seventh cervical vertebra

• Posterior thorax - vertebral line, right and left scapular

• Lateral thorax - midaxillary line, anterior and posterior

Trachea and Bronchi

• Trachea- is a flexible structure that lies anterior to the

• The right main bronchus is shorter and more vertical

• These hair-like projections help sweep dust, foreign bodies,

• Bronchioles→ alveolar ducts→ alveolar sacs→ alveoli

• Alveolar sacs contain a number of alveoli in a cluster

NOSE→ PHARYNX→LARYNX→TRACHEA→ BRONCHI

• Mediastinum - central area in the thoracic cavity

• Lungs - two cone-shaped, elastic structures

• Pleura - thin, double-layered serous membrane

lines thoracic cavity

The lubricating serous fluid between the layers

• Past health history

• Lifestyle and health practices

• Ask the client to sit in an upright position

• Mask; skin marker and metric ruler

– Spinal configurations- respiratory implications

inspiration in acute and chronic airway obstruction or

• Tenderness and sensation

• Crepitus- crackling sensation

• Palpate for fremitus - vibrations of air in the

• Assess chest expansion

• Three types of normal breath sounds

– Bronchial, bronchovesicular, vesicular

• Breath sounds: considered normal only

Is a forward protrusion of the sternum causing

• Ask the client to breathe normally and

• Observe for use of accessory muscles

• Hyperresonance - emphysema, pneumothorax

• Dullness - consolidation, pleural effusion, tumor

• Do not attempt to listen through clothing

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