Introduction
fremitus ( sabihin ng patient 99 or
 Name, age
 History, family history (about cancer
sa lung, heart tsaka breast)
Assessing the thorax
 inspect the shape and symmetry of
thorax from posterior and lateral
views (abnormal findings: kyphosis,
lordosis & scoliosis)
 inspect the spinal alignment for
deformities (abnormal findings:
Barrel ches, Pigeon chest and Funnel
chest)
 palpate the posterior thorax, palpate
for tenderness, warmth, pain and
other sensation.
 Palpate the posterior chest for
respiratory excursion (sa T9 or T10
tas inhale exhale) there must be full
and systemic expansion and the
thumbs must be separated to 3cm
during deep inspiration when
assessing for respiratory excursion
 Palpate the chest for vocal (tactile)
ung tres-tres) use ulnar part of hand.
Assess all areas for symmetry and
intensity of vibration
 Percuss the thorax, percuss per tone
starting at the apices of the scapulae
and across the top of both shoulder
resonance is the percussion tone
elicited over normal lung tissue.
Percussion elicits flat tones over the
scapula. (<<<< ung pic dito sa
palpate don den ung pepercuss)
 Percuss for diaphragmatic
excursion, hanapin muna T7 tas sa
left side below ng scapula place your
fingers and tell your patient to
inhale. Then percuss pababa
hanggang sa maging dull ung tone.
Tas pag dull na mark mo yun and tell
the patient to exhale, inhale ulit tas
pababa ulit start don sa namark
mong dull kanina tas percuss pababa
ulit until maging dull ung tone then
mark it <pag pinepercuss mo kasi
diba resonance- resonance-
resonance then magiging dull> . bali
dalawa na ung mark tas susukatin
mo siya gamit ruler, normal should
be 3-5cm
  Auscultate the chest using the flat
disc diaphragm of the stet. Place the
stet on posterior chest wall at the
apex of the lung at c7, then ask the
patient to breathe deeply through
her mouth for each area of
auscultation para marinig ung
respiratory and exploratory sounds.
There must be three types of normal
breath sounds bronchial, broncho
vesicular and vesicular. ( same
location ulit katulad nung pic sa
unang palpate)
If papagawa sainyo sa anterior part same lang
den ng ginawa mo sa posterior ung gagawin
pero baka di na hahaha
Assessing the breast and axillae
 Inspect the breast size, symmetry,
and contour while the patient is in a
sitting position.
 inspect the skin of the breast for
localized discolorations or
hyperpigmentation, retraction or
dimpling, localized hyper vascular
areas, swelling or edema
 observe the breast for shape, surface
characteristics and bilateral pull of
suspensory ligaments. Tell the
patient to raise arm above the head
and with elbows flex and press the
hands down on the hips. Inspect the
nipples for size, shape, position,
color, discharge and lesions <pero
baka di na to pagawa kasi kailanagan
dito expose boobs hahaha>
 palpate the breast, pili ka lang
isa jan kung pano mo papalpate
ung breast tas palpate the
supraclavicular and
infraclavicular lymph nodes area
tsaka axilliary lymph node
regions
 evaluation of breast mass
o breast lump
o demarcation
o mobility
o tenderness
o retraction
Assessing the heart
 inspect and palpate the precordium
or the presence of abnormal
pulsations, lifts, or heaves. Lay your
fingers slightly over each of the five
precordial landmarks.
 Auscultate the heart in all five key
landmarks
o 5 auscultatory areas
 Aortic (right- 2nd
intercostal space)
 Pulmonic (left 3rd
intercostal space)
 Erbs point (left- 4th
intercostal space)
 Tricuspid (left- 5th
intercostal space)
 Mitral (left- 6th
intercostal space)
 Begin auscultation using the
diaphragm of the stet for
transmission of high frequency
sounds listen to several “lob dub”
cycles in all 5 areas twice. First
identify s1 and s2 then listen for s3
and s4 for murmurs and friction.
drop locate aortic valve landmark
and listen for s2 auscultate pulmonic
valve listening for s2 Erbs point
auscultate for murmurs, tricuspid
area assesses for s1 instruct patient
to hold her breath while the client
holds her breath the splitting
disappears neutral bulb assess for s1