Activity E PERFORMING PHYSICAL ASSESSMENT OF THE THORAX AND LUNGS

Use the following Physical Assessment Guide to examine the thorax and lungs of a lab partner,
peer, or client. Column 1 will serve as a reminder as to what part of the exam you will do next.
Column 2 will be used to record your findings. Your instructor may ask you to turn this in to be
evaluated

Physical Assessment Guide to Collect Objective Client Data

Questions Findings
1. Gather equipment (gown and drape,
gloves, stethoscope, exam light, mask,
marker, metric ruler).

2. Explain procedure to client.

3. Ask the client to put on a gown.

Posterior Thorax
1. Inspect for shape and configuration of the
chest wall and position of scapulae.

2. Inspect for the use of accessory muscles.

3. Inspect the client’s positioning noting

posture and ability to support weight while
breathing.
4. Palpate for tenderness and sensation with
gloved fingers.

5. Palpate for surface characteristics such as

lesions or masses with gloved fingers.

6. Palpate for fremitus, using the ball or ulnar

edge of one hand while the client says
“ninety-nine.” Assess for symmetry and
intensity of vibration.

7. Palpate for chest expansion. Place hands

on the posterior chest wall with your
thumb at the level of T9 or T10, and
observe the movement of your thumb as
the client takes a deep breath.

8. Percuss the tone, starting at the apices

above the scapulae and across the tops of
both shoulders.

9. Percuss intercostal spaces across and

down, comparing sides.

10. Percuss to the lateral aspects at the bases

of the lungs, and compare sides.
11. Percuss for diaphragmatic excursion using
the procedure in Chapter 18 of the
textbook.

12. Auscultate for breath sounds (normal,

bronchial, bronchovesicular, and
vesicular), noting location.

13. Auscultate for adventitious sounds

(crackles, fine or coarse, pleural friction
rub, wheeze, sibilant, or sonorous).

14. Auscultate for voice sound over the chest

wall: Bronchophony—ask the client to
repeat the phrase “ninety-nine”;
egophony—ask the client to repeat the
letter “E”; whispered pectoriloquy—ask
the client to whisper the phrase “one-two-
three.”
Anterior Thorax
1. Inspect for shape and configuration to
determine the ratio of anteroposterior
diameter to transverse diameter (normally
1:2).

2. Inspect for position of sternum from

anterior and lateral viewpoints.

3. Inspect for slope of the ribs from anterior

and lateral viewpoints.
4. Inspect for quality and pattern of
respiration, noting breathing
characteristics, rate rhythm, and depth.

5. Inspect intercostal spaces while client

breathes normally.

6. Inspect for the use of accessory muscles.

7. Palpate for tenderness and sensation,

using fingers.

8. Palpate surface characteristics such as

lesions or masses, using fingers of gloved
hand.

9. Palpate for fremitus while the client says

“ninety-nine.”

10. Palpate for chest expansion by placing

hands on anterolateral wall with the
thumbs along the costal margins and
pointing toward the xiphoid process.
 Observe the movement of the thumbs as
the client takes a deep breath.
11. Percuss the tone above the clavicles, and
then the intercostal spaces across and
down, comparing sides.

12. Auscultate for breath sounds, adventitious

sounds, and voice sounds.

Analysis of Data
1. Formulate nursing diagnoses (wellness,
risk, actual).

2. Formulate collaborative problems.

3. Make necessary referrals.