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Physical Examination of the Chest RC 275

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Chest Topography: Anterior Chest

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Chest Topography: Lateral Chest

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Chest Topography: Posterior Chest

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Fissures:

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Location of Lobes

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Physical Exam Techniques Observation Palpation Percussion Auscultation

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Observation Patient s surroundings, ie: the view from the door Equipment present Posted signs SPUTUM!

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Observation: Breathing Patterns Eupnea Tachypnea/Bradypnea Biots Cheynes-Stokes Kussmaul

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Observation: Thoracic Contour

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Observation: Thoracic Contour (cont.) Pectus Excavatum Pectus Carinatum Kyphosis Scoliosis Kyphoscoliosis Symmetry of chest movement

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Observation: Clubbing

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Palpation: Tracheal Alignment

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Tracheal Alignment Abnormalities Pneumothorax shifts to unaffected side Pleural Effusion shifts to unaffected side Fibrosis or Atelectasis shifts towards affected side Pulmonary consolidation no shift

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Palpation : Chest Excursion

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Palpation: Vocal Fremitus BILATERAL comparison of vocal vibrations Increased with alveolar consolidation Decreased with increased distance between lung and chest wall Pneumothorax, Pleural effusion

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Percussion Assess density of underlying tissue

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Percussion Notes Resonance normal Dullness increased density Atelectasis, alveolar filling/consolidation, pleural effusion, fibrosis Hyperresonance decreased density Hyperinflation (COPD), Pneumothorax

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Case Study A patient is recently diagnosed with RLL bronchogenic CA. As you enter the room, you see that the patient is on 4 LPM nasal cannula. He appears short of breath with tachypnea and shallow respirations. Chest excursion appears normal except in the RLL. Vocal fremitus is also absent in the RLL. Percussion reveals dullness in the RLL.

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Case Study A 90 year old male is s/p CVA and has been hospitalized for two weeks. He has begun spiking a temp (101 f). Physical exam reveals an emaciated patient with audible gurgling, rapid shallow respirations, and O2 at 6 LPM via simple mask. There is also a suction machine set up for N-T suctioning. Vocal fremitus is increased in both bases and the trachea is midline.