Thorax examination
Inspection
the clinical setting examination of the thorax first includes a gross examination of the
patient. The patient will be comfortably seated on the edge of the bed, if possible, to best
visualize the thorax and breathing patterns. Keeping in mind the structures of the bony thorax,
visually inspect the thorax.
Assess the following:
Respiratory rate and rhythm
Gross deformities; curvatures, scars, discolorations, etc.
Abnormal breathing patterns (retractions included)
PALPATION:
Expose the patient’s thorax providing for as much comfort and privacy as possible. Use the
fingertips and flat of the hand in order to palpate the thorax. Use firm but gentle pressure to
assess the breathing and movements of the thorax. Next, palpate any abnormalities which you
noticed from the first step of this assessment the inspection phase.
Palpate the following:
Size and shape of the thorax during respirations
Intercostal spaces (for bulging or retractions)
Any scars or other skin abnormalities (skin temperature as well)
Tenderness or pain (palpate gently)
PERCUSSION
Percussion is of limited use to most nurses. The technique can reveal abnormalities which might
be better assessed by palpation of auscultation. Use percussion in conjunction with these other
methods of assessment in order to confirm suspicions of underlying pathology.
Always use a quick wrist motion and listen carefully to the pitch of the resulting vibrations set up
by the blow.
Use this chart for comparison:
FLAT High pitch solid tissue beneath
DULL Medium pitch firm tissue beneath
RESONANT Low pitch normal resounding lung tissue
(semi-hollow or “fluffy” sound)
HYPERRESONANT very low pitch very hollow sound, (emphysema)
TYMPANY musical very hollow sound (air bubble)
AUSCULTATION
This technique has many indications and is widely used today. It will indicate that there is
normal air flow through the trachea and the bronchi, and into the lungs. It can indicate the
presence of fluid and/or other obstruction in the air passages
You will be listening for:
Quality and intensity are they full and easily audible, rate, rhythm, are they diminished?
Adventitious sounds abnormal breath sounds; these sounds are distinguished from the
variations of normal breath sounds which can occur due to hypoventilation or
hyperventilation.
In this text, we use the definitions below for breath sounds:
heard over most of normal
Normal VESICUCLAR low pitch
lung
medium heard over mainstream
Normal BRONCRO-VESICULAR
pitch bronchi
BRONCHIAL-
Normal high pitch normally heard over trachea
(TRACHEAL)
SOUNDS tubular (like wind tunnel)
ABNORMAL RALES discrete non-continuous sound, produced by
moisture in the lung tissues; can be fine in quality
or coarse.
ABNORMAL RHONCRI continuous sounds produced by air being forced
through narrowed passages, narrowed by
secretions and/or constriction of the air passage.
ABNORMAL WHEEZES continuous musical sounds produced as air is
forced through narrowed passages, like rhonchi,
can occur in inspiration or expiration; with rales,
may change character after coughing
ABNORMAL STRIDOR loud musical sound of constant pitch, most
prominent during inspiration can be heard very
well at a distance due to its loud intensity; sound
is produced by obstruction of the airway,
laryngeal tumors, tracheal stenosis or aspirated
foreign body.
ABNORMAL PLEURAL non-musical sound, usually longer and lower
FRICTION RUB pitch than lung crackles, sounds like the creaking
of old leather; etiology; coarsened surface of the
normal pleura, due to fibrin deposits, thickened or
inflamed or with neoplastic cells.
ABNORMAL MEDIASTINAL (Harman’s Sign) This is a coarse, crackling
CRUNCH sound or vibration that is synchronous with
systole and is frequently heard over the
precordium in the presence of mediastinal
emphysema. This distinctive popping or
crunching sound is thought to originate from air
separating the parietal and visceral pericardium
during the contraction of the heart.
ABNORMAL BRONCHIAL This is heard in patients with
LEAK SQUEAK bronchopleurocutaneous fistula; a high-pitched
squeak over the affected chest area during
sustained Valsalva maneuver, the pitch being
higher in smaller fistules than in larger ones.
ABNORMAL INSPIRATORY A musical sound, squawk found in some patients
SQUAWK with diffuse pulmonary fibrosis; this squawk is
usually accompanied by rales (crackles) and also
predisposed by hypersensitivity pneumonitis
caused by inhaling antigens.
