ASSESSING THE CHEST AND THORAX

The video introduces the assessment of the thorax and lungs, outlining the four primary techniques: inspection, palpation, percussion, and auscultation. It highlights the necessary equipment, such as a stethoscope, and emphasizes the importance of hand hygiene and patient privacy before, during, and after the procedure. The discussion also touches upon determining the patient's medical history and current medications that may affect lung sounds.

Inspection, or observation, is the first step, focusing on the shape, symmetry, and alignment of the thorax from posterior, lateral, and anterior views. This includes observing the spinal cord alignment, usually done by asking the client to stand. The process ensures a thorough visual assessment of the chest and back for any abnormalities.

Palpation involves using touch to feel for any abnormal movements, tenderness, or unusual sounds. The instructor demonstrates palpating the posterior thorax, placing hands on the lower thorax and asking the client to inhale and exhale deeply to check for symmetrical lung expansion. This section also covers palpating for tactile fremitus by asking the client to say "blue moon" or count to three to feel for vibrations.

Percussion is demonstrated as a technique of tapping different body parts to produce sounds, typically resonance or hyperresonance in the lungs. The proper technique involves using the middle finger of one hand to tap the middle finger of the other hand, ensuring taps are performed in a systematic zigzag pattern across specified spots, typically 10 on the posterior thorax. The client is asked to bend slightly forward with hands on opposite shoulders to expose the scapulae, allowing for clear percussion of the intercostal spaces.

Auscultation involves listening to body sounds using a stethoscope. The video explains the use of the stethoscope's diaphragm for high-pitched sounds when assessing lung sounds and emphasizes a systematic zigzag approach. The client is asked to breathe slowly and deeply through the mouth, allowing the nurse to compare lung sounds on both sides. The video also introduces various normal lung sounds (bronchial, bronchovesicular, vesicular) and abnormal sounds like crackles, diminished breath sounds, wheezing (expiratory), and rhonchi.

The video then shifts to assessing the anterior thorax, applying the same four techniques: inspection, palpation, percussion, and auscultation. Inspection includes observing breathing patterns, respiratory rate, rhythm, and costal angle. Palpation involves checking for supraclavicular and infraclavicular tenderness and assessing respiratory excursion. Percussion is demonstrated across 18 spots on the anterior thorax, with specific considerations for female clients where percussion around breast tissue might be omitted unless medically necessary. Auscultation follows a similar systematic approach using the diaphragm of the stethoscope, ensuring skin-to-diaphragm contact for clear sound transmission.

The final part emphasizes the critical importance of documenting all findings, whether normal or abnormal. This documentation serves as vital data for primary healthcare providers. The instructor concludes by inviting questions about the assessment process.