Assessing the Thorax and Lungs

Goal: The assessment is completed without causing the patient to experience anxiety or discomfort, the findings are documented, and the appropriate referral is made to other healthcare professionals, as needed, for further evaluation.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Close curtains around bed and close the door to the room, if possible. Explain the purpose of the thorax and lung examination and what you are going to do. Answer any questions.

4. Help the patient undress, if needed, and provide a patient gown. Assist the patient to a sitting position and expose the posterior thorax.

5. Use the bath blanket to cover any exposed area other than the one being assessed. Inspect the posterior thorax. Examine the skin, bones, and muscles of the spine, shoulder blades, and back as well as symmetry of expansion and accessory muscle use during respirations.

6. Assess the anteroposterior (AP) and lateral diameters of the thorax.

7. Palpate over the spine and posterior thorax. a. Use the palmar surface of the hand to palpate for temperature, tenderness, muscle development, and masses. b. Instruct patient to take a deep breath. Assess for tactile fremitus by using the ball of the hands to palpate over the posterior thorax and while the patient says
“ninety-nine”.

8. Assess thoracic expansion by standing behind the patient, placing both thumbs on either side of the patient’s spine at the level of T9 or T10. Ask the patient to take a deep breath and note movement of your hands.

9. Percuss over the posterior and lateral lung fields for tone using a zigzag pattern, starting above the scapulae to the bases of the lungs. Note intensity, pitch, duration, and quality of sounds produced. Percuss for diaphragmatic excursion on each side of the posterior thorax.

10. Auscultate the lungs across and down the posterior thorax to the bases of lungs as the patient breathes slowly and deeply through the mouth.

11. Examine the anterior thorax. With the patient sitting, rearrange the gown so the anterior chest is exposed. Inspect the skin, bones, and muscles, as well as symmetry of lung expansion and accessory muscle use.

12. Palpate the anterior thorax using the proper sequence. Palpate for tactile fremitus (as the patient repeats the word “ninety-nine”).

13. Percuss over the anterior thorax using the proper sequence.

14. Auscultate the lungs through the anterior thorax as the patient breathes slowly and deeply through the mouth.

15. Inspect the breasts and axillae with the patient’s hands resting on both sides of the body, placed on the hips, and then raised above the head.

16. Palpate the axillae with the patient’s arms resting against the side of the body. Assist the patient into a supine position. Place a small pillow or towel under the patient’s back. Palpate the breasts and nipples. Wear gloves if there is any discharge from the nipples or if a lesion is present.

17. Assist the patient in replacing the gown. Remove gloves and any additional PPE, if used. Perform hand hygiene. Continue with assessments of specific body systems, as appropriate or indicated. Initiate appropriate referral to other healthcare practitioners for further evaluation, as indicated.