PHYSICAL PHYSICAL ASSESSMENTASSESSMENTTHE THORAX ANDTHE THORAX AND

LUNGSLUNGS

Assessing The Thorax and Assessing The Thorax and LungsLungs

Anatomy of the ChestAnatomy of the Chest

Anatomy of the ChestAnatomy of the Chest

Chest bonesChest bones• SternumSternum• ManubriumManubrium• Xiphoid processXiphoid process• ClaviclesClavicles• 12 Pairs of ribs12 Pairs of ribs• 12 Thoracic 12 Thoracic

vertebraevertebrae• ScalpulaScalpula

Chest LandmarksChest Landmarks

Anatomical Anatomical mappingmapping

• right anterior right anterior axillary lineaxillary line

• Right Right midclavicular midclavicular lineline

• Midsternal Midsternal lineline

Chest LandmarksChest Landmarks

Anatomical Anatomical mappingmapping

• posterior posterior axillary axillary lineline

• midaxillary midaxillary lineline

• Anterior Anterior axillary axillary lineline

Chest LandmarksChest Landmarks

AnatomicAnatomical al mappingmapping

• Vertebral Vertebral lineline

• Scapular Scapular lineline

Anatomy of the LungsAnatomy of the Lungs

LungsLungs• Right has 3 lobesRight has 3 lobes• Left has 2 lobesLeft has 2 lobes• Oblique fissure divides Oblique fissure divides

upper & lower lobesupper & lower lobes TracheaTrachea

• Anterior to esophagusAnterior to esophagus• Branches into right & left Branches into right & left

bronchibronchi Right wider, shorter, Right wider, shorter,

more vertical more vertical ((aspiration)aspiration)

• BronchiolesBronchioles• AlveoliAlveoli

Anatomy of the LungsAnatomy of the Lungs

Mapping of Mapping of the lungsthe lungs• Anterior Anterior

chest chest

primarily primarily upper lobesupper lobes

Anterior Chest LandmarksAnterior Chest Landmarks

Anatomy of the LungsAnatomy of the Lungs

Mapping of Mapping of the lungsthe lungs• Posterior Posterior

chestchest

primarily primarily lower lobeslower lobes

Posterior Chest LandmarksPosterior Chest Landmarks

Lateral Chest LandmarksLateral Chest Landmarks

HistoryHistory

Chief complaint / present illnessChief complaint / present illness• CoughCough• Shortness of breath / difficulty breathingShortness of breath / difficulty breathing• Chest painChest pain• CongestionCongestion• Sudden onset breathing problem (aspiration)Sudden onset breathing problem (aspiration)• ApneaApnea• SnoringSnoring

HistoryHistory

Past medical historyPast medical history• Hospitalizations for respiratory conditionHospitalizations for respiratory condition• Chronic pulmonary conditions, i.e., asthma, Chronic pulmonary conditions, i.e., asthma,

TB, emphysema, cystic fibrosisTB, emphysema, cystic fibrosis• Other chronic conditions, i.e., heart diseaseOther chronic conditions, i.e., heart disease• AllergiesAllergies• Trauma or surgery to thoracic, nose, mouthTrauma or surgery to thoracic, nose, mouth• Medications usedMedications used• PrematurityPrematurity

HistoryHistory

Family historyFamily history• TBTB• Cystic fibrosisCystic fibrosis• EmphysemaEmphysema• Allergies, asthma, atopic dermatitisAllergies, asthma, atopic dermatitis• BronchitisBronchitis• Clotting disorders (risk of pulmonary Clotting disorders (risk of pulmonary

emboli)emboli)• SmokingSmoking

HistoryHistory

Personal and socialPersonal and social• Tobacco use / exposureTobacco use / exposure• Environmental toxin exposure, i.e., air Environmental toxin exposure, i.e., air

pollution, pesticides, smoke, mold, pollution, pesticides, smoke, mold, animalsanimals

• Exposure to respiratory infectionsExposure to respiratory infections• OccupationOccupation• TravelTravel• Exercise toleranceExercise tolerance