Thorax and Lungs

Inspection:
Nasal Flaring
Pursed Lip Breathing
Color of Face, Lips, and Chest
Even without unusual or prominent discoloration
Ruddy-Purple
Cyanotic
Color and Shape of Nails:
Pinkish
Pale
Cyanotic
160-degree angle between the base and the skin
180-degree angle (Early Clubbing)
>180-degree angle (Late clubbing)

___Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Posterior Thorax:
Inspection:
Shoulders, Scapulae, and Spinous Process
Scapulae symmetric and non protruding
___ Yes ___ No
Shoulders and Scapular are at equal horizontal position ___ Yes ___ No
Ratio of anteroposterior to transverse diameter (1:20) ___ Yes ___ No
Spinous process; Straight
___ Yes ___ No
Thorax:
Symmetric with ribs
___ Yes ___ No
Spinous deviate laterally
___ Yes ___ No
Barrel chest
___ Yes ___ No
Use of Accessory Muscles
___ Yes ___ No
Clients Positioning:
Sitting up, relaxed, and breathing easily
___ Yes ___ No
Tripod position
___ Yes ___ No
Palpation:
Tenderness and Sensation
Tenderness, Pain or Unusual Sensation
Temperature equal bilaterally
Muscle soreness
Crepitus
Surface Characteristics:
Skin and Subcutaneous Tissue
Lesions
Masses:
Palpable
Movable
Hard

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Soft

___ Yes ___ No

Fremitus:
Symmetric
Easily Identified
Unequal fremitus
Diminished fremitus

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Chest Expansion:
Expands symmetrically (5-10 cms apart)

___ Yes ___ No

Percussion:
Resonance
Hyperresonance
Dull
Flat Tones

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Diaphragmatic Excursion:
Equal bilaterally (3-5cms)
Level of Diaphragm higher on the right
Descent limited

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No

Auscultation:
Breath Sounds:
Bronchial
Bronchovesicular
Vesicular
Diminished
Absent
Louder breath sounds

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Adventitious sounds
Crackles
Continuous Sounds
Wheeze
Voice Sounds:
Bronchophony: 99
Voice transmission:
Soft
Muffled
Indistinct
Words easily understood
Loud

Fine ___

Coarse ___

Sibilant ___ Sonorous ___

___ Yes ___

___ Yes ___
___ Yes ___
___ Yes ___
___ Yes ___

No
No
No
No
No

Egophony: E
Soft
Muffled
Letter E distinguishable
Louder ___ Yes ___ No
Sounds like A ___ Yes ___ No
Whispered Pectoriloquy: 1-2-3
Transmission Sounds:
Faint
Muffled
Inaudible
Clear
Distinct

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Anterior Thorax:
Inspection:
Shape and Configuration:
Anterior diameter < transverse diameter (1:2) ___ Yes ___ No
Barrel Chest
___ Yes ___ No
Position of Sternum
Midline and Straight
Funnel Chest
Pigeon Chest
Sternal Retractions
Slope of Ribs:
Slope
Symmetric ICS
Costal Angle within 90 degrees
Barrel Chest Configuration
Quality and Pattern of Respirations:
Relaxed
Effortless
Quiet
Labored
Noisy
Tachypnea
Bradypnea
Hyperventilation
Hypoventilation
Cheyne Stokes Respirations
Biots Respiration

___ Yes ___

___ Yes ___
___ Yes ___
___ Yes ___

No
No
No
No

Downward ___ Upward ___

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Intercostal Spaces:
Retractions
Bulging

___ Yes ___ No

___ Yes ___ No

Use of Accessory Muscles

___ Yes ___ No

Palpation:
Tenderness over thoracic muscles
Tenderness at Costochondral junction of Ribs
Crepitus
Surfaces Masses
Palpable
Movable
Hard
Soft
Fremitus
Symmetric bilaterally
Easily identified
Diminished vibrations

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Anterior Chest Expansion

Symmetrical
Unsymmetrical

___ Yes ___ No

___ Yes ___ No

Percussion:
Percussion:
Resonance
Hyperresonance
Dull
Flat TonesAuscultation:
Breath Sounds:
Bronchial
Bronchovesicular
Vesicular
Diminished
Absent
Louder breath sounds
Adventitious sounds
Crackles
Continuous Sounds
Wheeze
Voice Sounds:
Bronchophony: 99
Voice transmission:

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
Fine ___

Coarse ___

Sibilant ___ Sonorous ___

Soft
Muffled
Indistinct
Words easily understood
Loud

___ Yes ___

___ Yes ___
___ Yes ___
___ Yes ___
___ Yes ___

No
No
No
No
No

Egophony: E
Soft
Muffled
Letter E distinguishable
Louder
Sounds like A

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No

Whispered Pectoriloquy: 1-2-3

Transmission Sounds:
Faint
Muffled
Inaudible
Clear
Distinct

___ Yes ___ No

___ Yes ___ No
___ Yes ___ No
___ Yes ___ No
___ Yes ___ No