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Evaluation of the Lungs and Thorax
There are several ways to examine lungs and thoracic cavity. The easiest method is simple observation. Noting if there are accessory muscles are used, cyanosis present, deformities of the thoracic cavity, audible noises with respiration, and delays in inspiration or expiration call all give clues as to the patient’s respiratory status (Bickley, 2017).
Palpation is the next method of examination. When palpating the thoracic cavity, feel tender areas. Crepitus is a clue that air has leaked into the subcutaneous tissue. The clinician should test for expansions by placing both hands on the patient’s back. The thumbs should be located at the tenth rib and the fingers should be loosely parallel to each other and on the lateral portion of the rib cage. As the patient breaths the clinician’s hands should apart in an equal manner (Bickley, 2017).
Percussion is another important tool. While percussion does not help with lesions deep in the thoracic cavity, it does allow for the clinician to understand whether air, fluid, or a solid mass lies five to seven centimeters bellowed the percussed area (Bickley, 2017).
Auscultation is an excellent skill for a clinician. Every clinician should know the different adventitious lung sounds and their clinical significance (Bickley, 2017).
Factors that Influence Change in the Evaluation
Patient history, presenting symptoms, and abnormal findings, all help guide a physical assessment.  Some common thoracic and lung presenting symptoms include pain in the chest, back, and substernally, shortness of breath or wheezing, as well as a cough with or without hemoptysis (Bickley, 2017).
An asthmatic patient should be evaluated to make sure there is no wheeze present, that they are not frequently short of breath and using their rescue inhaler, and that they have not lost lung function (Cramer, Davidson, & Alic, 2015; Bickley, 2017).
Pain in the thoracic cavity can be cardiac, gastric, pneumonia, anxiety, or even a lesion on the lung (Frey, 2015; Bickley, 2017). Patient history and a focused assessment can help narrow down a diagnosis and treatment plan (Bickley, 2017).
References
Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking, 12th Edition. [Vitalsource]. Retrieved from https://online.vitalsource.com/#/books/9781496354709
Cramer, D. A., Davidson, T., & Alic, M. (2015). Asthma. In J. L. Longe (Ed.), The Gale Encyclopedia of Medicine (5th ed., Vol. 1, pp. 545-553). Farmington Hills, MI: Gale. Retrieved from http://link.galegroup.com.prx-herzing.lirn.net/apps/doc/CX3623300200/GVRL?u=lirn50909&sid=GVRL&xid=644b6d6a
Frey, R. J. (2015). Lung Abscess. In J. L. Longe (Ed.), The Gale Encyclopedia of Medicine (5th ed., Vol. 5, pp. 3088-3091). Farmington Hills, MI: Gale. Retrieved from http://link.galegroup.com.prx-herzing.lirn.net/apps/doc/CX3623301121/GVRL?u=lirn50909&sid=GVRL&xid=f4e0f075
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