WSylvas2+student+Assessment
Comprehensive Physical Assessment
Chapter 30 Overview
- Authors: W. Sylvas, BSN, RN
Key Topics Covered:
- Chest and Lungs
- Cardiovascular System
- Breast and Axillae
- Abdomen
- Genitourinary and Rectum
- Musculoskeletal System
- Neurological System
Chest and Lungs
Anatomy and Physiology
- Bronchial Tree Structure:
- Main right stem bronchus
- Main left stem bronchus
- Trachea
- Bronchi
- Bronchioles
- Lobes of the Lungs:
- Pleura:
- Diaphragm
- Alveoli
Chest Landmarks
- Anterior Chest:
- Angle of Louis
- Midsternal line
- Right and Left Midclavicular line
- Right and Left Midaxillary line
- Posterior Chest:
- Midspinal line or vertebral line
- Right and Left Midscapular line
- Lateral Chest:
- Anterior Axillary line
- Midaxillary line
- Posterior Axillary line
Chest Inspection
- Assessments:
- Chest Size and Shape:
- Pigeon-shaped, funnel-shaped, flail-shaped
- AP Lateral Ratio:
- Normal ratio is approximately 1:2
- Spinal Deformities:
- Kyphosis, lordosis, scoliosis
Respiratory Rate and Rhythm
- Normal respiratory rate: 12-20 breaths/min
- Assess:
- Rhythm and depth
- Symmetry of chest wall movement
- Accessory muscle use
- Intercostal area retractions
Palpation
- Assess:
- Skin turgor
- Chest tenderness, masses, crepitus
- Respiratory excursion
- Tactile fremitus
Sound Assessment
- Posterior Thorax:
- Best location for chest excursion
- Auscultation of vesicular sounds at bases
- Tactile fremitus is most reliable at this region
- Lateral Thorax:
- Assess following posterior assessment
- Normal breath sounds: vesicular
- Anterior Thorax:
- Inspect symmetry and accessory muscle use
- Palpate for chest expansion (3–5 cm)
- Auscultate systematically to compare