Chest Assessment Procedural Steps

Initial Patient Preparation and Identification

  • Standard Precautions:

    • Maintain universal standard precautions prior to and throughout the entire clinical assessment.

  • Patient Identification, Introduction, and Explanation (ID / INTRO / Explain):

    • Verify patient identification (id pt.).
    • Introduce self to the patient.
    • State department affiliation (dept.).
    • Thoroughly explain the purpose of the chest assessment to the patient.

Clinical Inspection

  • Overall Appearance:

    • Assess general patient characteristics, including age, sex, and weight.

  • Patient Position:

    • Observe body posture and positioning, specifically noting tripod position or Fowler's position.

  • Chest Structure and Configuration:

    • Evaluate overall chest shape.
    • Assess anteroposterior (A-P) diameter.
    • Inspect for sternal deformities.
    • Check for surgical or traumatic scars.
    • Evaluate bilateral chest symmetry.

  • Spinal Alignment:

    • Inspect the spine for normal alignment or abnormal curvatures.

  • Breathing Signs and Work of Breathing:

    • Check for intercostal, subcostal, or suprasternal retractions.
    • Observe for pursed-lip breathing.
    • Inspect for nasal flaring.
    • Assess for abdominal paradox (asynchronous movement of the chest and abdomen).

  • Invasive Lines and Equipment:

    • Note the presence and placement of any chest tubes.

  • Skin Condition, Cyanosis, and Perfusion:

    • Inspect skin for cyanosis.
    • Check for diaphoresis.
    • Assess for peripheral or localized edema.
    • Inspect for bruises, swelling, and nodules.
    • Assess capillary refill time in the nail bed.

  • Respiratory Parameters:

    • Evaluate respiratory depth, pattern, and regularity.
    • Observe for accessory muscle use during respiration.

Chest Palpation

  • Pulse Palpation:

    • Palpate arterial pulse to determine rate, rhythm, and quality.

  • Tracheal Position:

    • Palpate the trachea to verify midline position or detect tracheal deviation.

  • Subcutaneous Assessment (SUB Q):

    • Palpate the chest wall for the presence of subcutaneous emphysema (crepitus).

  • Tactile Fremitus:

    • Palpate tactile fremitus across chest fields while having the patient repeat "99".

Diagnostic Chest Percussion

  • Chest Percussion:
    • Perform diagnostic chest percussion systematically across chest fields to evaluate tissue density and resonance.

Chest Auscultation and Voice Sound Tests

  • Breath Sound Evaluation:

    • Auscultate normal breath sounds.
    • Identify abnormal breath sounds.
    • Listen for adventitious breath sounds.

  • Special Voice Sound Auscultation:

    • Listen for egophony.
    • Listen for bronchophony.
    • Listen for whispered pectoriloquy (whispered pectrilloquy).

Post-Assessment Follow-Up Procedures

  • Patient Comfort and Safety:

    • Ensure patient comfort, verify patient safety, and address any immediate needs.
    • Express appreciation and thank the patient (thank pt).

  • Sanitation and Hygiene (WASH):

    • Dispose of Personal Protective Equipment (PPE) first.
    • Wash hands thoroughly after PPE removal.

  • Documentation and Clinical Communication:

    • Accurately chart and document all findings (document / chart).
    • Notify appropriate clinical personnel (notify personal) and communicate any needed recommendations.