Auscultating the anterior thorax involves the following steps (see Video 3.9): Show
1. Perform hand hygiene and cleanse the stethoscope. 2. Ensure the client is in an upright position and ask them to take a big breath in and out through the mouth each time they feel the stethoscope on their chest. 3. Place the stethoscope’s diaphragm on the chest in about three to six locations on each side of the anterior thorax so that you listen to all lung lobes. Ensure you have a complete seal. See Figure 3.16 for stethoscope placement pattern. Remember the number of locations depends on the size of the thorax; fewer locations are needed on a client with a smaller thorax (e.g., infants). Also remember that the anterior thorax has more upper lobes and that the right lung has three lobes while the left lung has two lobes.
Figure 3.17: Stethoscope placement pattern when auscultating anterior thorax Photo by Armin Rimoldi from Pexels (image was cropped and illustrated upon for the purposes of this chapter) 4. In each location, listen to one full respiration (inspiration and expiration) and compare air entry bilaterally. 5. Listen for the following:
6. Note the findings
Video 3.9: Auscultation of anterior thorax For a client with breast tissue, you may need to have them reposition their breast so that you can place the stethoscope flat on their chest. This repositioning is also important when you palpate and percuss. It may feel awkward for the client to perform this action, so some nurses demonstrate on themselves over their own uniform to show the client what they would like them to do. Depending on where the breasts are positioned on the thorax, you may need to ask the client to reposition their breasts laterally and up or down. If the client is unable to do so, you may ask permission to reposition their breast. In this case, do so with the ulnar aspect of your hand. Avoid grasping or cupping the breast with your hand as this can be misinterpreted as a sexual motion. Always ask permission and inform the client what you will be doing in order to apply a trauma-informed approach and support the therapeutic nurse-client relationship. The priorities of care related to auscultation of the anterior thorax are the same as those for the posterior thorax. Absence of air entry and presence of stridor are considered urgent situations: you should call for assistance and notify the physician or nurse practitioner. If you think the stridor is caused by a foreign body that you can quickly remove, do so. Otherwise, follow the steps of the primary survey (check airway patency, measure respiratory rate, work of breathing, and oxygen saturation, assess pulse rate/rhythm, blood pressure, assess level of consciousness). If the oxygen saturations are low, apply oxygen if you are permitted to do so. With the presence of crackles and wheezes, use the primary survey to determine whether there is a risk of clinical deterioration. Also consider whether the wheezing is new onset and could be caused by a severe allergic reaction (i.e., anaphylaxis) and requires immediate intervention. If not, and the client is stable, you can move the head of the bed up to assist with breathing and continue the focused assessment of the respiratory system. What is the correct method to use when progressing from one auscultatory site on the thorax to another?Resonance is the expected finding in normal lung tissue. The most important technique when progressing from one auscultatory site on the thorax to another is: 1. side-to-side comparison.
What is the proper technique used when assessing a patient's thorax?General approach to the thoracic examination:
The posterior thorax is best examined with the patient sitting upright, arms folded across the chest, and hands placed on opposite shoulders. This displaces the scapulae laterally and exposes more pulmonary parenchyma to the examiner's hands and ears.
What is the appropriate technique for auscultation?Methods of performing auscultation
Auscultation should never be done through the clothing. Ask the patient to take deep breaths through the open mouth. Using the diaphragm of the stethoscope, start auscultation anteriorly at the apices, and move downward till no breath sound is appreciated.
Which techniques would the nurse utilize to Auscultate the patient's chest during the respiratory assessment?Auscultation. Using the diaphragm of the stethoscope, listen to the movement of air through the airways during inspiration and expiration. Instruct the patient to take deep breaths through their mouth. Listen through the entire respiratory cycle because different sounds may be heard on inspiration and expiration.
|