Physical Assessment Part 2A: Assessing the Thorax, Lungs, and Breast
(Before starting, gather all necessary equipment: PPE, stethoscope, skin marker, and
centimeter ruler.)
Introduction
● "Good day, [Mr./Ms.] [Client's Last Name]. I’m [Your Name], your student nurse. I will be
assessing your thorax, lungs, and breasts to check for any abnormalities. This will help
in your care and treatment. Do you have any questions before we start?"
● Rationale: Explaining the procedure builds rapport and ensures cooperation.
General Preparations
1. Hand Hygiene & Infection Control
○ (Washes hands, wears PPE.)
○ Rationale: Prevents the spread of infection.
2. Ensure Privacy
○ "I will drape your chest for privacy during the assessment."
○ Rationale: Maintains client dignity and comfort.
3. Health History
○ *"Before we begin, I need to ask some questions:
■ Do you have a family history of lung or breast diseases, such as cancer or
tuberculosis?
■ Are you exposed to occupational hazards like fumes, asbestos, or
radiation?
■ Do you smoke or take any medications?
■ Are you experiencing any symptoms like cough, wheezing, pain, or
swelling?"*
○ Rationale: Identifies risk factors for lung and breast conditions.
Posterior Thorax Assessment
1. Inspection
○ (Observe shape, symmetry, and AP to transverse diameter.)
○ Rationale: Detects structural deformities affecting breathing.
○ Normal Findings: Thorax symmetrical, AP diameter < transverse diameter (1:2
ratio).
2. Palpation
○ (Palpates for tenderness, lumps, or abnormalities.)
○ Rationale: Identifies any pain, masses, or inflammation.
○ Normal Findings: No tenderness or masses.
3. Respiratory Excursion
○ "Take a deep breath while I place my hands on your lower back."
○ Rationale: Checks lung expansion.
○ Normal Findings: Symmetrical movement of both hands.
4. Tactile Fremitus
○ "Please say ‘blue moon’ as I place my hands on your back."
○ Rationale: Assesses vibration transmission through lung tissue.
○ Normal Findings: Equal vibrations bilaterally, stronger near upper lungs.
5. Percussion
○ (Percusses from scapula downward, comparing sides.)
○ Rationale: Determines lung density and presence of fluid or air.
○ Normal Findings: Resonant sound over lungs, dull over bones.
6. Diaphragmatic Excursion
○ "Take a deep breath and hold it while I percuss your lower lungs."
○ Rationale: Measures diaphragm movement.
○ Normal Findings: 3-5 cm difference between inspiration and expiration.
7. Auscultation
○ "Breathe deeply through your mouth while I listen to your lungs."
○ Rationale: Detects normal and abnormal breath sounds.
○ Normal Findings: Clear breath sounds (vesicular, bronchovesicular, bronchial).
Anterior Thorax Assessment
1. Inspection
○ (Observes breathing pattern and chest structure.)
○ Rationale: Detects any abnormal breathing efforts.
○ Normal Findings: Regular, unlabored breathing; symmetrical chest movement.
2. Palpation
○ (Palpates for tenderness, respiratory excursion, tactile fremitus.)
○ Rationale: Assesses lung movement and tissue consistency.
○ Normal Findings: No pain, symmetrical chest expansion.
3. Percussion
○ (Percusses from clavicles downward, comparing sides.)
○ Rationale: Identifies lung abnormalities like fluid or air.
○ Normal Findings: Resonant sound over lungs.
4. Auscultation
○ "Please breathe through your mouth while I listen to your lungs and trachea."
○ Rationale: Evaluates air movement and presence of abnormal sounds.
○ Normal Findings: Clear breath sounds, no wheezing or crackles.
Breast Assessment
1. Inspection
○ "I will inspect your breasts for size, shape, and skin changes."
○ Rationale: Detects abnormalities such as dimpling or swelling.
○ Normal Findings: Symmetrical, smooth skin, no retraction.
2. Retraction Check
○ "Please raise your arms, press your hands together, and push down on your
hips."
○ Rationale: Helps identify hidden abnormalities.
○ Normal Findings: No skin pulling or dimpling.
3. Areola & Nipple Inspection
○ (Checks for color, symmetry, discharge, or lesions.)
○ Rationale: Identifies changes that may indicate disease.
○ Normal Findings: Even color, no discharge, no lesions.
4. Lymph Node Palpation
○ "I will feel under your arms and collarbone for swollen lymph nodes."
○ Rationale: Enlarged nodes may indicate infection or cancer.
○ Normal Findings: Non-palpable or small, soft, non-tender nodes.
5. Breast Palpation
○ "I will gently press on your breasts to check for lumps or tenderness."
○ Rationale: Detects masses, tenderness, or cysts.
○ Normal Findings: No lumps, uniform tissue consistency.
6. Nipple Discharge Check
○ "I will now press your nipples to check for discharge."
○ Rationale: Abnormal discharge may indicate infection or malignancy.
○ Normal Findings: No discharge, no pain.
Final Steps
● "That concludes the assessment. Thank you for your cooperation. I will document the
findings and inform the healthcare team if there are any concerns."
● Rationale: Ensures accurate medical records and further evaluation if needed.
● (Removes PPE, washes hands, documents findings.)
