Narrator: : Positioned behind the patient, continue by inspecting and palpating the muscles of the upper back. Then, inspect and palpate the chest and percuss the lungs. Inspect for shape, symmetry, and deformities. Percuss the lungs in a systematic manner, going from side to side as you move down the thorax from the apices to the bases of the lungs. Listen to the intensity, pitch, and duration of your percussion notes and decide what kind of notes you are hearing. Normal lungs are resonant. Locate any areas where you hear abnormal notes.
Lynn Bickley: : Breathe out.
Narrator: : Next, use percussion to identify the level of diaphragmatic dullness and measure descent of the diaphragm.
Lynn Bickley: Breathe.
Narrator: To assess respiratory excursion, place your thumbs close to the patient’s spine at the level of the 10th ribs and spread your hands lightly over the lower thorax. Ask the patient to inhale deeply and exhale fully while you watch the divergence of your thumbs and feel for the range and symmetry of movement.
To auscultate the posterior thorax, begin at the apices and proceed downward, moving systematically from side to side while comparing the sounds in symmetrical areas. Using the diaphragm of the stethoscope, observe the rate, rhythm, depth, and effort of breathing and listen for adventitious sounds that my indicate abnormal respiratory conditions. Listen to at least one entire breathing cycle at each location.