Thorax Objectives
• Identify surface landmarks on the
Thorax, Skin, Hair, Nails
NURB 3060 Spring 2008
Jarvis Chapter 12, 18
• Identify subjective data
needed to assess respiratory
function
• Describe techniques utilized
to assess the thorax and
lungs
–Inspection
–Palpation
–Percussion
–Auscultation
Skin, Hair, Nails, Objectives
• Obtain subjective data relative to
assessment of the skin, hair, nails
• Describe skin lesions using 6
characteristics as listed on page 235
• Describe 5 danger signs of
pigmented lesions
• Describe skin color variations and
their clinical implications
thorax
• Identify transcultural and
developmental considerations in the
assessment of the lungs and thorax
• List equipment needed to perform
and assessment of the lungs and
thorax
• Differentiate normal and abnormal
assessment findings in the normal
adult, infant, child, and older adult
lung
• Discuss implications of abnormal
findings from the assessment of the
lungs and thorax
• List NANDA diagnoses commonly
used in clients with lung disease
• Correlate assessment findings with
common cardio- pulmonary
problems
• Quantify edema
• Teach skin self-examination
• Describe skin changes occurring
throughout the lifespan
• Describe etiology and detect color
changes in light and dark colored
skin
• Describe common skin, hair, and nail
lesions and their clinical implications
1
 • Inspect and palpate the skin, noting color, Palpation
vascularity, edema, moisture, temperature, • Changes in fremitus due to sound is
texture, thickness, mobility, turgor, and
any lesions conducted through dense
• Inspect the fingernails noting color, structures
shape, and any lesions – Decreased
• Inspect
I t the
th hair,
h i noting
ti texture,
t t • Obstruction of vibrations
distribution, and any lesions –Eg. Pleural effusion
• Record the history and physical findings
– Increased
accurately, reach an assessment of the
health state, and develop a plan of care. • Consolidation or compression of lung
tissue
–Eg pneumonia

Percussion Auscultation
• Normal Breath Sounds
• Resonance
– bronchial
• Hyperresonance – bronchovesicular
– Increased air – Vesicular
• emphysema • Increased breath sounds
• Dull – Indicates consolidation
– Increased density • Decreased breath sounds
• Pneumonia – Obstruction
– Hyperinflation

Adventitious Sounds Pulmonary Functions

• Wheeze • Crackles • Pulse oximetry
(rhonchi) – Fine (rales) – non-invasive
–High
High pitch – Course
C – percentt off Hgb
H b
• Sibilant saturation
• Stridor
–Low pitch – normal 95 -
• Pleural friction
• Sonorous 100%
rhonchi rub

2
 Schamroth technique
• Place (dorsal) together Nails
surfaces of the
fingertips of
corresponding fingers
from the right and left
hands. Normally, a
diamond-shaped
window is formed at the
base of the nails. With
clubbing, the diamond-
shaped window
disappears and the
angle between the distal
tips increases.

Documentation of Skin Documentation of Hair:

• Dark brown, soft, moist, warm; • Coarse, curly, black mixed with
turgor; resilient, returns to place gray; male distribution patterns;
immediately; no edema,
edema odor,
odor or thinning on crown; no
excess perspiration; freckling infestations
over cheeks and nose; 2 cm scar
over right scapula, no keloid; no
lesions

Websites of interest
Nail Documentation • Dermatlas.org
• Nail plate smooth, hard, uniform,
with longitudinal pigmented
bands; nail base angle 160
degrees, nail bed firm, adhered;
nail folds without redness,
tenderness, lesions
Impetigo