Advanced Health Assessment (Due 12 hours)

Thorax, Lungs, and Cardiovascular System

P - Position the patient. In this examination, the patient should be supine and reclined at sitting position or 45 degrees.

E - Expose the necessary parts of the patient. Ideally the patient should be undressed from the waist up, taking care to ensure the patient is not cold.

Is there anything you wanted to tell me concerning your breathing before I begin?

Thorax

Assess the patient’s for any signs of respiratory difficulty

Denies cough or Shortness of breath. No wheezing or crackles

Normally chest is symmetric and spine is vertically aligned

Inspect the shape and movement of the chest

Normal or there is no deformity. When the patient takes a deep breath, is possible to observe the chest wall symmetrical or a symmetrical movement.

Asses for chest expansion

Place your hands on the patient’s chest, inferior to the nipples

Wrap your fingers around either side of the chest

Bring your thumbs together in the midline, so that they touch

Ask the patient to take a deep breath

Observe the movement of your thumbs, they should move apart equally

Normal Chest expansion, there is no collapse/pneumonia

Palpate for tactile fremitus posteriorly

Equal and moderate vibrations are noticed during speech

Percuss the posterior chest

Percuss for diaphragmatic excursion

Excursion is about 5 cm interval As a result, bronchial breath sounds are heard normally over the trachea

in systematic sequence

Auscultate posterior breath sounds

No skin abnormalities. No abnormalities in breath sounds, including the lateral aspects of the back

Auscultate for egophony, bronchophony and pectoriloquy

No abnormalities.

Examine the anterior chest

Normal chest size and shape

Observe for any abnormalities (size, shape, bruising)

Normal chest size and shape, warm, dry skin, no tender spots, symmetrical chest expansion

Auscultate for tactile fremitus anteriorly

Moderate vibrations are noticed during speech

Percuss the anterior chest

Normal, percussion notes resonance

Auscultate anterior breath sounds

Normal chest size and shape

Cardiovascular System

Assess JVP

Vertical distance above the midpoint of the right atrium, is 7 cm H2O

Assess carotid pulses

70 beats per minute (bpm).

Assess the brachial artery

90 beats per minute

Inspect and locate the PMI

Located near the mid-clavicular point at intercostal space 5.

Palpate for thrills/bruits

No thrills, bruits or abnormal vascular.

Auscultate heart sounds