{"id":341,"date":"2021-08-28T02:27:37","date_gmt":"2021-08-28T06:27:37","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/?post_type=chapter&#038;p=341"},"modified":"2022-06-30T15:52:22","modified_gmt":"2022-06-30T19:52:22","slug":"posterior-and-lateral-thorax-inspection","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/chapter\/posterior-and-lateral-thorax-inspection\/","title":{"raw":"Posterior and Lateral Thorax - Inspection","rendered":"Posterior and Lateral Thorax &#8211; Inspection"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">1. \u00a0Inspect for<strong> symmetry of thorax<\/strong> and <strong>chest expansion<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Compare the left and right sides of the thorax. Are the shoulders, scapula, and ribs on symmetrical upon observation?<\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">When the client breathes, does the left and right sides of the thorax expand and recoil symmetrically? Also, t<\/span><span style=\"text-align: initial;font-size: 1em\">est for symmetrical chest expansion by placing your thumbs (on either side of vertebra) just below the inferior border of the scapula (about T9\/T10) with fingers stretched out to the lateral sides of the thorax. Pinch a piece of skin in between your thumbs and ask the client to take a big breath in and out. If the thumbs move equally apart and back together at the same time upon inspiration and expiration, this indicates symmetrical expansion. Make a note if the expansion is asymmetrical (one side has limited expansion, lags in expansion, or does not expand). This can happen when one lung cannot expand due to conditions that involve inflammation and air between the lungs and chest wall (i.e., pneumothorax) or partial or complete collapse of the alveoli (i.e., atelectasis). You may also notice that in pregnant women, the thorax shortens while the costal angle widens to accommodate the enlarging uterus: this is normal.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. \u00a0Inspect the <strong>spinous process<\/strong>, <strong>ribs<\/strong>, <strong>[pb_glossary id=\"2109\"]deformities[\/pb_glossary]<\/strong>, <strong>masses<\/strong>, and <strong>swelling<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Do the spinous processes appear in a straight line down the vertebral line of the posterior thorax?<\/span><\/li>\r\n \t<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Are the ribs sloping downwards?<\/span><\/li>\r\n \t<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Do you observe any deformities, masses or swelling?<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Inspect <strong>skin colour<\/strong> and <strong>skin integrity<\/strong><\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Is the skin colour consistent across the posterior and lateral thorax?<\/span><\/li>\r\n \t<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Do you notice any skin discolouration?<\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">Do you notice any scars? If so, ask the client the cause. For example, a client may have a scar from lung surgery such as a<\/span> <span style=\"text-align: initial;font-size: 1em\">[pb_glossary id=\"1192\"]lobectomy[\/pb_glossary]<\/span><span style=\"text-align: initial;font-size: 1em\">, and this surgery can lead to no air entry when you auscultate the lungs.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. \u00a0Inspect the <strong>anteroposterior to transverse<\/strong> <strong>diameter<\/strong> of the thorax. See <strong>Figure 3.10<\/strong>. The transverse diameter is shown in the first image across the chest. The anteroposterior diameter is show in the second image from front to back. In most adults, the <\/span><span style=\"color: #000000;font-size: 1em\">anteroposterior to transverse diameter ratio is about 1:2.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">The ratio will be closer to equal (1:1) when a client has conditions that give rise to hyperinflated lungs (e.g., emphysema). Also, a 1:1 ratio is usually present in children younger than two years of age.<\/span><\/li>\r\n<\/ul>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP-225x300.jpeg\" alt=\"Anterior perspective of an individuals chest\/thorax.\" width=\"225\" height=\"300\" class=\"alignnone size-medium wp-image-1435\" \/>\u00a0 <img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-227x300.jpeg\" alt=\"Lateral (transverse) perspective of an individuals chest\/thorax.\" width=\"227\" height=\"300\" class=\"alignnone size-medium wp-image-1436\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 3.10<\/strong>: Anteroposterior to transverse diameter<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. \u00a0Note the <strong>findings<\/strong><\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cSymmetrical posterior thorax with symmetrical chest expansion, no thorax deformities or masses, spinous process in a straight line, no skin discolouration, anteroposterior to transverse diameter 1:2.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"text-align: initial;font-size: 1em;color: #000000\">Abnormal findings might be documented as: \u201cHorizontal ribs with a 1:1 anteroposterior to transverse diameter.\u201d<\/span><\/li>\r\n<\/ul>\r\n&nbsp;\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\">Priorities of Care<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">None of the abnormal findings on their own are considered critical findings. However, if you notice asymmetrical lung expansion, be aware that this is associated with decreased ventilation. You should investigate whether there is decreased or absent air entry in the affected lung, which may be lagging behind or not expanding at all. Examples of underlying pathologies can include <strong>[pb_glossary id=\"448\"]pneumothorax[\/pb_glossary]<\/strong>, <strong>[pb_glossary id=\"449\"]atelectasis[\/pb_glossary]<\/strong>, <strong>[pb_glossary id=\"450\"]pleural effusion[\/pb_glossary]<\/strong>, or partial or complete obstruction of the airway on the <strong>[pb_glossary id=\"451\"]ipsilateral[\/pb_glossary]<\/strong> side.<\/span><\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">[h5p id=\"18\"]<\/span><\/p>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">1. \u00a0Inspect for<strong> symmetry of thorax<\/strong> and <strong>chest expansion<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Compare the left and right sides of the thorax. Are the shoulders, scapula, and ribs on symmetrical upon observation?<\/span><\/li>\n<li><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">When the client breathes, does the left and right sides of the thorax expand and recoil symmetrically? Also, t<\/span><span style=\"text-align: initial;font-size: 1em\">est for symmetrical chest expansion by placing your thumbs (on either side of vertebra) just below the inferior border of the scapula (about T9\/T10) with fingers stretched out to the lateral sides of the thorax. Pinch a piece of skin in between your thumbs and ask the client to take a big breath in and out. If the thumbs move equally apart and back together at the same time upon inspiration and expiration, this indicates symmetrical expansion. Make a note if the expansion is asymmetrical (one side has limited expansion, lags in expansion, or does not expand). This can happen when one lung cannot expand due to conditions that involve inflammation and air between the lungs and chest wall (i.e., pneumothorax) or partial or complete collapse of the alveoli (i.e., atelectasis). You may also notice that in pregnant women, the thorax shortens while the costal angle widens to accommodate the enlarging uterus: this is normal.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. \u00a0Inspect the <strong>spinous process<\/strong>, <strong>ribs<\/strong>, <strong><button class=\"glossary-term\" aria-describedby=\"341-2109\">deformities<\/button><\/strong>, <strong>masses<\/strong>, and <strong>swelling<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Do the spinous processes appear in a straight line down the vertebral line of the posterior thorax?<\/span><\/li>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Are the ribs sloping downwards?<\/span><\/li>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Do you observe any deformities, masses or swelling?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Inspect <strong>skin colour<\/strong> and <strong>skin integrity<\/strong><\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Is the skin colour consistent across the posterior and lateral thorax?<\/span><\/li>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Do you notice any skin discolouration?<\/span><\/li>\n<li><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">Do you notice any scars? If so, ask the client the cause. For example, a client may have a scar from lung surgery such as a<\/span> <span style=\"text-align: initial;font-size: 1em\"><button class=\"glossary-term\" aria-describedby=\"341-1192\">lobectomy<\/button><\/span><span style=\"text-align: initial;font-size: 1em\">, and this surgery can lead to no air entry when you auscultate the lungs.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. \u00a0Inspect the <strong>anteroposterior to transverse<\/strong> <strong>diameter<\/strong> of the thorax. See <strong>Figure 3.10<\/strong>. The transverse diameter is shown in the first image across the chest. The anteroposterior diameter is show in the second image from front to back. In most adults, the <\/span><span style=\"color: #000000;font-size: 1em\">anteroposterior to transverse diameter ratio is about 1:2.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">The ratio will be closer to equal (1:1) when a client has conditions that give rise to hyperinflated lungs (e.g., emphysema). Also, a 1:1 ratio is usually present in children younger than two years of age.<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP-225x300.jpeg\" alt=\"Anterior perspective of an individuals chest\/thorax.\" width=\"225\" height=\"300\" class=\"alignnone size-medium wp-image-1435\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP-225x300.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP-768x1024.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP-65x87.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP-350x467.jpeg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Anterior-AP.jpeg 960w\" sizes=\"auto, (max-width: 225px) 100vw, 225px\" \/>\u00a0 <img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-227x300.jpeg\" alt=\"Lateral (transverse) perspective of an individuals chest\/thorax.\" width=\"227\" height=\"300\" class=\"alignnone size-medium wp-image-1436\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-227x300.jpeg 227w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-774x1024.jpeg 774w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-768x1016.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-65x86.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-225x298.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP-350x463.jpeg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/11\/Lateral-AP.jpeg 968w\" sizes=\"auto, (max-width: 227px) 100vw, 227px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 3.10<\/strong>: Anteroposterior to transverse diameter<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. \u00a0Note the <strong>findings<\/strong><\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cSymmetrical posterior thorax with symmetrical chest expansion, no thorax deformities or masses, spinous process in a straight line, no skin discolouration, anteroposterior to transverse diameter 1:2.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"text-align: initial;font-size: 1em;color: #000000\">Abnormal findings might be documented as: \u201cHorizontal ribs with a 1:1 anteroposterior to transverse diameter.\u201d<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\">Priorities of Care<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: left\"><span style=\"color: #000000\">None of the abnormal findings on their own are considered critical findings. However, if you notice asymmetrical lung expansion, be aware that this is associated with decreased ventilation. You should investigate whether there is decreased or absent air entry in the affected lung, which may be lagging behind or not expanding at all. Examples of underlying pathologies can include <strong><button class=\"glossary-term\" aria-describedby=\"341-448\">pneumothorax<\/button><\/strong>, <strong><button class=\"glossary-term\" aria-describedby=\"341-449\">atelectasis<\/button><\/strong>, <strong><button class=\"glossary-term\" aria-describedby=\"341-450\">pleural effusion<\/button><\/strong>, or partial or complete obstruction of the airway on the <strong><button class=\"glossary-term\" aria-describedby=\"341-451\">ipsilateral<\/button><\/strong> side.<\/span><\/p>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-18\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-18\" class=\"h5p-iframe\" data-content-id=\"18\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 3 - Posterior and Lateral Thorax - Inspection\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"341-2109\" hidden><p>are abnormal malformations of the body.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"341-1192\" hidden><p>is the surgical removal of one of the lobes of the lung.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"341-448\" hidden><p>is a collapsed lung as a result of air entering the pleural space between the visceral and pleural layers.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"341-449\" hidden><p>is a partial collapse of lung when the alveoli become deflated usually caused by shallow breathing following surgery, blocked airways, or insufficient surfactant.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"341-450\" hidden><p>refers to excessive fluid accumulation in the pleural space between the visceral and parietal pleura.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"341-451\" hidden><p>refers to same side.<\/p>\n<\/div><\/div>","protected":false},"author":177,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-341","chapter","type-chapter","status-publish","hentry"],"part":25,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/341","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/users\/177"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/341\/revisions"}],"predecessor-version":[{"id":2110,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/341\/revisions\/2110"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/parts\/25"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/341\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/media?parent=341"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapter-type?post=341"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/contributor?post=341"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/license?post=341"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}