{"id":244,"date":"2021-08-28T02:28:25","date_gmt":"2021-08-28T06:28:25","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/posterior-and-lateral-thorax-percussion\/"},"modified":"2024-06-28T16:43:10","modified_gmt":"2024-06-28T20:43:10","slug":"posterior-and-lateral-thorax-percussion","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/posterior-and-lateral-thorax-percussion\/","title":{"raw":"Posterior and Lateral Thorax \u2013 Percussion","rendered":"Posterior and Lateral Thorax \u2013 Percussion"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">The steps in percussing the posterior and lateral thorax are as follows (see <strong>Video 8<\/strong>):<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. \u00a0Ensure the client is in an <strong>upright position<\/strong>, and perform <strong>indirect percussion<\/strong> to evaluate the elicited sounds.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">The lung is an air-filled organ, so the normal percussion note over the lungs of older children, adolescents, and adults is resonance, which is a low-pitched and hollow sound. With very young children under the age of about 5, you will hear a lower-pitch and booming sound (this is described as hyperresonance).<\/span><\/li>\r\n \t<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Listen for any abnormal percussion notes such as dull notes that can occur when the lung tissue is filled with fluid or solid matter (e.g., a tumour close to the chest wall, pneumonia, pleural effusion, atelectasis) or hyperresonance with lung conditions that lead to hyperinflation of part or all of a lung (e.g., emphysema, pneumothorax). Percussion does not elicit reliable data when a client is overweight or obese because the adipose tissue modifies the normal resonance to a dull note. However, the notes typically don't change with a client who is underweight. Keep in mind that you should not percuss over ribs or the heart. If you do, the sound elicited over the heart (a dense organ) will be a dull high-pitched sound that quickly stops and over the ribs (composed of bone and cartilage will be a flat high-pitched sound that stops promptly with a very short duration). If abnormal percussion sounds are noted, describe the sound and identify the location. Then, perform a complete focused assessment on the respiratory system and check for other related cues.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. \u00a0Percuss in about four to eight locations on each side of the posterior thorax and then at three locations on the right lateral thorax and at two locations on the left lateral thorax. See <strong>Figure 14<\/strong>\u00a0for the <strong>percussion pattern<\/strong>. Remember that the number of locations depends on the size of the thorax; less locations are needed on a client with a smaller thorax (e.g., infants). Also remember that the posterior thorax is primarily lower lobes.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. \u00a0On the <strong>posterior thorax<\/strong>, begin at the shoulders at the scapular line. As you move down the thorax, place your finger close to the vertebral line to avoid percussing over the bone of the scapula. Toward the bottom, percuss close to the vertebral line and then move laterally.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Avoid percussing over ribs because this will elicit a flat note and does not provide you with any important information. You can rock your finger back and forth to ensure you are in an intercostal space. Typically, you will skip the percussion step when the client has a muscular chest or a lot of adipose tissue as this will modify the normal resonant sound to a flat sound. However, a client who is underweight will typically still have a resonant sound.<\/span><\/li>\r\n<\/ul>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/12.-Posterior-Auscultation.jpg\" alt=\"A person's posterior chest\/thorax naked, with blue dots outlining the pattern of auscultation.\" width=\"297\" height=\"304\" class=\"alignnone wp-image-591\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 14: <\/strong>Percussion pattern for posterior thorax.<\/span><\/p>\r\n<span style=\"color: #000000\">Image by<\/span> <a href=\"https:\/\/pixabay.com\/users\/claudio_scott-4913238\/\">Claudio_Scott<\/a> <span style=\"color: #000000\">from<\/span> <a href=\"https:\/\/pixabay.com\/\">Pixabay<\/a> <span style=\"color: #000000\">(image was cropped and illustrated upon for the purposes of this chapter)<\/span>\r\n\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. \u00a0On the <strong>lateral thorax<\/strong>, begin percussing inferior to the axilla and percuss in about three locations on the right side and then two locations on the left side (see <strong>Figure 15<\/strong>).<\/span><\/p>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/11.-Lateral-Left-Auscultation-214x300.jpg\" alt=\"A person's left lateral chest naked, with blue dots outlining the patter of auscultation.\" width=\"214\" height=\"300\" class=\"alignnone size-medium wp-image-590\" \/> <img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/10.-Lateral-Right-Auscultation-198x300.jpg\" alt=\"A person's right lateral chest naked, with blue dots outlining the patter of auscultation.\" width=\"198\" height=\"300\" class=\"alignnone size-medium wp-image-589\" \/>\u00a0<strong>\u00a0<\/strong>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 15<\/strong>: Percussion pattern for lateral thorax.<\/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: \u201cResonance heard through lungs on posterior and lateral thorax.\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: \u201cResonance heard throughout except hyperresonance heard in left lower lobe on posterior and lateral thorax.\u201d<\/span><\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/XSWU-T7e6Es[\/embed]\r\n\r\n<strong>Video 8<\/strong>: Percussion of posterior and lateral thorax (NOTE: percuss down to just below the bottom of the thorax).\r\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\r\n<span>[h5p id=\"208\"]<\/span>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">The steps in percussing the posterior and lateral thorax are as follows (see <strong>Video 8<\/strong>):<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. \u00a0Ensure the client is in an <strong>upright position<\/strong>, and perform <strong>indirect percussion<\/strong> to evaluate the elicited sounds.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">The lung is an air-filled organ, so the normal percussion note over the lungs of older children, adolescents, and adults is resonance, which is a low-pitched and hollow sound. With very young children under the age of about 5, you will hear a lower-pitch and booming sound (this is described as hyperresonance).<\/span><\/li>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Listen for any abnormal percussion notes such as dull notes that can occur when the lung tissue is filled with fluid or solid matter (e.g., a tumour close to the chest wall, pneumonia, pleural effusion, atelectasis) or hyperresonance with lung conditions that lead to hyperinflation of part or all of a lung (e.g., emphysema, pneumothorax). Percussion does not elicit reliable data when a client is overweight or obese because the adipose tissue modifies the normal resonance to a dull note. However, the notes typically don&#8217;t change with a client who is underweight. Keep in mind that you should not percuss over ribs or the heart. If you do, the sound elicited over the heart (a dense organ) will be a dull high-pitched sound that quickly stops and over the ribs (composed of bone and cartilage will be a flat high-pitched sound that stops promptly with a very short duration). If abnormal percussion sounds are noted, describe the sound and identify the location. Then, perform a complete focused assessment on the respiratory system and check for other related cues.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. \u00a0Percuss in about four to eight locations on each side of the posterior thorax and then at three locations on the right lateral thorax and at two locations on the left lateral thorax. See <strong>Figure 14<\/strong>\u00a0for the <strong>percussion pattern<\/strong>. Remember that the number of locations depends on the size of the thorax; less locations are needed on a client with a smaller thorax (e.g., infants). Also remember that the posterior thorax is primarily lower lobes.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. \u00a0On the <strong>posterior thorax<\/strong>, begin at the shoulders at the scapular line. As you move down the thorax, place your finger close to the vertebral line to avoid percussing over the bone of the scapula. Toward the bottom, percuss close to the vertebral line and then move laterally.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Avoid percussing over ribs because this will elicit a flat note and does not provide you with any important information. You can rock your finger back and forth to ensure you are in an intercostal space. Typically, you will skip the percussion step when the client has a muscular chest or a lot of adipose tissue as this will modify the normal resonant sound to a flat sound. However, a client who is underweight will typically still have a resonant sound.<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/12.-Posterior-Auscultation.jpg\" alt=\"A person's posterior chest\/thorax naked, with blue dots outlining the pattern of auscultation.\" width=\"297\" height=\"304\" class=\"alignnone wp-image-591\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 14: <\/strong>Percussion pattern for posterior thorax.<\/span><\/p>\n<p><span style=\"color: #000000\">Image by<\/span> <a href=\"https:\/\/pixabay.com\/users\/claudio_scott-4913238\/\">Claudio_Scott<\/a> <span style=\"color: #000000\">from<\/span> <a href=\"https:\/\/pixabay.com\/\">Pixabay<\/a> <span style=\"color: #000000\">(image was cropped and illustrated upon for the purposes of this chapter)<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. \u00a0On the <strong>lateral thorax<\/strong>, begin percussing inferior to the axilla and percuss in about three locations on the right side and then two locations on the left side (see <strong>Figure 15<\/strong>).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/11.-Lateral-Left-Auscultation-214x300.jpg\" alt=\"A person's left lateral chest naked, with blue dots outlining the patter of auscultation.\" width=\"214\" height=\"300\" class=\"alignnone size-medium wp-image-590\" \/> <img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/10.-Lateral-Right-Auscultation-198x300.jpg\" alt=\"A person's right lateral chest naked, with blue dots outlining the patter of auscultation.\" width=\"198\" height=\"300\" class=\"alignnone size-medium wp-image-589\" \/>\u00a0<strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 15<\/strong>: Percussion pattern for lateral thorax.<\/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: \u201cResonance heard through lungs on posterior and lateral thorax.\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: \u201cResonance heard throughout except hyperresonance heard in left lower lobe on posterior and lateral thorax.\u201d<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Percussion of Posterior and Lateral Thorax\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/XSWU-T7e6Es?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong>Video 8<\/strong>: Percussion of posterior and lateral thorax (NOTE: percuss down to just below the bottom of the thorax).<\/p>\n<h2><span style=\"color: #000000\">Activity: Check Your Understanding<\/span><\/h2>\n<p><span><\/p>\n<div id=\"h5p-208\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-208\" class=\"h5p-iframe\" data-content-id=\"208\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 3 - Posterior and Lateral Thorax - Percussion\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n","protected":false},"author":34,"menu_order":10,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[72],"license":[56],"class_list":["post-244","chapter","type-chapter","status-publish","hentry","contributor-december-2021","license-cc-by-nc"],"part":224,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/244","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":5,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/244\/revisions"}],"predecessor-version":[{"id":2807,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/244\/revisions\/2807"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/224"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/244\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=244"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=244"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=244"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=244"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}