{"id":246,"date":"2021-08-28T02:28:41","date_gmt":"2021-08-28T06:28:41","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/anterior-thorax-inspection\/"},"modified":"2024-06-28T16:44:17","modified_gmt":"2024-06-28T20:44:17","slug":"anterior-thorax-inspection","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/anterior-thorax-inspection\/","title":{"raw":"Anterior Thorax - Inspection","rendered":"Anterior Thorax &#8211; Inspection"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection of the anterior thorax involves the following steps:<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Inspect for <strong>symmetry, observable deformities, masses, swelling<\/strong>, and <strong>shape of the thorax <\/strong>(see <strong>Figure 16 <\/strong>as a reminder for landmarks).<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Compare the left side of the thorax to the right side of the thorax. Are the clavicles and ribs on each side symmetrical upon observation? Are the ribs sloping downwards? Is the trachea and sternum midline? (note which side, if trachea is deviated [i.e., pulled to one side]).<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Do you notice any deformities, masses, or swelling? (note location and describe)<\/span><\/li>\r\n \t<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Observe the costal angle which is the angle between the costal margins inferior to the xiphoid process. Normally, it is about 90 degrees.<\/span>\r\n<ul>\r\n \t<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">An abnormal finding is when the angle flattens out. This happens with chronic lung conditions associated with hyperinflation of the lungs (e.g., emphysema). This abnormal finding is often associated with ribs that flatten out and an anteroposterior to transverse diameter that is no longer 1:2, but rather is closer to 1:1 resembling a barrel chest.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Inspect for <strong>skin colour<\/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 anterior 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<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Note 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 anterior thorax, downward sloping ribs, trachea and sternum midline, no thorax deformities, masses, or swelling, costal angle 90 degrees. Consistent skin colour across anterior thorax, no discolouration\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: \u201cTracheal deviation to the right side. Costal angle 170 degrees, horizontal ribs with a 1:1 anteroposterior to transverse diameter.\u201d<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/6.-Respiratory-Landmarks-755x1024.jpg\" alt=\"Anterior image of a naked person's chest. The chest has drawings of the clavicle, ribs, and anatomical descriptions.\" width=\"445\" height=\"614\" class=\"alignnone wp-image-586\" \/><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 16: <\/strong>Anatomical landmarks of thorax\u00a0<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Photo by\u00a0<\/span><a href=\"https:\/\/www.pexels.com\/@armin-rimoldi\">Armin Rimoldi<\/a>\u00a0<span style=\"color: #000000\">from<\/span>\u00a0<a href=\"https:\/\/www.pexels.com\/\">Pexels<\/a>\u00a0<span style=\"color: #000000\">(image was cropped and illustrated upon for the purposes of this chapter)<\/span><\/p>\r\n&nbsp;\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Upon inspection, the findings of most concern are usually a new onset of tracheal deviation or asymmetrical lung expansion. These cues are suggestive of decreased ventilation to one side of the lungs possibly caused by pneumothorax, atelectasis, or pleural effusion. If the client is showing other signs of respiratory distress, notify the physician\/nurse practitioner immediately. Otherwise, complete a primary survey followed by a focused assessment of the respiratory system so that you can provide a complete report of the relevant cues to the physician\/nurse practitioner.<\/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>[h5p id=\"209\"]<\/span><\/p>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection of the anterior thorax involves the following steps:<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Inspect for <strong>symmetry, observable deformities, masses, swelling<\/strong>, and <strong>shape of the thorax <\/strong>(see <strong>Figure 16 <\/strong>as a reminder for landmarks).<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Compare the left side of the thorax to the right side of the thorax. Are the clavicles and ribs on each side symmetrical upon observation? Are the ribs sloping downwards? Is the trachea and sternum midline? (note which side, if trachea is deviated [i.e., pulled to one side]).<\/span><\/li>\n<li><span style=\"color: #000000\">Do you notice any deformities, masses, or swelling? (note location and describe)<\/span><\/li>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Observe the costal angle which is the angle between the costal margins inferior to the xiphoid process. Normally, it is about 90 degrees.<\/span>\n<ul>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">An abnormal finding is when the angle flattens out. This happens with chronic lung conditions associated with hyperinflation of the lungs (e.g., emphysema). This abnormal finding is often associated with ribs that flatten out and an anteroposterior to transverse diameter that is no longer 1:2, but rather is closer to 1:1 resembling a barrel chest.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Inspect for <strong>skin colour<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Is the skin colour consistent across the anterior thorax?<\/span><\/li>\n<li><span style=\"text-align: initial;font-size: 1em;color: #000000\">Do you notice any skin discolouration?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Note 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 anterior thorax, downward sloping ribs, trachea and sternum midline, no thorax deformities, masses, or swelling, costal angle 90 degrees. Consistent skin colour across anterior thorax, no discolouration\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: \u201cTracheal deviation to the right side. Costal angle 170 degrees, horizontal ribs with a 1:1 anteroposterior to transverse diameter.\u201d<\/span><\/li>\n<\/ul>\n<p style=\"text-align: center\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/6.-Respiratory-Landmarks-755x1024.jpg\" alt=\"Anterior image of a naked person's chest. The chest has drawings of the clavicle, ribs, and anatomical descriptions.\" width=\"445\" height=\"614\" class=\"alignnone wp-image-586\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 16: <\/strong>Anatomical landmarks of thorax\u00a0<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Photo by\u00a0<\/span><a href=\"https:\/\/www.pexels.com\/@armin-rimoldi\">Armin Rimoldi<\/a>\u00a0<span style=\"color: #000000\">from<\/span>\u00a0<a href=\"https:\/\/www.pexels.com\/\">Pexels<\/a>\u00a0<span style=\"color: #000000\">(image was cropped and illustrated upon for the purposes of this chapter)<\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: left\"><span style=\"color: #000000\">Upon inspection, the findings of most concern are usually a new onset of tracheal deviation or asymmetrical lung expansion. These cues are suggestive of decreased ventilation to one side of the lungs possibly caused by pneumothorax, atelectasis, or pleural effusion. If the client is showing other signs of respiratory distress, notify the physician\/nurse practitioner immediately. Otherwise, complete a primary survey followed by a focused assessment of the respiratory system so that you can provide a complete report of the relevant cues to the physician\/nurse practitioner.<\/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><\/p>\n<div id=\"h5p-209\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-209\" class=\"h5p-iframe\" data-content-id=\"209\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch 3 - Anterior Thorax - Inspection\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n","protected":false},"author":34,"menu_order":11,"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-246","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\/246","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":4,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/246\/revisions"}],"predecessor-version":[{"id":2808,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/246\/revisions\/2808"}],"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\/246\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=246"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=246"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=246"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}