FOCUSED EXAMINATION O BJECTIVE DATA
T HORAX AND LUNGS
Now, we will move onto the objective data collection of this physical examination. I will
be first examining the posterior chest.
I would like to kindly ask you to sit upright and raise your shirt up to expose your back.
I will begin by inspecting the posterior chest, specifically the thoracic cage. I will be
noting the shape and configuration of the chest wall.
The spinous processes appear in a straight line.
The thorax is symmetrical, elliptical shape with downward sloping ribs angled at
approximated 45 degrees.
The scapulae are placed symmetrically in each hemithorax.
The neck and trapezius muscles are normally developed.
My client is breathing with a relaxed posture, and is supporting her own weight
The skin colour is consistent with the rest of the body. No cyanosis or pallor. I do not see
Now moving onto palpating of the posterior chest
I am going to confirm symmetrical chest expansion by placing my warmed hands on the
patient’s posterolateral chest wall, with my thumbs at the level of T9 or T10. I am sliding
my hands medially to pinch a small fold between my thumbs.
I am asking the patient to take a deep breath.
I can notice that my thumbs are moving apart symmetrically, and I do not notice any lag
Percuss I will first determine the predominant note over the lung fields. I am going to start at the
apices and percuss the band of normally resonant tissue across the tops of both shoulders.
Then, I am going to percuss bilaterally, comparing from side to side. Now, I am moving
down the lung region, percussing at 5 cm intervals, avoiding the damping effects of the
scapulae and ribs.
In healthy lung tissues in adults, I should hear resonance, a low pitched, clear, hollow
sound. I can hear resonance on both sides. Small lesions are not detectable through
percussion. I do not hear any hyper resonance or dull note, which indicate abnormal
Approaching the area of T9 to T10, I am hearing some dullness, this is expected because
this left area is visceral dullness and the right area is liver dullness.
Now moving onto auscultation, I am asking the client to sit, leaning forward slightly with
arms resting comfortably across lap. I need the client to breathe through the mouth, a
little bit deeper than usual. If the client begins to feel dizzy or hyperventilating, the client
may rest and momentarily pause.
Now with my clean stethoscope warmed, I will listen to breath sounds with the
diaphragm. I am listening to at least one full respiration.
I am going to listen to the breath sounds from the apices to T10, then laterally from the
axilla down to the 7 rib.
Beginning with the apices, I am hearing vesicular sounds, soft rustling like leaves. I
continue to hear vesicular sounds. As I move down the vertebrae, I am hearing some
bronchovesicular sounds, which is harsh, rustling, hollow sounds. Then continuing down,
I am hearing more vesicular sounds, so rustling, soft, low pitch, inspiration greater than
I can hear breath sounds throughout the posterior thoracic cage, and I do not hear any
decreased or absent breath sounds in any of the regions. I do not hear wheeze, crackles, or
any other adventitious sounds.
A NTERIOR C HEST
I am inspecting the anterior chest, and noting the shape and configuration of the chest
wall. The ribs are sloping downward with symmetrical interspaces. The costal angle is within 90 degrees. The abdominal muscles are developed according to client’s age,
weight and athletic condition.
The patient has a relaxed facial expression.
The patient is alert and cooperative.
No skin lesions are observed. I would like to inspect your hands. The lips and nail beds
have no sign of cyanosis or unusual pallor. The nails are normal configuration.
Now assessing the quality of respirations, the client is relaxed when breathing. Her
breathing is automatic, regular, even and effortless. Her chest expands symmetrically with
no lag in expansion.
There is no retraction or bulging of the interspaces.
Accessory muscles are not used for respiration.
Palpate the Anterior Chest
I am palpating for symmetrical chest expansion. I am placing my hands on the
anterolateral wall with thumbs along the costal margins and pointing toward the xiphoid
I am asking the patient to take a deep breath. I can see that m thumbs are moving apart
symmetrically with smooth expansion.
I am beginning to percuss at the apices in the supraclavicular areas. I am percussing
between the interspaces, and comparing bilaterally, moving down the chest. I would like
to kindly request the client to shift her breasts to the side.
I hear resonance over the lung fields. Moving down the anterior chest, some dullness can
be heard due to the location of the liver in the right hemithorax. Tympany can also be
heard in the left hemithorax due to stomach.
I am auscultating the lung field from the apices down to the sixth rib in the same
sequence as percussion.
I am asking the client to sit upright leaning forward slightly, arms resting comfortably. I
am listening to at least one full respiration. I need the client to move her breasts to the side, so I am not auscultating directly over her breast tissues. Take deep breaths. In the
anterior chest, I am hearing vesicular sounds, rustling like leaves in the wind. Inspiration
is longer than expiration.
I do not hear any adventitious sounds such as wheezing or crackles.
T HE ABDOMEN
Now we will move onto the objective data collection of the examination. I am instructing
the client to lie supine with the knees bent, and the arms resting at the side. Do you have
any painful areas?
I am first looking at the contour of the abdomen. I will first stand on the patient’s right
side, and then I will stoop to gaze across the abdomen. The contour of this patient is flat.
Using my penlight, I am shining a light across the abdomen lengthwise across the patient.
I can see that the abdomen is symmetrical bilaterally, no bulging, no visible mass. Then, I
am stepping to the foot of the table to recheck symmetry. Once again, the abdomen is
symmetrical, no masses, no bulging.
The umbilicus is midline and inverted, with no sign of discoloration, inflammation, or
hernia. It is not red or crusted.
The skin is smooth and even. Skin color is consistent. No redness, jaundice, lesions.
I am pinching the skin, and the skin has good turgor.
I do not see any pulsation or movement, a little bit of respiratory movement.
Pubic hair growth has the pattern of inverted triangle shape.
Patient is relaxed quietly on examining table, slow and even respirations.
Auscultate Bowel Sounds and Vascular Sounds
When examining the abdomen, auscultation is performed first, because percussion and
palpation can increase peristalsis, which would give false interpretation of bowel sounds.
I am using the diaphragm to hear the higher pitched bowel sounds. I will listen to all four
quadrants, beginning with the RLQ then moving clockwise.
In all four quadrants, the bowel sounds are highpitched, gurgling, cascading sounds,
occurring irregularly about 1030 times a minute. I will now listen to vascular sounds with the bell of the stethoscope to go over the aorta,
renal, iliac, femoral arteries. I do not hear any bruits, any blowing sounds.
I am percussing to assess the relative density of abdominal contents. I am agoing to
percuss lightly in all four quadrants. I hear tympany and I do not hear any dullness.
I am conducting the scratch test to define the liver border. I am placing my stethoscope
over the liver, and with one fingernail, I am scratching short strokes over the abdomen,
starting in the RLQ and moving slowly towards the liver. The sound was magnified at
about the area of the lowest rib cage. So the liver is within healthy span.
Finally, I am going to lightly palpate in all the quadrants. Using 4 fingers, I am making