Checklist for Posterior Chest Examination

The checklist for posterior chest examination includes the following:

Observation of Surroundings:

 

• Posture: Sitting leaning forward
• Medications: (inhalers, nebulizers, O₂ cylinder)
• Sputum cup: Color, quantity, smell
• Edibles

 

Introduction

 

• Introduction
• Greetings
• Permission for examination
• While introducing observe for hoarseness, pursing of lips, use of accessory muscles and nasal flaring

 

Inspection

 

• Intercostal recession
• Chest shape-barrel, pectus excavatum/carinatum
• Chest movements- symmetry
• Prominent chest wall veins
• Scars
• Deformities- kyphosis, scoliosis
• Aspirations marks or dressing
• Respiratory rate and pattern of respiration
• Audible sounds

 

Palpation:

 

• Bony tenderness
• Subcutaneous emphysema if appropriate
• Chest expansion posteriorly
• Tactile vocal fremitus

 

Percussion:

 

• Supraclavicular fossae and back of chest wall including axillae
• Check for diaphragmatic excursion

 

Auscultation:

 

• Supraclavicular fossae and back of chest wall including axillae
•  If areas of dullness on percussion, test for vocal resonance
• Listen for added sounds (rhonchi, crackles, wheeze, rub)

 

Examine the Front Chest:

 

• Visible apex beat, displaced trachea
• Palpate for tracheal tug, tracheal shift, apex beat

 

Relative GPE:

 

• Examine hands to assess circulation for warmth and venodilation- (CO₂ retention)
• Nails- tar staining (smoking), clubbing/cyanosis (fibrosis, bronchiectasis)
• Hands- flapping tremor (CO₂ retention), HPOA (Chronic pul. Conditions)
• Pulse- bounding ( CO₂ retention)
• Raised JVP- cor pulmonale
• Lymph nodes- cervical, supraclavicular and axillary (infection, malignancy)
• Face- polycythemia (COPD), cyanosis (respiratory failure I)
• Eyes- horner’s syndrome- pinpoint pupil and ptosis (malignancy)
• Tongue- central cyanosis (respiratory failure-I)
• Feet- ankle edema (cor pulmonale)

 

Conclusion:

 

• Thank the patient, summarize and present findings