The chest and back assessment in nursing will be performed as a part of the head-to-toe assessment. During this assessment, you'll assess the thorax, identify key landmarks, and then use your stethoscope to listen to heart and lung sounds.
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• Head-to-Toe Assessment...
Auscultate heart sounds at 5 locations, specifically valve locations: Remember the mnemonic: “All Patients Effectively (Erb’s Point…halfway point between the base and apex of the heart) Take Medicine”
-All: Aortic
-Patients: Pulmonic
-Effectively: Erb’s Point (no valve at this location)
-Take: Tricuspid
-Medicine: Mitral
Auscultate anteriorly: Start at: the apex of the lung which is right above the clavicle. Then move to the 2nd intercostal space to assess the right and left upper lobes.
Move to the 4th intercostal space, you will be assessing the right middle lobe and the left upper lobe.
Lastly move to the mid-axillary are at the 6th intercostal space and you will be assessing the right and left lower lobes.
Auscultate posteriorly: Start right above the scapulae to listen to the apex of the lungs.Then find C7 (which is the vertebral prominence) and go to T3…in between the shoulder blades and spine.
This will assess the right and left upper lobes.Then from T3 to T10 you will be able to assess the right and left lower lobes.
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Head -to-toe Assessment: • Head-to-Toe Assessment...
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