הערכה פיזיקלית של דרכי הנשימה III: מישוש

Nurses place their thumbs along the costal margin for anterior chest assessment or adjacent to the spinal column at the tenth rib level for posterior thorax examination. During breathing, they monitor thumb movement, which should be symmetric under normal conditions. Decreased excursion may indicate fibrotic disease, while asymmetric movement could signal trauma or splinting from fractured ribs.

The trachea should normally be midline. Any deviation from the midline during palpation may indicate serious conditions such as tension pneumothorax, neck mass, pneumonectomy, or lobar atelectasis. Tracheal position assessment is an important component of thoracic palpation to detect potentially life-threatening respiratory abnormalities.

Tactile fremitus refers to palpable chest wall vibrations resulting from speech, most pronounced with consonant sounds. To assess it, nurses place their palms or ulnar aspect of extended hands on the patient's thorax and ask them to repeat phrases like "ninety-nine." Fremitus is most pronounced where large bronchi are closest to the chest wall and typically more prominent on the right side.

Decreased fremitus may suggest lung hyperinflation, such as barrel chest from emphysema, or pleural effusion. Absent fremitus can indicate pneumothorax or atelectasis. Conversely, increased fremitus occurs when lung tissue becomes denser or fluid-filled, as seen in pneumonia, lung tumors, or thick bronchial secretions, making fremitus assessment valuable for identifying respiratory system abnormal finding palpation and auscultation patterns.

Palpation detects tenderness, masses, lesions, and abnormal respiratory excursions. Nurses systematically examine both anterior and posterior chest walls using standardized hand placements. This comprehensive assessment helps identify structural abnormalities, areas of pain, or unusual growths that may indicate underlying respiratory or thoracic pathology requiring further investigation.

Fremitus varies based on chest wall thickness, voice pitch, and proximity of large bronchi to the chest wall surface. Patients with emphysema exhibit almost no tactile fremitus due to air trapping, whereas those with pneumonia show increased fremitus over the affected lobe. These variations make fremitus assessment a sensitive indicator of underlying lung density and consolidation changes.

Palpation provides tactile information about chest wall movement, vibrations, and structural abnormalities that visual inspection alone cannot detect. Combined with other assessment methods, palpation helps nurses develop a comprehensive understanding of respiratory function and identify conditions affecting the lower respiratory tract anatomy and physiology.