Physical Assessment of the Respiratory Tract II: Palpation

Palpation is a method of assessing the respiratory tract to detect tenderness, masses, lesions, respiratory excursions, and fremitus.

First, the nurse assesses the patient's chest walls for range and symmetry of excursion.

The nurse places the thumb along the costal margin of the chest wall to assess the anterior chest and adjacent to the spinal column at the level of the tenth rib for examining the posterior thorax.

During breathing, the nurse monitors the movement of the thumb, which should be symmetric under normal circumstances.

Decreased chest excursion may indicate fibrotic disease, while asymmetric movement could signal trauma.

The tracheal position is also palpated, and any deviation from the midline is noted.

Next is tactile fremitus, the palpable chest wall vibrations resulting from speech, mainly consonant sounds.

To assess tactile fremitus, the nurse places the palms or ulnar aspect of the extended hands on the patient's thorax and asks them to repeat phrases like "ninety-nine" to detect vibration.

Decreased fremitus suggests hyperinflation or pleural effusion, while absent fremitus can indicate pneumothorax.