The nurse is assessing the symmetry of the client’s chest. The nurse recognizes that a client’s symmetric expansion of the chest is best confirmed by:
A.
Percussion of the posterior chest
B.
Inspection of the shape and configuration of the chest wall
C.
Placing the palmar surface of the fingers of one hand against the chest and having the client repeat “ninety nine”
D.
Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10
The Correct Answer and Explanation is:
The correct answer is:
D. Placing hands sideways on the posterolateral chest wall with thumbs pointing together at the level of T9 or T10.
Explanation:
Chest symmetry is an important part of a physical assessment and helps nurses identify underlying respiratory or musculoskeletal issues. Symmetric chest expansion refers to the equal movement of both sides of the chest during respiration, indicating normal lung function and chest wall mechanics.
Answer D is the most accurate method for assessing chest symmetry. Here’s how it works:
- The nurse places their hands sideways on the posterolateral chest wall, with thumbs pointing together along the midline at the level of T9 or T10, which is the lower thoracic vertebrae.
- The nurse then asks the client to take a deep breath.
- As the client inhales, the nurse observes the movement of their thumbs. In normal symmetric expansion, both thumbs should move apart an equal distance during inspiration.
This method provides direct tactile information about the expansion of both lungs. If one side of the chest moves less than the other, it could indicate conditions like atelectasis (collapsed lung), pneumonia, or a pleural effusion (fluid in the pleural space), which can restrict chest movement on the affected side.
Incorrect options:
- A. Percussion of the posterior chest: Percussion is used to assess for abnormalities like fluid or air in the lungs. It helps determine the presence of dullness (fluid) or hyperresonance (air), but it does not assess chest symmetry.
- B. Inspection of the shape and configuration of the chest wall: Visual inspection can provide clues about overall chest structure or deformities (e.g., barrel chest or scoliosis), but it is not a definitive method to assess symmetric chest expansion.
- C. Placing the palmar surface of the fingers of one hand against the chest and having the client repeat “ninety-nine”: This is a method used to assess for tactile fremitus, which evaluates the transmission of sound through the lungs. It can help identify lung consolidation but does not assess symmetric chest expansion.
In summary, placing the hands on the posterolateral chest at T9 or T10 provides a direct and reliable assessment of symmetric chest expansion, which is essential for detecting respiratory issues.