(5) Measure the diaphragmatic excursion (movement of the diaphragm from
a position of rest) by noting the difference between the levels of dullness when the
person inhales fully and exhales fully. See figure 2-11. The difference is normally
about 5 or 6 cm.
Figure 2-11. Diaphragmatic excursion.
AUSCULTATION OF CHEST
Auscultation (listening with a stethoscope) of the lungs is useful in estimating the
airflow through the tracheobronchial tree, detecting an obstruction, and assessing the
condition of the surrounding lungs and the pleural space.
a. Position the patient. Have the patient sitting or in a supine position. When
the patient is lying down, examine his back by turning the patient from side to side.
b. Show the patient how you want him to breath through the mouth, deeper and
more forcefully than usual.
c. Listen with the stethoscope.
(1) Start at the top of the back and work downward, comparing the right and
the left sides.
(2) Then, start at the top of the chest and work downward, comparing
symmetric points sequentially.
(a) Listen to one full breath in each location.
(b) Be alert for patient discomfort--light-headedness, faintness--that