9.6 Objective Assessment
An objective assessment of the respiratory system includes:
- Brief scan of the respiratory system.
- Inspection and palpation of the nose and sinuses.
- Inspection of the trachea (palpation *advanced skill*)
- Inspection, auscultation, palpation, and percussion (advanced skills) of the posterior and lateral thorax followed by the anterior thorax.
An objective assessment is usually completed after the subjective assessment, but if the client shows signs of respiratory distress during the brief scan, you may proceed directly to the objective assessment and associated interventions. In this case, it is important to prioritize care after a brief scan that involves components of the primary survey (ABCCS). The physical techniques of inspection and auscultation are usually prioritized.
Clinical Tip
Always use a trauma-informed approach to inform your respiratory assessment. This is particularly important considering that areas of the chest will be exposed. Do not assume who may have experienced trauma: it can happen to anyone, regardless of gender, age, or socioeconomic/educational level.
You could start by asking the client if they would like a family member or friend present, or another health care provider. You should explain what you are doing throughout the assessment and explain why these actions are important to perform. Sometimes it is helpful to show on your own chest (over your uniform) where you will be palpating and placing your hands or the stethoscope.
Maintain privacy by closing the door and/or curtains. Use draping and only expose the necessary areas of the chest. Clients may feel awkward or embarrassed having their thorax exposed, particularly the anterior side. This feeling can be felt by people of all genders and ages. While you have the gown open at the back, use the drape to cover the lower half of the thorax. When you need to assess the anterior thorax, use the drape to cover any area not being assessed; the drape can be secured around the abdomen. With the anterior thorax, you can ask the client to lower the patient gown at the top so that you can assess the upper thorax and then, you can have them pull the gown up at the bottom to assess the lower thorax. Another alternative method is to have gown open at the front instead of the back.
You should always be professional, confident, and efficient. Try to be responsive to the client’s verbal and nonverbal cues. If they seem uncomfortable, you could acknowledge this by saying, “Many clients feel uncomfortable having their lungs assessed because it involves exposing their chest. I will only ask you to expose the areas that I need to assess and then you can cover back up again. Is there anything I can do to make this easier for you?”
Contextualizing Inclusivity: Chest Binding
An inclusive approach to health assessment is vital because clients need to feel accepted for who they are. Some non-binary and transmasculine clients may wear a chest binder because they feel uncomfortable or distressed about having breast tissue. Binders are garments designed to flatten the appearance of the chest wall. They come in different forms and can extend from the chest down to the diaphragm or to the hips; they may look like a sports bra or tank top, and some clients may use compression bandages.
The binder needs to be removed to adequately listen to the lungs, as these sounds may be diminished through the binder. You may or may not be aware of whether the client you are assessing wears a chest binder, so you can apply an inclusive approach by acknowledging the vulnerability that clients may feel. Provide step-by-step instructions so that they are prepared, and ask nonjudgmental questions like, “Assessing your lungs requires me to assess on the bare skin on the front and back of your chest. Is there anything that would impede me from doing so?” You can also ask if they have any questions before beginning, e.g., “Do you have any questions before we begin?”
You should also assess the binder for proper fit: a good fit allows for normal chest expansion and deep breathing.
