When assessing the thyroid gland you locate the isthmus where is the isthmus located?

The neck is inspected for position symmetry and obvious lumps visibility of the thyroid gland and Jugular Venous Distension.

Normal Findings:

1. The neck is straight.
2. No visible mass or lumps.
3. Symmetrical
4. No jugular venous distension (suggestive of cardiac congestion).

The neck is palpated just above the suprasternal note using the thumb and the index finger.

The neck is palpated just above the suprasternal note using the thumb and the index finger.

Normal Findings:

1. The trachea is palpable.
2. It is positioned in the line and straight.

• Lymph nodes are palpated using palmar tips of the fingers via systemic circular movements. Describe lymph nodes in termsof size, regularity, consistency, tenderness and fixation to surrounding tissues.

Normal Findings:

1. May not be palpable. Maybe normally palpable in thin clients.
2. Non tender if palpable.
3. Firm with smooth rounded surface.
4. Slightly movable.
5. About less than 1 cm in size.
6. The thyroid is initially observed by standing in front of the client and asking the client to swallow. Palpation of the thyroid can be done either by posterior or anterior approach.

1. Posterior Approach:

1. Let the client sit on a chair while the examiner stands behind him.
2. In examining the isthmus of the thyroid, locate the cricoid cartilage and directly below that is the isthmus.
3. Ask the client to swallow while feeling for any enlargement of the thyroid isthmus.
4. To facilitate examination of each lobe, the client is asked to turn his head slightly toward the side to be examined to displace the sternocleidomastoid, while the other hand of the examiner pushes the thyroid cartilage towards the side of the thyroid lobe to be examined.
5. Ask the patient to swallow as the procedure is being done.
6. The examiner may also palate for thyroid enlargement by placing the thumb deep to and behind the sternocleidomastoid muscle, while the index and middle fingers are placed deep to and in front of the muscle.
7. Then the procedure is repeated on the other side.

1. Anterior approach:

1. The examiner stands in front of the client and with the palmar surface of the middle and index fingers palpates below the cricoid cartilage.
2. Ask the client to swallow while palpation is being done.
3. In palpating the lobes of the thyroid, similar procedure is done as in posterior approach. The client is asked to turn his head slightly to one side and then the other of the lobe to be examined.
4. Again the examiner displaces the thyroid cartilage towards the side of the lobe to be examined.
5. Again, the examiner palpates the area and hooks thumb and fingers around the sternocleidomastoid muscle.

Normal Findings:

1. Normally the thyroid is non palpable.
2. Isthmus maybe visible in a thin neck.
3. No nodules are palpable.

Auscultation of the Thyroid is necessary when there is thyroid enlargement. The examiner may hear bruits, as a result of increased and turbulence in blood flow in an enlarged thyroid.

• Check the Range of Movement of the neck.

Lung borders

In the anterior thorax, the apices of the lungs extend for approximately 3 – 4 cm above the clavicles. The inferior borders of the lungs cross the sixth rib at the midclavigular line.

In the posterior thorax, the apices extend of T10 on expiration to the spinous process of T12 on inspiration.

In the Lateral Thorax, the lungs extend from the apex of the axilla to the 8th rib of the midaxillary line.

Lung Fissures

The right oblique (diagonal) fissure extend from the area of the spinous process of the 3rd thoracic vertebra, laterally and downward unit it crosses the 5th rib at the midaxillary line. It then continues ant medially to end at the 6th rib at the midclavicular line.

The right horizontally fissure extends from the 5th rib slightly posterior to the right midaxillary line and runs horizontally to thee area of the 4th rib at the right sternal border.

The left oblique (diagonal) fissure extend from the spinous process of the 3rd thoracic vertebra laterally and downward to the left mid axillary line at the 5th rib and continues anteriorly and medially until it terminates at the 6th rib in the midclavicular line.

Borders of the Diaphragm.

Anteriorly, on expiration, the right dome of the diaphragm is located at the level of the 5th rib at the midclavicular line and he left dome is at the level of the 6th rib. Posteriorly, on expiration, the diaphragm is at the level of the spinous process of T10; laterally it is at the 8th rib at the midaxillary line. On inspiration the diaphragm moves approximately 1.5 cm downward.

Inspection of the Thorax

For adequate inspection of the thorax, the client should be sitting upright without support and uncovered to the waist.

The examiner should observe:

1. 1. Shape of the thorax and its symmetry.
   2. Thoracic configuration.
   3. Retractions at the ICS on inspiration. (suprasternal, costal, substernal)
   4. Bulging structures at the ICS during expiration.
   5. position of the spine.
   6. pattern of respiration.

Normal Findings:

• The shape of the thorax in a normal adult is elliptical; the anteroposterior diameter is less than the transverse diameter at approximately a ratio of 1:2.
• Moves symmetrically on breathing with no obvious masses.
• No fail chest which is suggestive of rib fracture.
• No chest retractions must be noted as this may suggest difficulty in breathing.
• No bulging at the ICS must be noted as this may obstruction on expiration, abnormal masses, or cardiomegaly.
• The spine should be straight, with slightly curvature in the thoracic area.
• There should be no scoliosis, kyphosis, or lordosis.
• Breathing maybe diaphragmatically of costally.
• Expiration is usually longer the inspiration.

Palpation of the Thorax

1. General palpation – The examiner should specifically palpate any areas of abnormality. The temperature and turgor of the skin should be assessed. Palpate for lumps, masses and areas of tenderness.
2. Palpate for thoracic expansion or lung excursion.

A.Anteriorly, the examiner’s hands are placed over the anterolateral chest with the thumbs extended along the costal margin, pointing to the xyphoid process. Posteriorly, the thumbs are placed at the level of the 10th rib and the palms are placed on the posterolateral chest.

B.Instruct the client to exhale first, then to inhale deeply.

C.The examiner the amount of thoracic expansion during quiet and deep inspiration and observe for divergence of the thumbs on expiration.

D.Normally, symmetry of respiration between the left and right hemithoraces should be felt as the thumbs are separated are separated approximately 3 – 5 cm (1 – 2 inches) during deep inspiration.

1. Palpate for the tactile fremitus.

A.Place the palm or the ulnar aspect of the hands bilaterally symmetrical on the chest wall starting from the top, then at then medial thoracic wall, and at the anterolateral

B.Each time the hands move down, ask the client to say ninety-nine.

C.Repeat the procedure at the posterior thoracic wall.

D.Normally, tactile fremitus should be bilaterally symmetrical. Most intense in the 2nd ICS at the sternal border, near the area of bronchial bifurcation. Low pitched voices of males are more readily palpated than higher pitched voices of females.

E. Basic abnormalities like increased tactile fremitus maybe suggestive of consolidation; decreased tactile fremitus may be suggestive of obstructions, thickening of pleura, or collapse of lungs.

Percussion of the Thorax

Anterior thorax:

1. Patient maybe placed on a supine position.
2. Percuss systematically at about 5 cm intervals from the upper to lower chest, moving left to right to left. (Percuss over the ICS, avoiding the ribs. Use indirect percussion starting at the apices of the lungs.
3. The examiner notes the sound produced during each percussion.

Whispered Pectorioquy – Ask the client top whisper “1-2-3” Over normal lung tissue it would almost be indistinguishable, over consolidated lung it would be loud and clear.

Complete Head to Toe Assessment with Videos

What Do You Think?

What is the correct procedure for palpation of a client's thyroid gland?

What method is used to assess the thyroid gland quizlet?

When assessing the thyroid gland the nurse practitioner Palpates for abnormalities while asking the patient to?

Which structure in the neck is being examined when the nurse palpates the sternal notch with her finger?