During a comprehensive physical examination, a nurse evaluates a client's posterior thorax to determine diaphragmatic excursion. Arrange the following procedural steps of this specific percussion technique in the correct chronological sequence to accurately measure diaphragmatic movement. (Place the first step at the top and the final step at the bottom.)
- 1Position the client upright with arms crossed over the chest to separate the scapulae.
- 2Instruct the client to exhale forcefully and temporarily hold their breath.
- 3Percuss downward along the scapular line until the percussion note changes from resonant to dull, placing a mark at this level.
- 4Direct the client to take a deep inspiration and temporarily hold their breath.
- 5Continue percussing downward from the initial mark until the note again changes to dull, placing a second mark.
- 6Measure the vertical distance between the two marks using a centimeter ruler.
Answer
The correct sequence is: position the client, instruct them to exhale and hold, percuss downward to mark the upper boundary, instruct them to inhale and hold, percuss downward to mark the lower boundary, and finally measure the distance.
Measuring diaphragmatic excursion requires a precise sequence to map the full range of diaphragmatic movement. First, proper positioning (arms crossed) pulls the scapulae laterally to expose the posterior lung fields. The nurse must then determine the diaphragm's highest point by having the client exhale completely and percussing downward until the normal lung resonance changes to dullness (indicating solid tissue). Next, the lowest point is determined by having the client inhale deeply, expanding the lungs downward, and percussing from the initial mark until dullness is found again. Finally, measuring the distance between these two marks yields the total functional excursion.
Step-by-Step Solution
Key Concept
Percussion Techniques: Measuring Diaphragmatic Excursion