The nurse is examining a client for tactile fremitus. The nurse recognizes that when examining for tactile fremitus it is important to:
A.
Have the client breathe quickly
B.
Palpate the chest symmetrically
C.
Ask the client to cough
D.
Use the bell of the stethoscope
The correct answer and Explanation is :
Correct Answer: B. Palpate the chest symmetrically
Explanation:
Tactile fremitus is a clinical assessment technique used by healthcare professionals to evaluate the vibrations produced by the voice as they travel through the chest wall. The vibrations can be felt through the hands placed on the patient’s chest, and this helps in assessing conditions affecting the lungs or pleura.
Importance of Symmetrical Palpation
When assessing tactile fremitus, palpating the chest symmetrically (option B) is crucial. This is because tactile fremitus is normally symmetrical on both sides of the chest, and any asymmetry may indicate pathology. The nurse places both hands on equivalent areas of the chest (e.g., both sides of the upper or lower chest) and asks the patient to say a simple phrase, typically “ninety-nine” or “blue moon.” The vibrations are compared between the two sides of the chest, moving down symmetrically to cover all lung fields.
Rationale for Incorrect Options:
- Option A (Have the client breathe quickly): This is not relevant to the assessment of tactile fremitus. Tactile fremitus is not related to the speed of the client’s breathing but to the vibrations generated by vocal sounds.
- Option C (Ask the client to cough): Coughing is not part of the tactile fremitus assessment. It may be useful in clearing airway secretions but does not directly affect fremitus.
- Option D (Use the bell of the stethoscope): The bell of the stethoscope is used for auscultating low-pitched sounds. However, tactile fremitus is assessed by palpation, not auscultation.
Tactile fremitus can be diminished or increased depending on underlying lung conditions. For example, increased fremitus may suggest lung consolidation, as seen in pneumonia, while decreased fremitus can be caused by pleural effusion or pneumothorax. Therefore, symmetrical palpation is vital in identifying such abnormalities.