In assessing tactile fremitus in the client with suspected pneumonia, the nurse should perform which action?
A.
Looking at the client from the side, observe the size and shape of the chest wall.
B.
Use the fingertips to compress tissue over the lungs for evidence of a crackling sensation.
C.
Place the palm of the hand on the chest wall to feel vibrations while the client speaks.
D.
Use a stethoscope to listen to and compare breath sounds anteriorly and posteriorly.
The correct answer and Explanation is :
The correct answer is C. Place the palm of the hand on the chest wall to feel vibrations while the client speaks.
Explanation:
Tactile fremitus is a clinical technique used to assess the presence and intensity of vibrations transmitted through the lung tissues when a patient speaks. This assessment is valuable in diagnosing conditions such as pneumonia, where alterations in lung tissue density can affect the transmission of these vibrations.
How to Perform Tactile Fremitus:
- Positioning: The nurse should position the client comfortably, usually in a sitting or semi-sitting position. The nurse then places their hands, specifically the palms or the ulnar edges, against the patient’s chest wall, typically starting at the upper areas and moving downwards.
- Assessment: As the patient is asked to repeat a phrase, such as “ninety-nine” or “one-two-three,” the nurse palpates the chest wall to detect vibrations. The vibrations felt through the nurse’s hands are referred to as tactile fremitus. The intensity and quality of these vibrations can help indicate changes in lung or pleural tissue density.
- Interpretation: Increased tactile fremitus may be observed in conditions where lung tissue is consolidated, such as in pneumonia, due to denser lung tissue that transmits vibrations more effectively. Conversely, decreased tactile fremitus can be noted in conditions with pleural effusion or pneumothorax, where there is less dense or air-filled space between the lung and the chest wall.
Why Not the Other Options:
- Option A: Observing the size and shape of the chest wall is part of a general inspection but does not directly assess tactile fremitus.
- Option B: Compressing tissue over the lungs for a crackling sensation describes palpation for subcutaneous emphysema or other textures, not tactile fremitus.
- Option D: Using a stethoscope to listen to and compare breath sounds is a technique for assessing breath sounds, not tactile fremitus.
Tactile fremitus is a simple yet effective examination tool in the physical assessment of lung conditions, providing valuable diagnostic information about the underlying pathology affecting lung tissues.