Respiratory Assessment

This lung sound is continuous, high-pitched with musical instrument sound that is polyphonic and occurs mainly during expiration but can be present with inspiration as well?

High-pitched wheeze

Percussion of the respiratory system

Resonant = normal

what does it mean if bronchial breath sounds are heard somewhere other than the trachea and bronchi?

possible pneumonia

R. Mainstem

shorter and more vertical (easier to aspirate)

vesicular breath sounds

soft, fine, breezy, low-pitched sounds heard over peripheral lung tissue long inspiration, shorter expiration -lowest pitched

fine crackles

sounds like hair moving between fingers -high pitch

course crackles

sounds like velcro -low pitch

hyper-resonant sound

that are louder and lower pitched than resonant sounds are normally heard when percussing the chests of children and very thin adults. Hyperresonant sounds may also be heard when percussing lungs hyperinflated with air, such as may occur in patients with COPD, or patients having an acute asthmatic attack. An area of hyperresonance on one side of the chest may indicate a pneumothorax.

abnormal breath sounds

-hearing "normal" breath sounds where they should not be heard

pericardial rub

-high pitched scrapping/scratching sound -rub may increase with exhalation -commonly heard after MI

stridor

-inspiration -high pitched whistle gasps

pleural rub

-low pitched, dry, squeaking grating sound -sounds like crackles -occurs during inspiration and expiration -pleural friction

rubs

-pericardial -pleural

lung anatomy

-right has 3 lobes -center lobe right side can only be assessed anteriorly -left has two lobes slightly smaller

things to address in health hx

-smoking -exercise -obesity -recreational drugs -etc.

resonant sound

over normal lung tissue are low pitched, hollow sounds heard over normal lung tissue.

where are bronchial breath sounds heard?

over the trachea

tactile fremitus

palpable vibration

normal bronchophony

patient says "99," normal transmission is muffled.

where are vesicular breath sounds heard?

peripheral lung fields

Age related changes in the respiratory system

-decrease in elastic recoil of the lung -loss of skeletal muscle strength in thorax and diaphragm -fibrosis in the alveoli -fewer functional capillaries -less effective cough -decrease in PO2

adventitious lung sounds

-crackles (course or fine) -wheezes (sibilant or sonorous)

Normal Breath sounds

-bronchial -bronchovesicular -vesicular

abnormal egophony

E will sound like an A

where to listen to the upper lobes

2nd ICS midclavicular line

where to hear the right middle lobe

4th ICS right side

where to hear the lower lobes

6th ICS-mid axillary

discontinuous breath sounds

<0.2 sec crackles, pleural friction rub

continuous breath sounds

>0.2 sec wheezing and stridor

bronchovesicular breath sounds

Breath sounds normally heard in the posterior chest between the scapulae and in the center part of the anterior chest in the adult; softer than bronchial sounds; about equal during inspiration and expiration -medium pitched

These type of breath sounds are found at the site of the bronchi and are located anteriorly at the 1st and 2nd intercostal space & posteriorly in between the scapulae?

Bronchovesicular

pigeon chest

Anterior displacement of the sternum

The right middle lobe is auscultated with the stethoscope where?

Anteriorly on the right at the 4th intercostal space

When auscultating the posterior part of the chest the upper lobes are found?

Between C7 to T3

Select all of the following that are considered discontinuous breath sounds: A. High-pitched wheeze B. Stridor C. Pleural friction rub D. Fine crackles E. Low-pitched wheeze F. Coarse Crackles

C. Pleural friction rub D. Fine crackles F. Coarse Crackles

True or False: Low-pitched wheezes are polyphonic sounds that can be cleared when coughing.

FALSE

True or False: The left lung has 3 lobes: left upper lobe, left middle lobe, and left lower lobe.

FALSE

You are auscultating a patient's lung sounds. During your assessment, you note there is a low-pitched harsh, grating sound that sounds like a pleural friction rub. However, you're not sure if this is a pleural friction rub or pericardial friction rub. What do you do next to determine the difference?

Have the patient hold their breath and note if the sound is still present

where are bronchovesicular breath sounds heard on the anterior side?

The 2nd and 3rd ICS

abnormal bronchophony

Increased lung density will enhance transmission of voice sounds; you auscultate a clear "ninety-nine"

While assessing a patient's lung sounds you note bronchial breath sounds in the peripheral lung fields. What could this finding represent?

Lung consolidation like with pneumonia

When auscultating the anterior part of the chest, specifically the apex of the lungs, it is best to auscultate where with the stethoscope?

Slightly above the clavicle

On auscultation of a patient in respiratory distress, you hear a high-pitched, harsh sound that is monophonic and is present only during inspiration. This is known as:

Stridor

True or False: During auscultation, the anterior part of the chest mainly provides an assessment of the upper lobes of the right and left lungs, while the posterior part of the chest provides mainly provides an assessment of the lower lobes of the right and left lungs.

TRUE

Bronchial breath sounds can be auscultated where?

Tracheal area

These breath sounds are found anteriorly and posteriorly throughout the peripheral lung fields?

Vesicular

normal egophony

You should hear "eeee" through your stethoscope"

sibilant wheeze

abnormal breath sound that is high pitched and musical in nature and is heard on expiration

sonorous wheeze

abnormal breath sound that is low pitched and snoring in nature and is louder on expiration

Dull or thudlike sounds

are normally heard over dense areas such as the heart or liver. Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors.

where to auscultate vesicular breath sounds?

best heard at the base of the lung fields

where to auscultate bronchial breath sounds

between clavicles and mid sternum, and over main bronchus

where are bronchovesicular breath sound heard posterior?

between the scapula

which breath sound is heard anteriorly only?

bronchial

upper respiratory system

nose, sinuses, pharynx, larynx, trachea -passage way for air, cleanses, humidifies, warms

Normal whispered pectoriloquy

faint, muffled, and almost inaudible

plural friction rub

grating sound or vibration heard during inspiration and expiration. *cause by inflamed pleura, does not clear by coughing.

bronchophony

have your patient say "99"

egophony

have your patient say "E"

whispered pectoriloquy

have your patient whisper 1,2,3

Where can bronchovesicular breath sounds be heard?

heard over large airways, either side of the sternum, at the angle of Louis, and between scapulae

R. Diaphragm

higher than the left side

how to distinguish between pericardial and pleural friction rub.

if the person holds their breath you will no longer hear the pleural friction rub.

abnormal whispered pectoriloquy

is when the whispered words are transmitted clearly and distinctly and sound as if person is whispering right into your stethoscope

palpating respiratory system

lungs should expand so that the thumbs move apart 5-10cm

lower respiratory system

lungs, bronchi, alveoli -respiratory membrane for gas exchange

bronchial breath sounds

normal breath sounds made by air moving through the bronchi -shorter inspiration, long expiration -shallow sounding -high pitch