Sienna Rhodes
Listening to lung sounds is a vital part of a patient's assessment and a fundamental skill for nurses in clinical practice. This process, known as auscultation, involves using a stethoscope to listen to the sounds produced by the lungs and airways. Nurses must be competent in this skill to differentiate between normal and abnormal lung sounds, such as tracheal, bronchial, bronchovesicular, and vesicular sounds. Recognising these sounds helps nurses identify potential problems, monitor patient progress, and plan appropriate care. Correct stethoscope placement is essential for obtaining a quality assessment, and nurses should listen to sounds from side to side to compare symmetrical lung fields. Lung sound auscultation provides valuable insights into respiratory function, which is crucial for maintaining patients' overall health.
| Characteristics | Values |
|---|---|
| Objective | To differentiate various lung sounds to plan appropriate care |
| Tools | Stethoscope |
| Patient Position | Sitting upright; side-lying if acutely ill or unable to sit upright |
| Stethoscope Placement | Directly on the skin over designated auscultation areas, avoiding clothes, hair, bones, and female breasts |
| Lung Sounds | Normal, Bronchial, Vesicular, Adventitious, Wheezing, Rales, Stridor, Cheyne-Stokes |
| Patient Instructions | Take deep breaths through the mouth |
| Assessment Considerations for Children | Respiratory rate can range from 30 to 60 breaths per minute depending on activity; irregular breathing patterns in infants |
| Documentation | Findings are documented in the medical record, including respiratory rate, skin condition, presence of retractions or muscle use, and lung sound clarity |
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What You'll Learn
Recognising normal lung sounds
Normal lung sounds are the sounds produced by the lungs and airways during normal breathing. They are described as soft, blowing, or rustling sounds that can be heard in most lung spaces. These sounds are also referred to as "vesicular" or "clear to auscultation bilaterally". Vesicular lung sounds indicate that nothing is blocking the airways, and they are fully open and not narrowed, swollen, or inflamed. Normal lung sounds can be heard over the majority of the lung fields.
To recognise normal lung sounds, nurses should follow certain procedures. Firstly, instruct the patient to take deep breaths through their mouth. Listen through the entire respiratory cycle, as different sounds may be heard during inhalation (inspiration) and exhalation (expiration). Move the stethoscope across different lung fields, as the sounds produced by airflow vary depending on the area being auscultated due to changes in airway size. Ensure correct placement of the stethoscope to obtain a quality assessment. Do not place it over clothes, hair, or bones, as these can create inaccurate sounds from friction. The best position for listening to lung sounds is with the patient sitting upright. However, if the patient is acutely ill or unable to sit upright, they can be turned side to side in a lying position.
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Identifying abnormal sounds
Recognising abnormal lung sounds is a critical skill for nurses. Auscultation, or listening to lung sounds using a stethoscope, is a fundamental part of nursing practice. It is important to be able to differentiate between normal and abnormal lung sounds to identify potential problems and monitor patients' progress.
Normal lung sounds are soft, blowing, or rustling sounds that can be heard in most lung spaces. They are also called vesicular lung sounds. Vesicular lung sounds usually mean that nothing is blocking the airways, and they are fully open and not narrowed or swollen.
Abnormal lung sounds, on the other hand, can indicate various conditions and diseases. These sounds are often described as adventitious and can be continuous or non-continuous, musical or non-musical, and dry or wet. The five most common abnormal lung sounds are:
- Wheeze/Sibilant rhonchus: A continuous, high-pitched hissing sound, often heard when breathing out but can sometimes be heard during inhalation as well. It indicates a narrowed airway that limits airflow and is commonly associated with asthma or COPD.
- Rhonchi: Continuous, low-pitched sounds, often heard during exhalation. It may sound like snoring or gurgling and can move around the chest when the patient coughs, indicating mucus movement.
- Stridor: A harsh, high-pitched sound caused by a blockage in the upper airway or constriction of the upper airway. It is considered a medical emergency.
- Rales/Crackles: Discontinuous, interrupted, or explosive lung sounds that may sound like pulling Velcro apart. They are caused by air passing through the alveoli or tiny air sacs in the lower lungs.
- Pleural rub: A rough, grating sound caused by the inflamed lining of the lungs (pleurae) rubbing against each other. It is usually louder than other lung sounds as it is generated closer to the chest wall.
Other less common abnormal lung sounds include Cheyne-Stokes lung noises or the "death rattle," which includes wheezes, rattles, and high-pitched whistles, indicating the respiratory system is struggling to meet the body's oxygen demands.
It is important to note that while lung sounds are a useful tool in predicting chest pathology, a diagnosis should not be based solely on lung sounds. Other information, such as patient symptoms, health history, and additional tests, are necessary for an accurate understanding of the underlying condition.
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Correct stethoscope placement
Auscultation is a technique used by nurses to listen to the internal sounds of the body, such as the heart, lungs, and bowel sounds. This is done using a stethoscope, which is placed flat on the body at different locations corresponding to different organs.
To correctly place the stethoscope for listening to lung sounds, it is important to first instruct the patient to breathe deeply through their mouth. This makes it easier to listen to lung sounds, especially if there is any nasal congestion or obstruction. It is also important to ensure that the stethoscope is placed directly on the skin and not over clothes or hair, as this can create inaccurate sounds from friction. The best position for the patient is sitting upright, but if they are acutely ill or unable to sit, they can lie on their side.
The stethoscope should be placed at various locations on the chest to listen to all lung lobes. On the posterior thorax, the stethoscope's diaphragm should be placed at four to eight locations on each side, and on the right lateral thorax, it should be placed at three locations (right upper, middle, and lower lobes), and on the left lateral thorax, it should be placed at two locations (left upper and lower lobe).
It is important to listen to sounds from side to side, rather than down one side and then the other, to compare sounds in symmetrical lung fields. Nurses should also be aware of the different types of breath sounds, such as bronchial and vesicular, and be able to identify any abnormal or adventitious sounds, such as wheezes, rattles, or high-pitched whistles, which could indicate a medical emergency.
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Patient positioning
When listening to lung sounds, the patient should ideally be positioned in an upright, seated position. This ensures optimal sound transmission and allows for a comprehensive assessment of the lungs. The patient should be instructed to breathe a little deeper than normal through the mouth, allowing the healthcare provider to listen through a full cycle of inspiration and expiration.
However, if the patient is acutely ill or unable to sit upright, an alternative position is to turn them side to side in a lying position. This ensures that the vulnerable lower lobes of the lungs can be assessed before the patient becomes too fatigued.
It is important to avoid listening over bones, such as the scapulae or clavicles, as this can interfere with sound transmission. Additionally, in female patients, the stethoscope should not be placed over the breasts for the same reason.
During auscultation, the healthcare provider will typically follow a stepladder pattern, listening to the same location on both the right and left sides of the chest before changing positions. This allows for a direct comparison of the sounds in symmetrical lung fields.
Overall, proper patient positioning during auscultation is crucial for accurately assessing lung sounds and making informed clinical decisions.
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Lung sound documentation
To obtain a quality assessment, correct placement of the stethoscope is important. It should not be placed over clothes or hair, as this may create inaccurate sounds from friction. The patient should be sitting upright where possible, and the nurse should listen to sounds from side to side, rather than down one side and then the other. This allows for a comparison of sounds in symmetrical lung fields.
There are two types of breath sounds: bronchial and vesicular. Bronchial sounds are heard over the trachea, and vesicular breath sounds are heard over the lung fields. Normal lung sounds are soft, blowing, or rustling, and can be heard in most lung spaces. Nurses should be able to differentiate these from pathological sounds such as rhonchi, wheezing, stridor, or rales. Wheezing sounds are typically caused by inflamed lung tissue and are often heard in patients with asthma or COPD. Rales, or crackling lung sounds, are caused by air passing through the alveoli in the lower lungs. Stridor, a harsh, high-pitched sound, indicates a medical emergency and requires immediate treatment.
When documenting lung sounds, nurses should note the type of sounds heard, their location, and any absence of expected sounds. For example, documentation might state: "Normal vesicular breath sounds heard over the majority of the lung fields. No adventitious sounds noted. No wheezing, crackles, rhonchi, or stridor." This indicates that the expected sound (vesicular) was heard, specifies its location, and notes the absence of any additional (adventitious) sounds.
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Frequently asked questions
Listening to lung sounds is a vital part of a patient assessment. Nurses must be competent in assessing a patient's lung sounds to be able to differentiate between normal and abnormal sounds and plan appropriate care.
Nurses use a stethoscope to listen to lung sounds. The stethoscope should be placed directly on the skin over designated auscultation areas. The patient should be sitting upright, and the nurse should listen through the entire respiratory cycle as different sounds may be heard on inspiration and expiration.
Normal lung sounds are soft, blowing, or rustling sounds that can be heard in most lung spaces. There are two types of breath sounds: bronchial and vesicular. Bronchial sounds are heard over the trachea, and vesicular sounds are heard over the lung fields.
