Chapter 3 – Respiratory System Show
Auscultating the posterior and lateral thorax involves the following steps (see Video 3.5): Step 1: Perform hand hygiene and cleanse the stethoscope. Step 2: Ensure the client is in an upright position and ask them to take a big breath in and out through the mouth each time they feel the stethoscope on their posterior thorax.
Step 3:Place the stethoscope’s diaphragm on the chest in about four to eight locations on each side of the posterior thorax and then at three locations on the right lateral thorax and at two locations on the left lateral thorax so that you listen to all lung lobes. Make sure you have a complete seal. See Figure 3.11 for the placement pattern. The number of locations depends on the size of the thorax. For example, less locations are needed on a client with a smaller thorax (e.g., infants). Note that the posterior thorax is primarily lower lobes.
Figure 3.11: Placement pattern for auscultation of posterior thorax
Figure 3.12: Placement pattern for auscultation of lateral thorax Step 4: In each location, listen to one full respiration (inspiration and expiration) and compare air entry bilaterally. Step 5: Listen for the following:
NOTE: When a person takes a breath in, it takes time for the air to get to the periphery of the lung fields resulting in a long inspiration phase. When a person breathes out, the expiration phase is short with vesicular sounds because the breath leaves the periphery of the lung fields quickly. NOTE: Another type of normal breath sounds are bronchial sounds, which are heard over the tracheal area. These sounds are described as hollow sounds and harsh sounds, particularly upon expiration; the expiration phase is longer than the inspiration phase. These are heard over the trachea area, and are not heard on the posterior thorax except in the case of an underlying pathology. Audio 3.1: Normal breath sounds
Audio 3.2: Adventitious sounds: Wheezes
Audio 3.3: Adventitious sounds: Stridor
Audio 3.4: Adventitious sounds: Crackles Step 6:Note the findings:
Video 3.5: Auscultation of posterior and lateral thorax If a newborn or young child is sleeping, begin with auscultation. It is difficult to accurately listen to lungs when a client is crying. If a client is crying, consider ways to reduce this. For example, a newborn/young child will feel safer if the parent/care partner is engaged. You could have a young child play with your stethoscope so that it is familiar, or ask them to take a big breath and pretend they are blowing out birthday candles. Absence of air entry and stridor are considered urgent situations. You should notify another provider like a physician or nurse practitioner. If you think the stridor is caused by a foreign body that you can quickly remove, do so. Otherwise, follow the steps of the primary survey (check airway patency, measure respiratory rate, work of breathing, and oxygen saturation, assess pulse rate/rhythm, blood pressure, assess level of consciousness). If the oxygen saturations are low, apply oxygen if you are permitted to do so. With the presence of crackles and wheezes or decreased air entry, you should rely on the primary survey to determine whether there is a risk of clinical deterioration. You should also consider whether the wheezing is new onset and could be caused by a severe allergic reaction (i.e., anaphylaxis) and requires immediate intervention. If not, and the client is stable, you can move the head of the bed up to assist with breathing and continue the focused assessment on the respiratory system. Abnormal findings should be reported. When Auscultating a client's lungs The nurse notes the presence of adventitious sounds What action would the nurse do first?While auscultating a client's lungs, the nurse notes the presence of adventitious sounds. What action would the nurse do first? Have the client cough, then listen again.
What should you hear when Auscultating the lungs?Normal: There are two normal breath sounds. Bronchial and vesicular. Breath sounds heard over the tracheobronchial tree are called bronchial breathing and breath sounds heard over the lung tissue are called vesicular breathing.
What adventitious lung sound can you assess on a patient with pleurisy?Listen to stridor: Pleural rub may be heard on either inspiration or expiration and sounds like the rubbing together of leather. A pleural rub is heard when there is inflammation of the lung pleura, resulting in friction as the surfaces rub against each other.
What adventitious lung sound is heard most often in a patient with pneumonia?Crackles: Crackles commonly happen as a result of fluid accumulation in the lungs. Conditions such as pneumonia or left-sided heart failure may cause this buildup. Wheezing: Wheezing is a common symptom of conditions that narrow the small airways in the lungs, such as asthma and COPD.
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