Introduction to Lung Sounds & Auscultation
Lung sounds are detected by auscultation (listening via a stethoscope), and come from listening to the client inhale and exhale breaths. Becoming competent in auscultating lung sounds takes practice and knowledge of what sounds are normal and abnormal.
There are two types of breath sounds: bronchial and vesicular. Bronchial sounds are heard over the trachea, and vesicular breath sounds are heard on the thorax over the lung fields.
Adventitious lung sounds are described as abnormal. Various conditions will warrant different types of breath sounds. As a nurse, you need to know the different types of breath sounds and necessary nursing interventions.
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Wheezes can sound like a whistle which is caused by a narrow airway or “bronchoconstriction,” or inflamed lung tissue. Wheezing sounds typically come from clients experiencing asthma or COPD.
The two types of wheezing lung sounds are inspiratory and expiratory wheezes.
Inspiratory wheezing is a high-pitched blowing sound that occurs during inspiration. Usually this sound comes from the upper or middle portions of the lungs, and may be heard on both sides of the chest.
Expiratory wheezing occurs during expiration – however, it can be low and soft-pitched, making it more difficult to hear. Medications such as Albuterol, Ipratropium, or Methylprednisolone can be used to relieve wheezing.
Crackles can also be described as rales and come from “crazy fluid.” This sound comes from air moving through the tiny air sacs in the lower lungs, called alveoli. Alveoli are clusters of small, thin, fragile air sacs in the bronchial tubes inside the lungs. Crackles are the result of fluid-filled air sacs.
Fine or high-pitched crackles sound like rubbing hair between your fingers. Coarse or low-pitched crackling sounds like velcro pulled apart.
Crackles can be caused by any inflammation of the lungs, such as asthma, pneumonia, bronchitis, and emphysema. Treatment can include diuretics (furosemide) or antibiotics for infection.
Stridor is a sharp, high-pitched sound (or “serious squeak”) that occurs when the upper airway is narrowed or obstructed.
It indicates a medical emergency, and blockage in the larynx (voice box) or trachea (windpipe) needs to be addressed immediately. Stridor can be treated with emergency medical attention, including medications, endotracheal intubation or surgery.
Rhonchi can be described as a low-pitch continuous gurgling or bubbling sound. These sounds are caused by fluid movement and secretions in larger airways related to conditions such as asthma, and viral or upper respiratory infection. It is an easily recognizable sound and a sign that the client needs to cough to clear the airway.
Rhonchi can also be related to excess mucous secretions or obstruction from bronchitis, COPD, pneumonia, or cystic fibrosis. These conditions are often treated with chest percussion (vibration vest) and fluids to loosen mucus.
Pleural Friction Rub
Pleural friction sounds (also described as “pebbles friction”) are a type of lung sound from the front side of the lungs that occurs when the pleural layers rub against each other. It is described as low-pitched and can sound like two rocks grinding.
Pleural friction results from inflammation, which can be caused by various conditions such as pneumonia or lung cancer. These sounds are more common in older clients and those with emphysema. Causes of pleural friction sounds are treated with antibiotics.
Cheyne-Stokes is also known as the “death rattle,” It can be heard in the form of wheezes, rattles, and high-pitched whistles. These sounds are caused by the client’s respiratory system struggling to maintain enough oxygen to keep up with the body’s demands for oxygen.
This breathing pattern changes from deep to shallow, then becomes more shallow until it stops. This pattern may repeat a few times before the person goes into a deep sleep, followed by another period of normal breathing.
Cheyne-stokes are typically seen in clients with apnea, head injuries, and strokes. These causes are treated with intubation or mechanical ventilation.
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Lung Sounds & Auscultation Conclusion
Lung noises are heard through auscultation and come from the trachea and bronchial tubes. Nurses must be competent when assessing a client’s lung sounds in order to prioritize client care. The objective is to be able to differentiate various lung sounds as it relates to client conditions and to plan appropriate care.
The cause of wheezing lung sounds (inflamed lung tissue) is constricted airways, often known as bronchoconstriction. Clients with asthma or COPD frequently make wheezing noises.
Rales, or crackling lung sounds, are caused by air passing through the alveoli, or tiny air sacs, in the lower lungs.
When the upper airway is constricted or blocked, a harsh, high-pitched sound known as the stridor lung sound (or “serious squeak”) is produced. A client’s stridor signals a medical emergency, and any blockage in the trachea (the windpipe) or larynx needs to be treated right once.
The rumbling sound of bronchial lung sounds is a symptom of bronchial mucus accumulation (not alveoli). A sign that your client needs to cough up some phlegm, they are among the most distinct and unmistakable noises you will hear during auscultation.
Pleural friction noises, also known as “pebbles friction,” are a particular kind of lung sound that emanates from the front side of the lungs and is brought on by the friction of the pleural layers.
Cheyne-Stokes lung noises, also called the “death rattle,” include wheezes, rattles, and high-pitched whistles. This is because the client’s respiratory system is straining to keep up with the body’s demands for oxygen, which is the origin of these noises.