Took a Peds/Infant assessment class today,.."homework" question,..

[BrnEyedGirl, BSN, MSN, RN, APRN]

Okay guys,.know you hate these questions,..took a Peds/infant assessment class as part of ER orientation,..which is good since I haven't taken care of kids since nursing school,..more than a few years ago,..here's what I'm supposed to ask "experienced nurses"....short and sweet,...define "rales" and "rhonci"??? ,.....perhaps I'm going to get different answers than I'm expecting???

I'm also supposed to find the pediatric doses for fentanyl, demerol and Morphine,..is this a trick question?,..or do I need a peds med book,.because all I can find is IM/SQ doses,..no IV???? Any comments??

[Myxel67]

Rales & thonchi--rales is same as crackles & result of moisture in the alveoli. Sounds like when you rub your hair together next to your ear--sort of like rice crispies in milk. Rhonchi are deep, low pitched "snoring sounds." resulting from large airway obstruction. At least that's what I remember. Both are called adventitious (sp?) breath sounds.

[canoehead, BSN, RN]

Rales are crackles and rhonchi are wheezes.

[prmenrs, RN]

from: http://pediatrics.aappublications.org/cgi/content/full/101/1/e13

Fentanyl

Indication: Pain

Dosage: IV: 0.5 µg to 2.0 µg/kg. Repeat dose as necessary for clinical effect.

Note: Higher doses may be necessary if the patient is tolerant.

Note: Rapid administration of fentanyl has been associated with both glottic and chest wall rigidity even with dosages as low as 1 µg/kg. Therefore, fentanyl should be titrated in slowly over several minutes.

WARNING: There is an increased incidence of apnea when combined with other sedative agents, particularly benzodiazepines. Be prepared to administer naloxone. Monitor the patient's vital signs and oxygen saturation. Be prepared to provide respiratory support.

The other ones are there, too.

[Myxel67]

Rales are crackles and rhonchi are wheezes.

Rhonchi and wheezing aren't the same. Wheezes are sort of high pitched whistling sounds produced by airway constriction & often can be heard even without a stethoscope

[prmenrs, RN]

Wheezes are usually heard on exhalation.

Rales are heard on inspiration. I think rhonchi are, too.

[canoehead, BSN, RN]

Perhaps it depends on where you train or work. We differentiate between fine and coorifice wheezing, and the coorifice sound like they are the same as your rhonchi description.

[morte, LPN, LVN]

wheezing is a bronchial issue, can be both inspiratory (sp) or expiratory(sp)

more common exp. .....important to doc which..and can sometimes be heard from several feet away....

[traumaRUs, MSN, APRN]

Here ya go - hope this helps:

"Wheezing noises are heard during inspiration, expiration or both. They are present when an airway is partially obstructed owing to secretions, mucosal swelling, or tumour tissue pressing on the passage. The sounds are gurgling noises heard on auscultation of the lungs with a stethoscope during inhalation or exhalation. The sounds are caused by the flow of air through thick mucous secretions in the larger air passages such as the bronchioles but can also be associated with smaller structures such as the alveoli.

Rhonchi can be heard in patients with chronic obstructive pulmonary disease (COPD) and acute or severe bronchitis. COPD is an all inclusive syndrome that stems from the reduction of surface area associated with emphysema and the production of mucous secretions, bronchospasm and inflammation associated with bronchitis."

http://en.wikipedia.org/wiki/Rhonchi

[brighella]

It was explained to me that wheezes are high pitched and can sometimes be heard w/o stethoscope, and that rales and ronchi sound pretty simmilar (the hair rubbing, rice crispy sounds described earlier) but with with rales it doesnt clear with coughing where with ronchi it can clear with coughing. My assessment instructor told us that if we hear rales/ronchi, we should have the pt cough to try and clear. After removing the stethoscope from the chest wall of course...talk about explosions in your ears if you dont.

Sarah

[TazziRN, RN]

After removing the stethoscope from the chest wall of course...talk about explosions in your ears if you dont.

Sarah

Off topic, but along this same line.....if you have a hard of hearing pt without aids, put the earpieces in the pt's ears and speak (normally, don't yell!) into the bell.

[checkb]

Generally, you will here wheezes/ rhonchi when a patient has an obstructive condition like COPD, asthma, etc. And rales with fliud in the lungs at the alveolar level, like CHF. You will hear both at the same time, on occasion. Now that you can identify them........Next question......Quiz time..........what do you do to tx the underlying condition?