[lisa41rn]

It seems like all I see on flowsheets is "lung sounds diminished" or "clear" for the older folks (and others) who have a hard time taking a deep breath. I see docs go in and listen on the front of the chest for patients who are difficult to turn, but that just doesn't work well for me. I have a great electronic stethoscope, but really want an idea from other nurses out there!! There are some great websites where you can hear crackles, etc., but when a patient doesn't take deep breaths, it makes it tough sometimes to hear accurately. Any ideas? Thanks.

[suzanne4]

If the patient cannot take a deep breath, then you are not going to hear good air exchange in the lower lung fields, so yes, those would be called diminished. Even if they have poor air exchange, if there are crackels throughout, you are going to hear it. Remember that crackles always start low and move up, you are never going to have them just in the upper lobes without having them lower. If you are hearing them in the upper fields as well, then they have crackles that need to be treated.

[truern]

http://www.emory.edu/WHSCL/grady/inetgrp/hplung.html

[Daytonite]

http://sprojects.mmi.mcgill.ca/mvs/mvsteth.htm - This is the Virtual Stethoscope. You need to click on Physical Exam for Pulmonary and then "Go There!" It shows you the places to put your stethoscope and just where the lungs lie in relation to the outside appearance of the body. There is a description of normal, abnormal and adventitious breath sounds.

You just have to listen to many, many lungs. The sounds are so subtle sometimes that you really have to listen closely to figure out exactly what you're listening to. Sometimes it's just where you place your stethoscope. If the patient is breathing shallowly, try placing your scope a little higher on the chest. Remember, that unlike fluid, air is going to go to the highest point it can because it is lighter than gravity, so take the patient's position and respiratory effort into mind as you are trying to find a good site to listen. I often found that getting the patient to laugh got them to take a deep breath--they just couldn't help it. It invariably resulted in a productive cough which helps to clear the lung passages so they are breathing better.

[Indy]

Originally Posted by lisa41rn

It seems like all I see on flowsheets is "lung sounds diminished" or "clear" for the older folks (and others) who have a hard time taking a deep breath. I see docs go in and listen on the front of the chest for patients who are difficult to turn, but that just doesn't work well for me. I have a great electronic stethoscope, but really want an idea from other nurses out there!! There are some great websites where you can hear crackles, etc., but when a patient doesn't take deep breaths, it makes it tough sometimes to hear accurately. Any ideas? Thanks.

You didn't mention, but do you work in a hospital? If so, respiratory techs can be your friends! I will sometimes ask them what they heard when I'm having a hard time with a patient. They seem to really like being asked for their expertise, especially from a nurse. One guy told me he's got a pre-wheeze, before his asthma kicks in. So I got behind him and listened. I didn't hear the wheeze but he corrected me on my auscultation technique.

It is possible to get a pretty good idea of lung sounds from the front, but it's more difficult in women and for me, complicated by telemetry wires (darn things are where I wanna put my scope!). If you get a little extra time, try it with coworkers for practice. One big thing to remember when listening from the front is to not forget the right lower lobe that you can access from under the arm in the front. Same for left lower lobe but you'll need to listen to heart sounds first to make sure you don't mistake some funky multi-valve regurg for a friction rub in the lungs.

When you are just stumped, ask someone else, also maybe look up the doctor's h & p and see what they heard. Note: That may not be accurate for acute care as lung sounds can and do change dramatically sometimes. If you don't hear much, it might be diminished. If you don't hear squat, check the battery in your scope, check again, then ask for someone else to listen - you might have a collapsed lung or a post lobectomy, or pulmonary edema. Don't be afraid to say what you hear.

What type of electronic do you use? I have the littman 4000 thing that runs on AAA's, but I started with a phillips.

[wt2001]

The Auscultation Assistant @http://www.med.ucla.edu/wilkes/inex.htm. You can also listen to heart sounds(systolic,diastolic,rub,and gallop) at this site. I hope this will help.