Lung sounds question....

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    I sometimes have a difficult time distinguishing lung sounds. A person with pnuemonia...should there be deminished lung sounds, what about people with CHF? Which patients would you hear crackles, ronchi in? Thanks for your help.
  2. 7 Comments so far...

  3. 5
    Lung sounds are not always the same in everyone. Even two people with the same diagnosis might sound different, but here are just a few points that I have learned along the way. Usually the COPD patients are diminished. Some to the point that you barely hear lung sounds at all. CHF patients are usually the ones that sound "wet" ( they need lasix IV when its that bad ). They can have various sounds depending on how sick they are. Usually you will hear rhonci and rales. Some nurses/ facilities interchange the descriptive words rhonci, rales, crackles. Rales and crackles are the same, they mean it sounds wet and crackly. Rhonci sound like leather rubbing together. Pneumonia patients may have a smorgasborg of sounds. I have also heard pneumonia patients that lung sounds are pretty much clear, but the xray shows infiltrates. Ususally these are the ones that after a few breathing treatments and meds they start to loosen up. Hope i helped you at least a little and didn't confuse you!!!!
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    Thank you, this info makes sense:wink2:.
    Quote from trmr
    Lung sounds are not always the same in everyone. Even two people with the same diagnosis might sound different, but here are just a few points that I have learned along the way. Usually the COPD patients are diminished. Some to the point that you barely hear lung sounds at all. CHF patients are usually the ones that sound "wet" ( they need lasix IV when its that bad ). They can have various sounds depending on how sick they are. Usually you will hear rhonci and rales. Some nurses/ facilities interchange the descriptive words rhonci, rales, crackles. Rales and crackles are the same, they mean it sounds wet and crackly. Rhonci sound like leather rubbing together. Pneumonia patients may have a smorgasborg of sounds. I have also heard pneumonia patients that lung sounds are pretty much clear, but the xray shows infiltrates. Ususally these are the ones that after a few breathing treatments and meds they start to loosen up. Hope i helped you at least a little and didn't confuse you!!!!
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    Rhonchi sound very coarse like snoring,: rales /crackles like you would hear if you rubbed your hair together( if it's long enough!) finer- usually denotes fluid; different sounds under different conditions, and many times within the same patient.ie wheezes,diminished sounds.

    The important thing in your assessment is differentiating what is normal vs, abnormal and what has changed in the assessment for that patient in the big picture of whether that pt is improving or decompensating
    smstar1996 likes this.
  6. 3
    I too had a very hard time differentiating between lung sounds. I would hear things nobody else would, and was the only thing i really struggled with when i started. A good way to help you would be get someone else to listen too, determine what you think you heard.. chf, usually crackly and wet sounding, sometimes you won't hear any air movement if they are totally full. Try some online sites as well, there are a few out there that have sound files that you can listen too. here's a decent site, there are more out there

    http://www.stethographics.com/main/p...roduction.html
    NurseDawgJess, smstar1996, and sirI like this.
  7. 1
    Quote from smstar1996
    I sometimes have a difficult time distinguishing lung sounds. A person with pnuemonia...should there be deminished lung sounds, what about people with CHF? Which patients would you hear crackles, ronchi in? Thanks for your help.
    In lobar pneumonia, infection in lung parenchyma leaves alveolar membrane edematous and porous. RBCs and WBCs pass to alveoli; alveoli fillup and become consolidated with bacteria, solid cellular debris, fluid and blood cells (these all replace alveolar air). This results in decreased surface area of the respiratory membrane.
    Breath sounds are louder with patent bronchus, as if coming directly from larynx. Voice sounds have increased clarity, bronchophony, egophony, whispered pectoriloquy present. And there can be adventitious sounds - crackles (fine to medium).
    all4schwa likes this.
  8. 0
    Quote from GingerSue
    In lobar pneumonia, infection in lung parenchyma leaves alveolar membrane edematous and porous. RBCs and WBCs pass to alveoli; alveoli fillup and become consolidated with bacteria, solid cellular debris, fluid and blood cells (these all replace alveolar air). This results in decreased surface area of the respiratory membrane.
    Breath sounds are louder with patent bronchus, as if coming directly from larynx. Voice sounds have increased clarity, bronchophony, egophony, whispered pectoriloquy present. And there can be adventitious sounds - crackles (fine to medium).

    GingerSue, you forgot to add a reference from Jarvis inc. for that detailed explanation ahah, kidding. I would accuse you of copyright if you hadn't have spelled fillup as one word
  9. 1
    Check out this thread in the CCU forum: Helpful Information for the Unit

    Many links on breath sounds including the link posted by nursemoons14 (thank you).
    smstar1996 likes this.


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