Lung Sounds: Diminished or Shallow?

[mommatrauma, RN]

Diminished lung sounds are just what it sounds like. It means that the normal lung sounds are decreased and harder to hear. Either because of poor inspiratory effort. Asthma can cause this before you hear the wheezing because of poor air flow. COPD, common to have decreased sounds. Could also be pneumonia, CHF, although you usually hear other than normal sounds with that, ie rhonchi or rales. Also, having a pneumothorax can cause decreased sounds...if they aren't absent.

[Dorito, ASN, RN]

Spider Cat said:

Can someone explain to me what diminished lungs are and what is the significance of this?? Everyone I ask either doesn't know or they just say it means you don't hear the usual clear swooshing in and out (probably not a good way to put it).

It can be several different things. Most commonly a COPD patient will have diminished lungs (or almost non existent breath sounds), also some surgical patients may be "diminished" because they are splinting and not taking deep enough breaths. You also may notice this in someone with pneumonia or fluid in their lungs (CHF) When you listen to enough lungs you'll be able to tell when someone is "diminished"

[KimberlyT]

Spider Cat said:

Can someone explain to me what diminished lungs are and what is the significance of this?? Everyone I ask either doesn't know or they just say it means you don't hear the usual clear swooshing in and out (probably not a good way to put it).

I am a new RN -- I start my first job in 2 weeks. At one of my nursing school clinicals, I had an experience with diminished lung sounds and it was very obvious, but only when I listened on both sides. I had a 2 year old boy with pneumonia and right pleural effusion -- basically, a big wad of gunk in his right lower lobe. When I listened on that side, I could hear breath sounds. When I placed my stethoscope on the left side, however, the breath sounds were MUCH louder. Honestly, I don't think I would have known if the sounds were reduced bilaterally since I could hear something on the reduced side, just not as loud. I think breath sounds are the kind of thing we will just have to get experience with. Not sure there's any substitute for it!

Good luck.

[Pipsqueak, ADN]

I had a patient that had a chest x-ray show bilateral infiltrates. When I assessed his lung sounds, the upper lung fields were clear and I could not hear any breath sounds in the bases. I mean not even slightly. Is that charted as diminished even though I couldn't hear any air moving?

[PennyLane, RN]

Here's a related question, since I don't have much experience to gauge this against: yesterday I had an obese female patient and her lungs sounds were diminished (to my ears). She was in quite a lot of pain, so she may not have been breathing very deeply. But I was wondering if it's 'normal' to hear diminished lung sounds in an obese person? My thinking is that there's so much tissue between your stethoscope and the lungs that the sound doesn't carry as well.

[zacarias, ASN, RN]

A caveat too is when we chart "diminished lung sounds in the bases". The bases are the very end of the vesicular tree so really it is normally for those sounds to not be very loud; Essentially, diminished in the bases is kinda normal.

[leslie :-D]

zacarias said:

A caveat too is when we chart "diminished lung sounds in the bases". The bases are the very end of the vesicular tree so really it is normally for those sounds to not be very loud; Essentially, diminished in the bases is kinda normal.

that's very true- you have to look at the big picture, i.e., if the pt. is presenting with any s/s. but when you compare one base to another, that's when the assesment of diminished comes in.

also crackles at the bases can be someone's baseline if they do not ambulate or just don't expand their lungs. there are sev'l factors to be taken into acct when auscultating lung sounds.

and then of course, there are always the transmitted breath sounds which makes it twice as challenging to properly assess.

leslie

[butterflynurse03, RN]

Spider Cat said:

Can someone explain to me what diminished lungs are and what is the significance of this?? Everyone I ask either doesn't know or they just say it means you don't hear the usual clear swooshing in and out (probably not a good way to put it).

When a patient has diminished breath sounds this means that you can hear the breath sounds but they are quiet. This can be due to poor inspiratory effort on the patient's part or it may a a sign of impending pleural effusions. Either way, encourage your patient to improve their efforts, continue to monitor, and be sure to document your assessment.

[butterflynurse03, RN]

Pipsqueak said:

I had a patient that had a chest x-ray show bilateral infiltrates. When I assessed his lung sounds, the upper lung fields were clear and I could not hear any breath sounds in the bases. I mean not even slightly. Is that charted as diminished even though I couldn't hear any air moving?

No, lack of air movement would definitely qualify as ABSENT lung sounds, which is much more clinically significant than diminished sounds. Don't get me wrong, both are important, but the one may be more critical than the other at that point in time.

[paga, RN]

I'm a new grad RN from Ca. It's my first job as a nurse, a client becomes lethargic, restless, 02 sat shows 87%, but V/S normal. I charted diminished lung sounds and requested CXR to be done. How do I really hear a diminished lung sounds, he's on dialysis and has a non healing wound at the back. maybe because he's in too much pain or just tired of the dialysis, or there is impending S/S of pneumonia or atelactasis whatever.

[FreshRN05]

paga said:

I'm a new grad RN from Ca. It's my first job as a nurse, a client becomes lethargic, restless, 02 sat shows 87%, but V/S normal. I charted diminished lung sounds and requested CXR to be done. How do I really hear a diminished lung sounds, he's on dialysis and has a non healing wound at the back. maybe because he's in too much pain or just tired of the dialysis, or there is impending S/S of pneumonia or atelactasis whatever.

Question on order??? I'm also a new grad and will be starting my job in a local hospital near my house. I'll be going to ER overflow unit (patients waiting to be placed in proper units..ei Tele, med surg...), so I'll be seeing a lot of patients with lots of different problems. Anyhoo, when you say after you assessed your patient and the patient had the above findings you ordered CXR. Is this an order that an RN can carry without a Dr's order/approval or do you wait until ordered by the Doctor? This is where I get confused, which tests an RN can order...Thanks...

[paga, RN]

Upon assessment and history of the patient, a nurse can recommend to the doctor labs to be done especially if the doctor is just on the phone. A nurse assessment and recommendation is the doctor's guide in treating the patient, remember the nurse spend more time with the client rather than the doctor.