Respiratory assessment question

paraloco · Dec 16, 2004

Hello fellow nurses. I'm a new nurse on a medical floor- listening to so many patient's lungs now, I still have a hard time distinguishing between rales and rhonchi. I get crackles though. My many research efforts only confuse the two and me- can anyone give me a good description for me? Documenting that the patient "sounds junky" isn't a solid enough description. Thanks!

Rales sound thin and watery, you usually hear them first in the lower lobes. History helps too. If the patient suddenly woke up in the middle of the night with dyspnea, has a history of hypertension and the associated meds, no fever, and JVD bilaterally, think rales. If you hear thick secretions in isolated patches, think rhonchi. Rales will be uniform. So, try this. Get a focused history first, then ascultate.

nursbee04 · Dec 20, 2004

Rales sound like little pops to me, rhonchi sounds coorifice and junky (I can't think of something besides junky) . One of my nsg instructors used to say rhonchi sounds kind of like blowing through a straw into milk.

I can't remember the site, but somewhere there is a website that lets you listen to heart and breath sounds online.

Someone please correct me if I am wrong (and how embarrassing if I am) but I was told in nsg school that rales and crackles are the same thing.

nursbee04 · Dec 20, 2004

try this site

breath sounds

This isn't the one I was thinking of but it is the first one I found. Click on the different sounds and there is an audio example.

Here is something I did as a new grad. When the respiratory therapists came around to do their assessment, I would listen and then they would listen, I would tell them what I heard and they would compare it to what they heard.

nursing04 · Dec 30, 2004

try this site
breath sounds
This isn't the one I was thinking of but it is the first one I found. Click on the different sounds and there is an audio example.
Here is something I did as a new grad. When the respiratory therapists came around to do their assessment, I would listen and then they would listen, I would tell them what I heard and they would compare it to what they heard.

Thanks for the advice! Great idea- I'll ask one of the resp therapists. It gets very confusing b/c it seems to me that many nurses are describing what they hear differently then each other and myself. But, I definitely need and want to find out that I am describing what I am hearing correctly. Thanks!

mitchsmom · Dec 30, 2004

They taught us in assessment that rales & crackles were the same... anyone know how to describe the difference offhand? I just looked in my book and they are also described in basically the same category there. My ausculation CDROM just has crackles.

kek · Dec 31, 2004

crackles and rhales sp? are the same thing as far as I know too. they can sound like - rub a few strands of your hair next to your ear - crackling/mid to high pithed popping. Rhonchi can also change or clear almost if you ask your patient to cough - as this is basically thick junky/green yukky stuff that would come up IF a person could cough a big enough cough to get it up through their nose or mouth.

I also used to ask the resp. therapist to listen to what I thought I had heard and to learn that way. What I was told once though is - people, nurses and even resp. therapists often don't agree on what they have heard on the same patient. So don't beat yourself up about it - but do take the whole patient history into account as this will/can guide you with what you are hearing.

nursing04 · Dec 31, 2004

crackles and rhales sp? are the same thing as far as I know too. they can sound like - rub a few strands of your hair next to your ear - crackling/mid to high pithed popping. Rhonchi can also change or clear almost if you ask your patient to cough - as this is basically thick junky/green yukky stuff that would come up IF a person could cough a big enough cough to get it up through their nose or mouth.
I also used to ask the resp. therapist to listen to what I thought I had heard and to learn that way. What I was told once though is - people, nurses and even resp. therapists often don't agree on what they have heard on the same patient. So don't beat yourself up about it - but do take the whole patient history into account as this will/can guide you with what you are hearing.

I think you are right I found a website that said crackles and rales are the same but crackles are high pitched, and fine, whereas rales are low pitches and course. So, it sounds like they are the same it just depends if you want to be more descriptive. I think I'm getting better as I continue to listed to more patient's lungs. Speaking of listening well, I was pretty proud that I discovered an aortic bruit in a pt that the docs had missed. Thanks everyone for your help!!