Adventitious Breath Spunds

  1. 0
    I was wondering if I could get a little help here.

    I'm completing my homework and there is a chart which lists some of the adventitious breath sounds that can be heart. It asks for a description, a clinical example and nursing interventions for each.

    I'm not understanding what they want for nursing interventions...I know they're asking what would I do if a patient had crackles heard when auscultating..but I'm not sure what I would do.

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  2. 8 Comments...

  3. 2
    Quote from vintageandrea
    I was wondering if I could get a little help here.

    I'm completing my homework and there is a chart which lists some of the adventitious breath sounds that can be heart. It asks for a description, a clinical example and nursing interventions for each.

    I'm not understanding what they want for nursing interventions...I know they're asking what would I do if a patient had crackles heard when auscultating..but I'm not sure what I would do.
    What are crackles caused by? What happens if crackles were heard throughout all lung fields? What medications or nursing interventions could fix this? (COUGH lasix, pulmonary toileting, getting pt ambulatory COUGH)

    Think what the breath sounds are telling you -- something is abnormal with your patient. Think about how the crackles rhonchi etc get there...then think about what you need to do.
    psu_213 and Esme12 like this.
  4. 0
    Thanks very much!
  5. 2
    Lasix is not a nursing intervention. You may have a prn order for it as part of a medical plan of care, though. Remember, NCLEX questions ask you about nursing interventions.
    turnforthenurseRN and Esme12 like this.
  6. 0
    Quote from GrnTea
    Lasix is not a nursing intervention. You may have a prn order for it as part of a medical plan of care, though. Remember, NCLEX questions ask you about nursing interventions.
    True, however if it is mentioned as a possible answer on NCLEX it is safe to assume that you do have an order.
  7. 2
    Not unless it says so in the body of the question, or the answer choice includes the words "as ordered." They catch people with that all the time!
    psu_213 and turnforthenurseRN like this.
  8. 0
    Nursing interventions should focus on what you will do for the patient if they have this particular problem. Assessments? Teaching?
  9. 1
    Nursing interventions are normally action words, verbs, something that nurses do. In the phrase "drug administration", administration is the intervention and not the drug.
    GrnTea likes this.
  10. 0
    OK, as a concrete example, if there are rhonchi, usually caused by secretions in the larger airways, a nursing action would be to instruct in deep breathing and coughing, monitor sputum quality and color, patient teaching on self care, and repeat as needed. Does that help?


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