Help - Lung Sounds

[heaverboo]

I've been a nurse for almost 3 years but patient's lung sounds have always been a challenge to me! Everyone just sounds normal. The only abnormal sound I can pick out is wheezing. Can anyone help? I had a patient yesterday who I knew they wernt normal, had a second opinion and said he had rhonci, crackles, rales. I'm just so lost when it comes to this. Help!

[GilaRRT]

Yeah, a confusing subject, and in many cases quite subjective. The first order of business is proper terminology. Crackles are ~ rales. However, many experts do not advocate for the use of the term rales in in official setting.

With that, you first need to identify "normal" sounds and where these normal sounds are located. (Tracheal sounds on the lung bases is a problem for example.) Tracheal, versus broncial vesicular, versus vesicular. Obviously, much of what you hear has to do with turbulent, transitional, and laminar air flow patterns.

Then, you can identify common abnormal sounds:

-Stridor

-Wheezing

-Rhonchi

-Crackles

-Pleural Friction Rub

Here is an interactive introduction on this topic:

http://www.meddean.luc.edu/lumen/MedEd/MEDICINE/PULMONAR/IMAGES/CD-LungSounds/mac/cugell-07july11.swf

[beachbutterfly]

Yeah I can definitely relate.When I was in NS I always had problems with hearing any abnormal or diminished sounds...so I went ahead and purchased a book with the CD that has many different types of abnormal sounds you can listen to....I think it is really great and it can definitely help you to get better in the lung assesment.

[leslie :-D]

Here is an interactive introduction on this topic:

http://www.meddean.luc.edu/lumen/MedEd/MEDICINE/PULMONAR/IMAGES/CD-LungSounds/mac/cugell-07july11.swf

great link, gila.

i have added it to my cyber library.

leslie:)

[GOMER42]

Depending on where you work, you may have really only heard 'normal' breath sounds.

[heaverboo]

I worked in orthopedics before taking this current job on a cardiac telemetry unit, which really gets any person who needs monitoring.

[Melodix]

Here is another site with sample lung sounds (and heart sounds) -

http://www.wilkes.med.ucla.edu/intro.html

[EMAJA1827]

that link was from melodix?? thanks a bunch! good information indeed. i will send it to my friends. much appreciated

[nursej22, MSN, RN]

After I investing in a better stethoscope I discovered a whole new universe of chest sounds. Working on a cardiac telemetry unit, you are gonna get CHF, pneumonia, asthma, pleural effusions, pneumothoraces, not to mention all the cardiac sounds.

[GilaRRT]

Glad people found the link helpful.

[heaverboo]

I have a littman stethescope, so don't have a cheap one. I listened to patient's lung sounds today of course doing my assessment, heard abnormal things but couldnt really describe them, ugh! Feel like i'll never be proficient at them!

[becembrie]

I have the same problem. The link was helpful. I know when what I am hearing is abnormal, but not always able to correctly state what the sounds are. I don't recall learning much about the various lung sounds in nursing school, but that was over 20 years ago, so my old brain may have just filed it somewhere. Thanks for the link and what a great question.