Lung auscultation question

[lauderek]

Hi all, I am a nursing student going to my pre-grad in Jan. I have a question that bothered me for so long and I'm too scared to ask my instructor.

I often can't hear any lower lobe lung sounds. Like, 90% of the pts I auscultated I can't hear any lower lobe lung sounds. However, I see other nurses charted "A/E to bases bilat" for those pts. I don't think I have any hearing problems as I am able to hear upper lobe lung sounds. So I am wondering, and I hope you guys can answer me honestly, do nurses just assume pts have air entry to bases as long as they don't hear any adventitious lung sounds?

I want to be a better nurse, that's why I want to solve this puzzle I had for years. If there are really something wrong with my hearing or skills, I wanted to know.

Derek

[Bec7074]

Diminished lung sounds are what we call it when we don't hear much air moving. Lungs can be both clear and diminished. Are you sure you are placing your stethoscope the in correct location? Try listening to their back if possible...sounds are usually louder from the back as the diaphragm and/or distended bellies aren't in the way. Also, have you tried Googling lung sounds? I used to have an iPhone ap when I graduated that played a small sound bite of a variety of conditions. Just give it time. Soon those will be easy and you'll be moving on to something else...like heart sounds :)

Also, sometimes I find myself comparing sounds. For example, if I've cared for a pt for 8 hours and upon my last assessment I find the lungs are the clearest they've been, I have to remind myself they are still diminished just clearer. I usually chart a comment that says something like "increased air movement since previous assessment." you could ask a professor or respiratory therapist for more help.

[sbostonRN]

Are you listening to posterior sounds? They are easier to hear. Try listening on a totally normal person, like a classmate or a family member. Then you will know where the bases are located related to external parts, like the base of the scapula. Many hospitalized patients in my facility have diminished bases so you may well be picking up on some acute changes in condition.

[sbostonRN]

And don't be afraid of asking the patient to take a deep breath! That makes everything louder.

[sapphire18]

You should be able to hear lower lung sounds unless they are so diminished from atelectasis, pneumonia, etc. Where are you listening for them? I remember in nursing school learning the specific intercostal spaces to listen at; now I just know by look/feel where to listen.

[mappers]

Also, don't go too low. Lungs actually end a lot higher than a lot of people think. Lungs end around 7th rib. Look at this image.

Also remember to go to the side when you get low. Lungs taper away from the medial part of the body the lower they go.