Lung Sounds - Im confused

[Fairlythere, ASN, RN]

Hey all, I am a new RN on a med-surg floor. Mostly medical with COPD'rs, Pneumonia, empyema, etc. So we do computer charting. Almost everyone's assessment seems to have DECREASED under lung sounds. Or fine crackles/wheezes.

Am I just deaf or what? I listen in the bronchial area, I may hear inspiratory wheezes or "rhonchi" from gunky phlegm, or just nice clear sounds. I listen on the L and R anterior, I hear em breathe in, I hear em breathe out. I listen down both the L and R sides of the posterior. Same thing. How the heck do you know if its decreased if it sounds the same on both sides? I know what a "crackle" sounds like, and occasionally I hear em. The other day I heard the weirdest sound, like a rub. Still, I get back to chart and all I see is "decreased, decreased bilateral, fine crackles" Shift after shift.

I guess I need to find a pulmonologist and get another lesson. It seems there are even arguements over what to call the lung sounds now.

Is anyone else confused??

[EricJRN, MSN, RN]

I hear what you're saying! It's no easy task to differentiate normal from abnormal, or slightly abnormal from very abnormal. The lingo seems to vary a lot too. The crackles thing is a good example - all kinds of terms (moist, wet, dry, fine, coorifice).

Lately when I'm trying to describe sounds to another nurse or doc, I've just gotten away from the whole terminology contest. I'll often say, 'I hear velcro' or 'I hear bubbles' and leave it at that. Don't write that on your chart though.

[rninme]

Diminshed or decreased - I hear little air movement when I ask the patient to take a deep breath.

Rhonchi -- usually clears with a cough. Rales does not.

A wheeze is "musical" - usually but not always heard on pt's with "twitchy airways"....i.e. asthma.

With rales you can sometimes hear a "pop" when the airway opens at end-inspiration. If you hear "snap-crackle-pop" ... it's rales.

Remember....rhonchi is "junk" in the airways.....rales is fluid...wheeze is narrowing....a sound like leather rubbing together is a pleural friction rub.

Get a good lung-assessment audio tape and listen to difference. Hope this helps.

[cardiacRN2006, ADN, RN]

I don't think you're confused. I think you are assessing your pts and maybe some of the previous nurses aren't. I noticed this a lot in clinicals at certain hospitals. It was always clear BS dim at bases-documented over and over, shift after shift. If possible I make my pt sit up or roll and listen all over. In clinicals, the nurses would laugh at me and tell me I'll get lazy like them. They told me a time will come when I don't do as thorough of an assessment as I did when I was a student. I obviously, chose not to work there.

I once heard a rub on my heart sounds, and reported it to the nurse. She told me that she didn't hear it and the pt was fine. I asked my clinical instructor to verify if what I was hearing was a rub and she agreed. Next thing I knew, that nurse included it in her assessment and timed it before mine-which was already charted (computer charting can change time of assessment). So now it looks like I'm copying her assessment!

Yesterday, I had to take over an assignment of another nurse and she had documented lung sounds dim throughout. I listened (as well as my preceptor) and head rhonchi everywhere. Come to find out that the pt had not been suctioned all day (vented). But, that was after the chest tube was placed because our pt had a pneumo after dropping a swan in him. That was not caught by the previous nurse because she didn't listen to lung sounds after placement. What a mess!

Document what YOU hear when you are doing your assessment.

[beckabeckahi]

I always document what I hear, and it doesn't always agree with previous shift. There are even mix ups sometimes with what I get in report vs. what has been documented. I have even gotten in report rales, rhonchi, diminished, whatever and then see clear written on the previous assessment. I'm new too, but I trust myself that I do hear what I hear.

[sirI, MSN, APRN, NP]

hello, fairlythere,

check out these links. might help you with this.

http://www.wilkes.med.ucla.edu/intro.html heart and breath sounds

http://www.rale.ca/recordings.htm breath sounds

[RGN1]

Hehehe! Come to the UK - we are neither taught to assess for lung sounds & neither do we listen for them - that's the docs job!! Only exception is clinincal nurse specialists in critical care/respiratory - they learn.

Only down-side...I'm gonna have to learn when I get to the USA! So thanks for the links Siri!

[sirI, MSN, APRN, NP]

you are welcome, rgn1

[studentnurse74, LPN, LVN]

hello, fairlythere,

check out these links. might help you with this.

http://www.wilkes.med.ucla.edu/intro.html heart and breath sounds

http://www.rale.ca/recordings.htm breath sounds

thanks for the links! helpful! i thought i was hearing dim bases on 90% of the patients, and asked my preceptor if everyone is diminished or is it just me? she laughed, and said people usually are when they're in the hospital. i also learned to chart what you hear, someone may chart rhonchi, and it sounds clear to you. well, they could have coughed or had rt in there before your assessment and now they are clear. i'm learning to trust my judgement, but need more education on naming the types of lung sounds.

[RNLisa]

My last clinical day Spring quarter (I graduated in June), we did a 12 hour clinical day, and my last assessment was the first assessment of the LPN coming on for an 8 hour shift. I distinctly heard wheezing in the upper lobes with diminished in the bases. My nurse from the 1st shift had concurred. The LPN that came on did her assessment after me, and she literally came at me with attitude. She said and I quote "You are wrong, those lung sounds are rales". I said, "I didn't hear rales, I heard a few wheezes". She went to the nurse manager and said she wanted to change my charting!!! Can you believe that? The nurse manager said "You cannot change someone's charting, if that is what she heard, then that is what she heard and you just chart what YOU heard". So, actually feeling bad, I went up to the LPN and said "I am sorry, I really did hear wheezes". She told me to go listen again, and guess what?? I heard wheezes again. She got very angry with me and told me "Is this your last clinical? Well, good luck as a nurse, you'll need it". I had my instructor in there and she head the same as me. So, I don't know. Everyone interprets lung sounds alittle differently, but wheezes and Rales really don't sound alike.

[bleppity]

I have trouble with breath sounds too. Does anyone know the name of a CD that is good? Would like one that covers heart sounds as well.

[cardiacRN2006, ADN, RN]

Do you work anywhere as a CNA or a tech? I listened to every pt's heart and lungs sounds that I could as a tech. All the nurses knew that I was a nursing student, and anytime something was abnormal they called me over. Of course, you need to be comfortable knowing what a normal breath sound/heart tone is first. What kind of stethoscope do you own?