Lung Sounds - Im confused

[Fairlythere]

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??

[Lurksalot, BSN, RN]

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??

I felt the same way until an excellent pulmonary doc took me on his rounds, and he made me a chart on how to desribe lung sounds. He explained that usually he does not find the nurse notes very helpful, and they are often inaccurate. I'll look for my paper he made and try to scan it to post here, but in the meantime, here is a link to a site that has a great chart and good explanations.

http://rnbob.tripod.com/breath.htm

The doc explained to me that he likes sounds described as R or L or B/L, upper or lower, "continuous" or "discontinuous". Discontinuous sounds like velcro being torn apart, a series of sounds linked together but still individual, which is most times crackles. Low pitch discountinuous are coorifice crackles, high pitched discountinuous are fine crackles. If it is continuous, is it high pitched or low pitched? High continuous is a wheeze, Low continuous is rhonchi, usually expiratory. High pitched inspiratory over the trachea is stridor, always an emergency, because when stridor is heard a good percent of the trachea is obstructed.

But check out the chart, it gives some good ways to figure out what you are hearing. I found following a kind of logarithm helped give better lung sound descriptions to the docs, and helped me be able to learn them better. HTH.

[leslie :-D]

i remember one time i noted coorifice rales bilat.

along w/ausculating, pt rr increased, accessory muslces and temp; abrupt onset.

i reported findings to md who quickly retorted- "they could be transmitted breath sounds!"....wth?

first time i had ever heard that term used.

still, additional s/s had to be eval'd.

anyone else hear of transmitted breath sounds?

i now know what they are.

i just can't differentiate between actual and transmitted, esp in absence of other symptoms.

leslie

[DarlinNurseRed]

I don't understand arguing about it, obviously something is wrong and needs to be addressed anyway. Sounds like the patient is getting very good nursing care and a good assessment if it is being noted. Just continue to do that good assessment.

Usually if I think it may be rhonchi, I ask the patient to do a little coughing to see if it clears.

[crb613, BSN, RN]

http://rnbob.tripod.com/breath.htm

Great site! Thanks!

[loriannlpn]

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.

Very well put... Thank you for that.