Need help in my peds home health case

[Alhebran]

I am assigned to a six year old non verbal child. I am having difficulty trying to identify her lung sounds. She has quite a lot of mucous in her nasopharyngeal area and she doesn't always cough the way a "normal child" would. When I listen to her, the sounds I identify seem to be very superficial, mostly reflecting the "snoring quality" of her breathing. Would I document this as rhonchi, even if it just seems to be an echo of her breathing? I'm so confused!!!!

[JustBeachyNurse, LPN]

Are you sure it isn't resonance of upper airway? Especially smaller children...if you can hear it over the trachea it can just be an echo into the lungs. I'm trying to think of how to articulate this...I was shown how to differentiate between true rhonci and resonnance of upper airway congestion but a couple of pulmonologists.

I'm going to move your post to the pediatric nursing forum. There are quite a few very experienced pediatric nurses who frequent that forum that I'm sure can offer some great suggestions and advice.

[JustBeachyNurse, LPN]

Do you have an order for nasopharyngeal suction or at least saline and a bulb syringe to clear nasopharyngeal secretions? I know if I listened after clearing as many secretions I could it was easier to differentiate if there were true rhonchi vs. resonance of upper airway/tracheal/nasal congestion

[smurfynursey]

So this might not be the best of ideas...but it works.

If she lets you, plug her nose (just for a breath) and see if it goes away. If it does, its all UAC.

[typoagain]

try listening just under and forward ot the ear. if it is UAC it often is a lot louder.