Posterior Vs. Anterior lung sound ausculation

[luv2shopp85]

Do you think there is a difference with listening to lung sounds posteriorally vs. anteriorally? Is it necessary to listen to both sides every time you are checking lung sounds?

A lot of times I have patients in the hospital (i work on neurosurgical) and they will have a hard time turning over onto their side so I just listen to their lung sounds anteriorally only. Could I be missing something by not listening posteriorally as well?

Do you think hosp gowns muffle the lung sounds in any way? Sometimes I just listen right over the gown. I have a good stethoscope -LIttman that costed over $100.

I'm just curious about this... if someone could let me know i"d appreciate it!

[leslie :-D]

i find it more accurate, posteriorally.

the ribcage obstructs thorough auscultation.

if i'm assessing for pleural effusion, or copd exacerbation, auscultating anterior chest wall is fine.

but to r/o the spectrum of 'could-be's', you need to listen to both sides.

leslie

[luv2shopp85]

So with every patient do you listen to anterior and posterior? What if they can't roll onto their side, or they are in too much pain to do so?

[TazziRN, RN]

I rarely listen anterior except for up top. It's when you hear things in the bases only that they're the most fixable, and you can't hear the bases anteriorally. You can listen to the bases by working your hand underneath as far as you can without hurting the pt.

[rnmi2004]

If they have a hard time turning, then they are at increased risk of skin breakdown and therefore should be assisted in turning at least Q2hr.

Next time they are due to be turned, go in their with the aide & listen to the posteriors.

[rnmi2004]

Shoot! I managed to post before I was done.

If they have limited mobility, they are more likely to have respiratory complications and therefore merit a more thorough assessment, i.e., listening to all lung fields.

While you're back there, make sure you're checking for skin breakdown. A patient who has difficulty turning themself is the one that you should be most concerned about their posterior.

[leslie :-D]

you can also sit them up in bed, pull them forward, and take a listen.

leslie

[Laughs-a-lot, RN]

I have no hesitation to grab another nurse or a PCA and say hey can you help me turn this pt, I need to listen and take a peek. Also note when they are due for pain meds next, and choose that time to move them around more. Never be afraid to turn the pt, it's your license as well as their well being at stake, and sometimes you have medicate and 2-3 people help you carefully turn that little sweetie with the fx hip.

[peds4now, RN]

you cannot auscultate lower lobes from the front, so I hope you are not charting them if you only listen on the front. Very few patients cannot be turned at all. And in fact you should be turning them to cya concerning that giant pressure ulcer they have on their sacrum...

[sailornurse]

You need to listen to the front, back and SIDES, sides esp when you hear (or don't hear much) in the bases. You don't need to listen 10-15 places on all patients front & back like in assessment textbook will show you, but listen in enough places to get a good idea if there is anything going on. Esp as pointed out the patient that can not sit up, then roll them over. And you should never listen through clothing not matter how much you paid for your stethoscope,( I know, we see docs all the time do this but cloth can mimick crackles) Take into consideration the reason/primary dx of the patient and past medical hx (on 02/copd/smokers/CHD/pneumonia/post-ops).

Sometimes I can not do as thorough an assessment as I need to, so I do q quick one then come back within the hour and do a more thorough job.

[Virgo_RN, BSN, RN]

I've seen RTs auscultate anteriorly, but I prefer posterior. If there is any reason I can't have the patient sit up or turn to their side, I will listen to the bases at the sides, as far under as I can get my scope.