Respiratory Assessment

[kathysalvador12]

I just read about how to listen to breath sounds in my textbook. Whenever I see healthcare providers listen to breath sounds, I only see them listen to breath sounds in certain areas. What is the rational to this? Are there certain areas I am supposed to be listening to breath sounds as well or should I be following the textbook?

[nurseprnRN, BSN, RN]

Remember your pulmonary anatomy, and think what diagnoses the patients have (assuming they are already diagnosed).

For example, with someone with congestive heart failure (CHF), you're going to hear the increased wetness of decompensated failure first in the dependent sections of the lungs, the parts closest to the floor. That means in someone ambulatory, best heard in the bases. In someone upright in bed because they are short of breath, the same. Someone found down on the floor, the parts closest to the floor-- back, side, front, whatever it is.

For someone with pneumonia, you'll want to pay particular attention to the lobe(s) where the pneumonia is, listening for decreased/absent/noisy sounds.

For someone with acute one-sided chest pain and shortness of breath, when you listen on that side you might hear...nothing, because that person has a spontaneous pneumothorax and that lung is collapsed.

For someone with acute asthma, you might think that you'd hear a lot of wheezing, and you might be right. But an asthmatic with acute shortness of breath and no wheezing doesn't mean everything's fine-- it might mean that he is about ::this close:: to being dead because he isn't moving any air in those clamped-down airways.

For general assessment, you want to listen to all five lobes (three right, two left), front and back. You will also be listening to the heart and valves at the same time, so I wonder if perhaps the people you have been looking at are doing a cardiac exam instead or in addition, which might have confused you.

I am sure that someone will post some good YouTube videos on how to assess the chest. :)