Troubles with lung auscultation

[Meli Bee]

Am I doing something wrong, or is it very hard to hear lung sounds when patients can't or won't breathe deeply. Many of my patients are like that and I'm unable to hear breath sounds. I have a digital stethescope and am hard of hearing, mainly in the left ear, but I can hear heart and bowel sounds, as well as lung when the patient will take a deep breath. Help? 

[subee, MSN, CRNA]

Meli Bee said:

Am I doing something wrong, or is it very hard to hear lung sounds when patients can't or won't breathe deeply. Many of my patients are like that and I'm unable to hear breath sounds. I have a digital stethescope and am hard of hearing, mainly in the left ear, but I can hear heart and bowel sounds, as well as lung when the patient will take a deep breath. Help?

Yes!!  As deep as they can (until you are more proficient).  I also prefer that they exhale completely because there are wheezes and rattles that can't he heard earlier.  If you have a colleague who has a patient with prominent noisy sounds, ask to have a listen so you will know what you are looking for.  Patients with advanced COPD who aren't in the process of an infection, will have less breath sounds because less air is being exchanged secondary to the inability of the alveoli to squeeze air out.