Ok a question on one of my exams asks something like this, "The nurse decides suctioning is appropriate based on which one of the findings?"
Answer A: Crackles heard on auscultation
Answer B: Audible inspiratory wheezes.
The correct answer is A, but I chose B, although I feel like both are good answers. Here is my rationale. (this was sent in a separate email to my prof in attempt to defend my answer).
I know inspiratory wheezes are associated more with bronchoconstriction, but I associated it with mucus. Wheezes are a result of an obstructed airway, which is from mucus (inflammation). Also, audible inspiratory wheezes are more of a red flag for airway compromise, b/c it could (not is) be a sign of impending ARDS. Crackles can lead to ARDS as well, but that wouldn't happen right away. If I heard inspiratory wheezes in real life would I suction right away? Probably not, maybe I would collect other data first, and if anything, give a bronchodilator. But I thought this was a better answer than choosing crackles.
The answer regarding the crackles turned out to be correct, and I had a hard time between the two, but chose the wheezing. I understand that if the nurse hears crackles, there's clearly congestion in the lungs, but the stem didn't specify where s/he heard the crackles. Crackles are usually heard in the bases, so I went with that. With that said, I know you cannot suction past the carina, and usually crackles are at the bases, so even if I decided to suction just because I auscultated crackles, what would suctioning do to decrease the crackles? It wouldn't do a whole lot, and that's something to think about when choosing the right nursing intervention-Is it even going to be effective?.
Also, page 649 in our MS text at the top right corner states,
"Trachael suctioning is performed when adventitious breath sounds are detected or whenever secretions are obviously present" (p.649).
That's all I found about trach's in that volume text. Adventitious breath sounds include crackles and WHEEZES.
I know you said in lecture (and it was in the notes) that if the patient was wheezing that the RN should give a bronchodilator. But between the 2 answer choices, I had to defend the "wheezes" answer choice for the sake of correctly answering, what I thought was, a tricky question. You might think I read too far into the question, but I thought I was critically thinking.
...now that i reflect on all this stuff i wrote, I'm starting to realize why the "crackles"-answer was correct after all. But at the same time, I'm not going back! If i'm wrong, tell me why, and if i'm not, tell me why!-if your reason is different than mine. :)
um my head is hurting just thinking about this. Suctioning for wheezing and crackles. Sigh this is just rediculous. Nether should be suctioned THE ONLY TIME YOU SUCTION IS WHEN YOU HEAR RONCHI!!!!!!!!
For what it's worth, the term "rhonchi" and its singular, "rhonchus," are no longer approved for use in clinical documentation. Article in the New England Journal of Medicine recently recognizes that a lot of old folks still use it, and it's in older books, but there is not defined clinical criterion for it and it leads to confusion. As we see here. Put that in yer pipe(s) and smoke it :)
For what it's worth, the term "rhonchi" and its singular, "rhonchus," are no longer approved for use in clinical documentation. Article in the New England Journal of Medicine recently recognizes that a lot of old folks still use it, and it's in older books, but there is not defined clinical criterion for it and it leads to confusion. As we see here. Put that in yer pipe(s) and smoke it :)
It's still approved for use in clinical documentation, and the International Lung Sounds Association (yes such a group exists) still lists it in the official terminology. The 'article' in the NEJM was actually a letter; someone posting their view on the continued use of the term that had some well reasoned responses.
Rhonchi is typically defined as a sort of upper respiratory wheeze/rattle/crackle primarily, but the key is that's it's a wheeze that clears with a productive cough, in other words it's a low pitched wheeze caused by mucous in the bronchus, which would be a reason why a patient with trach should be suctioned. Crackles, which imply fluid in the lungs themselves actually doesn't benefit much from suctioning compared to suctioning bronchial mucous. So if we're going to just lump rhonchi in with wheezes, then that changes the answer to the OP's question, which is why maintaining terminology that differentiation clinically important differences is worth the effort.
That was the suggestion of the letter that appeared in the NEJM, although maybe it would help to clarify if we're talking about the same article. The recent article in NEJM that suggested we should do away with the term rhonchi that I'm aware of was Fundamentals of lung auscultation-NEJM which was in response to Lung Auscultation | Now@NEJM that defined rhonchi as a wet wheeze.
nurseprnRN, BSN, RN
1 Article; 5,116 Posts
For what it's worth, the term "rhonchi" and its singular, "rhonchus," are no longer approved for use in clinical documentation. Article in the New England Journal of Medicine recently recognizes that a lot of old folks still use it, and it's in older books, but there is not defined clinical criterion for it and it leads to confusion. As we see here. Put that in yer pipe(s) and smoke it :)