Auscultation of lungs, main and adventitious respiratory sounds

Auscultation: Prior to listening over any one area of the chest, remind yourself which lobe of the lung is heard best in that region: lower lobes occupy the bottom 3/4 of the posterior fields; right middle lobe heard in right axilla; lingula in left axilla; upper lobes in the anterior chest and at the top 1/4 of the posterior fields. This can be quite helpful in trying to pin down the location of pathologic processes that may be restricted by anatomic boundaries (e.g. pneumonia). Many disease processes (e.g. pulmonary edema,bronchoconstriction) are diffuse, producing abnormal findings in multiple fields.

auscultation of lungs

1. Put on your stethoscope so that the ear pieces are directed away from you. Adjust the head of the scope so that the diaphragm is engaged. If you're not sure, scratch lightly on the diaphragm, which should produce a noise. If not, twist the head and try again. Gently rub the head of the stethoscope on your shirt so that it is not too cold prior to placing it on the patient's skin.

2. The upper aspect of the posterior fields (i.e. towards the top of the patient's back) are examined first. Listen over one spot and then move the stethoscope to the same position on the opposite side and repeat. This again makes use of one lung as a source of comparison for the other. The entire posterior chest can be covered by listening in roughly 4 places on each side. Of course, if you hear something abnormal, you'll need to listen in more places.

3. The lingula and right middle lobes can be examined while you are still standing behind the patient.

4. Then, move around to the front and listen to the anterior fields in the same fashion. This is generally done while the patient is still sitting upright. Asking female patients to lie down will allow their breasts to fall away laterally, which may make this part of the examination easier.

Listen to the respiratory rate, including rhythm and depth of respirations. Compare rate with normal respiratory rates for the age of the client.

Auscultate the lungs, listening to inspiration and expiration at each site.

Auscultate the anterior lung fields. Listen for abnormal sounds, including rales, rhonchi, or wheezes.

Normal and abnormal respiratory patterns

Date: 2015-02-03; view: 1456