how to document course lung soynds

When documenting the lung sounds, they are usually described by: duration (how long the sound lasts) pitch (how low or high the sound is) intensity (how loud the sound is) timing (when the sound occurs in the respiratory cycle) Adventitious lung sounds

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What is a basic course in lung sounds?

 · Course crackle lung sounds tend to be a loud, low pitched bubbling sound. They can be heard anywhere in the anterior or posterior lung fields and it’s also possible for coarse crackles to be heard on one side of the chest, in both lungs, or in different spots throughout the lungs. Course crackles in the lungs can also be described as rattling ...

What is involved in a lung exam?

 · The pulmonary exam includes multiple components, including inspection, palpation, percussion, and auscultation. In this article, we will focus on auscultation of lung sounds, which are useful in predicting chest pathology when considered alongside the clinical context. The lungs produce three categories of sounds that clinicians appreciate during …

How do you do lung auscultation?

 · Here’s a quick review of what you’re looking for: Inspection – Inspect the external chest noting the chest shape (ex. barrel chest as seen in COPD), respiratory rate, signs of respiratory distress, nature of breathing, and external appearance of the skin. Auscultation – Listen to lung sounds noting any abnormalities.

Do you refer to the patient when charting the lungs?

3. Rhonchi.. This is the sound of air moving through secretions. It is a low-pitched, continuous sound that is best heard on expiration. Some describe it as coarse lung sounds, as it …

How do you describe coarse lung sounds?

Rhonchi. Sounds that resemble snoring. They occur when air is blocked or air flow becomes rough through the large airways.

How do you describe coarse crackles?

Coarse crackles are louder, more low pitched and longer lasting. They indicate excessive fluid on the lungs which could be caused by aspiration, pulmonary oedema from chronic heart disease, chronic bronchitis, pneumonia.

How do you describe lung sounds?

Types of breath sounds rhonchi (a low-pitched breath sound) crackles (a high-pitched breath sound) wheezing (a high-pitched whistling sound caused by narrowing of the bronchial tubes) stridor (a harsh, vibratory sound caused by narrowing of the upper airway)

How do nurses describe lung sounds?

6:0418:11Simple Nursing: Breath Sounds Made Easy - YouTubeYouTubeStart of suggested clipEnd of suggested clipSo what does wheezing sound like wheezing is a high-pitched continuous type of a sound it's causedMoreSo what does wheezing sound like wheezing is a high-pitched continuous type of a sound it's caused by the air going in and out of the lung.

What is the difference between coarse and fine crackles?

Auscultation of the Lungs There are coarse crackles, which are loud, low pitched, and fewer in number per breath, and fine crackles, which are soft, higher pitched, and greater in number per breath.

What does coarse rhonchi sound like?

Rhonchi, or “large airway sounds,” are continuous gurgling or bubbling sounds typically heard during both inhalation and exhalation. These sounds are caused by movement of fluid and secretions in larger airways (asthma, viral URI). Rhonchi, unlike other sounds, may clear with coughing.

How do you document lung assessment?

Documentation of a basic, normal respiratory exam should look something along the lines of the following: The chest wall is symmetric, without deformity, and is atraumatic in appearance. No tenderness is appreciated upon palpation of the chest wall. The patient does not exhibit signs of respiratory distress.

How would you describe auscultation?

Auscultation is listening to the sounds of the body during a physical examination.

What are the 4 respiratory sounds?

The 4 most common are:Rales. Small clicking, bubbling, or rattling sounds in the lungs. They are heard when a person breathes in (inhales). ... Rhonchi. Sounds that resemble snoring. ... Stridor. Wheeze-like sound heard when a person breathes. ... Wheezing. High-pitched sounds produced by narrowed airways.

How do you document respiratory rate?

Measuring the number of breaths in one minute determines respiratory rate. Respirations may be counted by watching the number of times the chest rises and falls or by placing the hand on the chest or stomach and feeling the number of times the chest rises and falls in one minute.

Is rhonchi and crackles the same?

This is a fine, high-pitched crackling or rattling sound that can occur when you inhale. Rhonchi. This is a low-pitched sound that resembles snoring.

How do you do a respiratory assessment in nursing?

A thorough respiratory assessment consists of inspection, palpation, percussion, and auscultation in conjunction with a comprehensive health history. Use a systematic approach and compare findings between left and right so the patient serves as his own control. If possible, have him sit up.

What does crackling sound like?

Crackles, also known as rales, are intermittent sounds generally audible during inhalation. They can sound similar to bubbling, popping, or clicking noises. Experts define a crackle as: Fine: These occur in the small airways and are soft and high pitched.

Are rales fine or coarse?

Types of abnormal breath sounds include: Rales. This is a fine, high-pitched crackling or rattling sound that can occur when you inhale.

Where do you hear coarse crackles?

Coarse crackles are heard during early inspiration and sound harsh or moist. They are caused by mucous in larger bronchioles, as heard in COPD. Fine crackles are heard during late inspiration and may sound like hair rubbing together.

What do crackles breath sounds sound like?

Crackles are abnormal lung sounds characterized by discontinuous clicking or rattling sounds. Crackles can sound like salt dropped onto a hot pan or like cellophane being crumpled or like Velcro being torn open.

How does lung tissue work?

Normal lung tissue acts as a low-pass filter in that it allows low-frequency sounds to move through easily while filtering high-frequency sounds.   Pathological lung tissue can transmit higher frequency sounds more efficiently; this occurs when a normally air-filled lung becomes occupied by another material, such as fluid.   Physicians can exploit this phenomenon through the physical exam.[2] Tests used to detect this phenomenon, known as vocal resonance, include bronchophony, egophony, and whispered pectoriloquy.   To test for these, the clinician places their stethoscope over symmetric areas of the patient’s chest and asks the patient to speak. The clinician usually would hear an unintelligible, distant, and muffled vocal sound.   In bronchophony, the voice appears closer and louder.  Egophony occurs when pathological lung tissue distorts vowel sounds and makes them more nasal in quality, and therefore makes the sound of a hard E heard as an A, referred to as “E to A changes.” [6] Pectoriloquy describes the finding of a clear and intelligible sound when the patient whispers; it usually is unclear and unintelligible.

What are the components of a pulmonary exam?

The pulmonary exam includes multiple components, including inspection, palpation, percussion, and auscultation. In this article, we will focus on auscultation of lung sounds, which are useful in predicting chest pathology when considered alongside the clinical context. The lungs produce three categories of sounds that clinicians appreciate during auscultation:  breath sounds, adventitious sounds, and vocal resonance.

Why is asymmetric breath sound important?

Asymmetric intensity of breath sounds is especially helpful, especially after intubation, where asymmetric breath sounds are pathognomonic for an accidental endobronchial placement of the tube.

What is the intensity of breath?

Breath sound intensity can be graded on a 0-4 scale (zero being none, one is barely appreciated, two is diminished, three is normal, and four is louder than normal), although the clinical utility of grading intensity has been questioned.[4]  In the right context, the intensity of vesicular breath sounds can indicate pathology.   Greater intensity of breath sounds correlates with more profound ventilation, in contrast, quieter breath sounds can indicate decreased ventilation, and the worsening of a disease such as asthma.[8]  If fluid, air, or other matter lies in the pleural space, it will decrease the intensity (as occurs in a pleural effusion).   Asymmetric intensity of breath sounds is especially helpful, especially after intubation, where asymmetric breath sounds are pathognomonic for an accidental endobronchial placement of the tube. [9]

What are some examples of Adventitious sounds?

For example, crackles, the sound of airways snapping open, frequently occur in interstitial lung disease, pulmonary edema from heart failure, and infection.   Later and higher pitched crackles often represent interstitial lung disease whereas earlier and lower pitched crackles tend more towards chronic obstructive lung disease. Wheezing, the sound of air movement through narrowed airways, occurs in conditions such as asthma, chronic obstructive lung disease, and focal masses. Without a specific clinical context, these sounds are fairly nonspecific. The duration, rather than pitch, of wheezing throughout the respiratory cycle is most predictive of the degree of pathology. [1]

What trait assists in the classification of adventitious sounds?

The first trait that assists in the classification of adventitious sounds is whether the sounds are continuous or intermittent. For example, rhonchi and wheezes are continuous sounds whereas crackles are not. Crackles could be counted by the examiner as discrete acoustic events [<25ms, interrupted, like dropping a marble on the floor], whereas rhonchi and wheezes are somewhat inseparable noise [>250ms, constant, like the whirring of a fan].   The next thing to note is the pitch:  wheezes and fine crackles are high pitched, whereas rhonchi and coarse crackles are low pitched.

Is breath sound clinically significant?

The intensity and duration of breath sounds is also clinically significant and will be covered in detail below.

How to examine the respiratory system?

Examining the respiratory system consists of a number of components, namely inspection, auscultation, percussion, and palpation. Given the importance of the respiratory system, at least a basic exam should be conducted and documented on nearly all patients. Here’s a quick review of what you’re looking for: 1 Inspection – Inspect the external chest noting the chest shape (ex. barrel chest as seen in COPD), respiratory rate, signs of respiratory distress, nature of breathing, and external appearance of the skin. 2 Auscultation – Listen to lung sounds noting any abnormalities. 3 Percussion – Percuss all lobes of the lung, front and back, listening for sounds that suggest complications like hyperinflation, consolidation, or effusion. 4 Palpation – Check the position of the trachea, feel for symmetrical chest expansion, and test for tactile vocal fremitus.

What is the term for listening to lung sounds noting abnormalities?

Auscultation – Listen to lung sounds noting any abnormalities.

What are the abnormalities on a respiratory exam?

Abnormals on a respiratory exam may include: Retractions, accessory muscle use, or nasal flaring. Chest wall tenderness, chest wall bruising, rib tenderness, sternal tenderness. Areas of increased or decreased tactile fremitus. Depression or protrusion of the sternum (pectus excavatum or pectus carinatum)

What is palpation test?

Palpation – Check the position of the trachea, feel for symmetrical chest expansion, and test for tactile vocal fremitus.

What is chest inspection?

Inspection – Inspect the external chest noting the chest shape (ex. barrel chest as seen in COPD), respiratory rate, signs of respiratory distress, nature of breathing, and external appearance of the skin.

What are the components of the respiratory system?

What You’re Looking For. Examining the respiratory system consists of a number of components, namely inspection, auscultation, percussion, and palpation. Given the importance of the respiratory system, at least a basic exam should be conducted and documented on nearly all patients.

Where is the respiratory abnormality located?

You may note, for example, abnormal lung sounds at the lung bases vs. the apex, or on the right vs. the left side of the chest .

What is the process of listening to lung sounds?

That said, here is a pithy lesson on the five basic lung sounds and what they mean. First, however, a few definitions. Auscultation: The process of listening to lung sounds. It can be done ear to chest, although most health professionals prefer to use a stethoscope. Stethoscope: It's a medical device used to auscultate (hear) lung and heart sounds.

Why do COPD patients have diminished lung sounds?

This is most commonly found when emphysema is present, as there is less lung tissue to move air.

Can COPD cause clear lungs?

People with asthma should have clear lungmsounds when their asthma is controlled, and between asthma attacks. You can have clear lungs ounds with COPD too. After using a bronchodilator, diminished lung sounds may become clear.

What does it mean when you hear a wet lungs?

Usually, but not always, this lung sound is heard on both sides of the lungs equally, as fluid is not prejudiced to one side of the lung. People with asthma should have clear lungmsounds when their asthma is controlled, and between asthma attacks.

What is the sound of air moving past an obstruction in the airway?

This is a high-pitched continuous sound heard on inspiration, expiration, or both. It's most commonly heard on expiration, though. It is the sound of air moving past an obstruction in the airway. This can occur in the large airways or smaller airways. An obstruction in the larger airways may produce an audible wheeze.

What is the sound of air moving through secretions?

3. Rhonchi. This is the sound of air moving through secretions. It is a low-pitched, continuous sound that is best heard on expiration. Some describe it as coarse lung sounds, as it sounds coarse. Some say it sounds like snoring. It's usually lower than a wheeze because it's occurring in the larger airways.

What does it mean when your lung sounds like it's moving?

Regardless, here are the basic five and what they might mean. 1. Clear. This is a normal lung sound. It means the airways are open and air is easily moving through airways. 2. Diminished. This means that air movement is difficult to hear.

How are lung sounds described?

When documenting the lung sounds, they are usually described by: duration (how long the sound lasts) pitch (how low or high the sound is) intensity (how loud the sound is) timing (when the sound occurs in the respiratory cycle)

What are some examples of lung sounds?

Crackles or Rales can be further differentiated by “fine” or “course”. Wheezes and Rhonchi are also example of adventitious or abnormal lung sounds.

Where can you hear lung sounds?

Lungs sounds are the same as breath sounds or respiratory sounds, these sounds can be heard (auscultated) on the anterior (front) and posterior (back) of the patients chest wall using a stethoscope.

What is an abnormal lung sound?

Adventitious lung sounds. Adventitious lung sounds are abnormal lung sounds that are heard when auscultating the patients lungs and airways. These sounds are defined as Crackles. Crackles are also known as Rales. Crackles or Rales can be further differentiated by “fine” or “course”.

What does listening to lung sounds tell you?

From the general practice to the ICU, listening to lung sounds can tell you a great deal about a patient and their relative health. However, knowing the difference between rales, a crackle, and a wheeze is sometimes still a confusing proposition for many health professionals, especially new grads. Part of the reason for that is that some ...

What is a stridor?

Stridoris a continuous, high-pitched, crowing sound heard predominantly on inspiration, over the upper airway. Stridor may be a sign of a life-threatening condition and should be treated as an emergency situation.

What do you need to hear to hear abnormal heart sounds?

This is where most people’s eyes start to glaze over, but it is where you can learn something useful to your patient. You will need to listen to the heart with the bell of your stethoscope to hear the abnormal heart sounds.

What is a sibilant wheeze?

2. Sibilant Wheezes (Wheezes) Formerly referred to as simply ‘ wheezes ’, sibilant wheezes are very closely related to the sonorous wheeze. Sibilant wheezes differ to sonorous wheezes as they are a higher-pitched, shrill, continuous whistling sound, occurring when the airway becomes obstructed and narrowed.

Where is the pleural effusion heard?

Potential causes include pleural effusion and pneumothorax. It is best heard in the lower anterior lungs and lateral chest, during both inspiration and expiration.

What is the hardest thing to do in a nursing assessment?

One of the hardest things about the nursing head to toe assessment is being able to recognize lung and heart sounds that are not normal. Some of them sound similar, and some are easier to tell apart. It is helpful to hear the different abnormal lung sounds back to back so that you can distinguish between them.

What to do if asthma patient stops wheezing?

Watch out: If you have a patient that is having an asthma attack and their wheezing suddenly stops (but they are obviously struggling for air), maintain a patent (clear) airway as best you can, give oxygen per facility policy and call for help. Their airway may have become severely blocked.

Can you hear a stridor without a stethoscope?

Stridor is higher-pitched and loud, and you can usually hear it without a stethoscope.

What are the signs of lung disease?

There are a number of other physical signs that may give clues to lung disease, and a lung exam should be performed along with a general physical exam when time allows. Skin color: A glimpse at a person's skin color may demonstrate pallor due to anemia, which can cause rapid breathing.

What is the ratio of obstructive lung disease?

For example, with obstructive lung diseases such as emphysema, the ratio may instead be 1:4 or even 1:5. 4 

What is the ratio of inspiration to expiration?

The normal ratio of inspiration to expiration (bronchial breath sounds) is 1:2 at rest and while sleeping, and 1:1 with exertion. 1 

Which phase is longer, inspiratory or expiratory?

The expiratory phase is usually longer than the inspiratory phase, and there is a pause between inspiration and expiration.

Where is the bronchial breath heard?

Bronchial breath sounds are heard over the large bronchi (over the breastbone or sternum in the mid-chest region and between the shoulder blades on the back). They are higher-pitched and louder than breath sounds heard over other parts of the lungs, but quieter and more hollow-sounding (tubular) compared with tracheal breath sounds.

How many types of breath sounds are there?

Three primary types of normal breath sounds may be heard, depending on location the stethoscope is placed: 2 

Where should an auscultation be performed?

The exam should extend from the top of the lungs down to the lower lung fields, with auscultation performed on the anterior chest, posterior chest, as well as under the armpits (mid-axillary region). 1