01.02 Lung Sounds

Overview

Each area of the lung should have a specific sound – if any other sound is heard in that location, there is a disease process occurring.

Nursing Points

General

1. Normal Lung Sounds
   1. Tracheal
      1. Over trachea
      2. Harsh, Hollow
   2. Bronchial
      1. Over bronchi, 1st and 2nd intercostal spaces (ICS)
      2. High-pitched , Loud, Hollow
   3. Bronchovesicular
      1. Medium airways
      2. Posterior chest between scapulae
      3. Center of anterior chest, 3rd and 4th ICS next to sternum
      4. Softer than bronchial, still hollow
   4. Vesicular
      1. The rest of lung fields
      2. Soft, low-pitch blowing sound

Assessment

1. Adventitious Lung Sounds
   1. Crackles
      1. Indicate fluid in alveoli
      2. Popping sound
         1. Like rubbing hair next to ear
   2. Rhonchi
      1. Indicate sputum or fluid in air passages
      2. Harsh gurgling sound
   3. Wheezes
      1. Indicate narrowing of small air passages
      2. High-pitched whistle
   4. Stridor
      1. Indicates narrowing of main airways (trachea, bronchi)
      2. High-pitched, loud, usually inspiration
      3. Can be heard without scope
      4. Emergency
   5. Friction Rubs
      1. Indicates inflammation of lining or presence of mass
      2. Low-pitched rubbing sound
   6. Absent
      1. Indicates fluid or air around lung, preventing expansion
      2. I.e. hemothorax, pneumothorax, pleural effusion

Therapeutic Management

1. Identify and treat cause of adventitious sound

Nursing Concepts

1. Oxygenation
2. Gas Exchange

Patient Education

1. It’s okay to teach the patient about what you are hearing and what it usually means. Just don’t ‘diagnose’.

Breath sound clips ©Sarah Flagg