Auscultation

Question 1

what is auscultation

Answer 1

the process of listening to and interpreting the sounds produced within the thorax-breathing, it is used to verify observed and palpated findings before, during and after treatment.

Question 2

what do you have to do before auscultation

Answer 2

prior to auscultation it is worth listening at the mouth, crackles heard at the mouth should be cleared by coughing in order to prevent them for masking other sounds during auscultation

Question 3

stethoscope labelled

Answer 3

earpieces-should be facing forward, conducting tube-12 inches long, bell- used for cardiac sounds and paediatrics or people smaller, diaphragm- area that physios use all of the time- listen to peoples breathing and respiratory sounds, check stethoscope is tuned to diaphragm

Question 4

what are the 2 elements of lung auscultation

Answer 4

breath sounds and added sounds

Question 5

what is breath sounds

Answer 5

the terminology breath sound is more accurate than air entry as air may be entering the lungs, but the transmission is blocked. breath sounds can be: normal, increased (AKA bronchial), decreased/ absent

Question 6

how are breath sounds generated

Answer 6

turbulent air in airways, only generated in small portions of the airway (first 4-5 generations- primary bronchi to bronchioles), transmitted through lung to chest wall

Question 7

how are breath sounds generated- conductors

Answer 7

lung tissue is a good sound conductor, air is a poor sounds conductor. want to consider intensity- expect there to be a change- closer to big aways= more intense (e.g. trachea), further away less intense

Question 8

how are breath sounds generated- breath sounds

Answer 8

consider quality of breath sounds, duration and pitch of inspiration to expiration

Question 9

breath sounds- normal

Answer 9

sounds heard over the entire lung field, muffled in quality, gets quitter the further from the trachea, inspiration is louder than expiration- active process- turbulence, inspiration is longer due to more turbulence, no pause between inspiration and expiration

Question 10

breath sounds- increased (bronchial)

Answer 10

it is a louder, more coarse sound compared to normal, inspiration and expiration are- equal pitch, intensity, duration, pause between inspiration and expiration, AKA- darth vader breathing

Question 11

where is increased breathing sound heard

Answer 11

normally over a trachea, occurs when the lung tissue is more dense due to pathology- increase breathing sound- good conductor

Question 12

breathing sound- decreased/ absent

Answer 12

decreased sound much quieter breath sound caused by pathology of the underlying causing a disproportionate reduction in normal breath sound

Question 13

breathing sound- decreased/ absent- cause

Answer 13

decreased ventilation to generate sound- e.g. collapse/ consolidation, decreased mechanics of breathing or chest wall movement (scoliosis or fractured rib), decreased transmission of the sound- e.g. obesity or pleural effusion- extra fluid in lungs, anything that creates extra barrier between lung tissue and breathing, can affect love or complete lung

Question 14

increased breathing sound- possible cause

Answer 14

consolidation, collapse, at the fluid line of pleural effusion, large mass

Question 15

decreased/absent breathing sound- possible cause

Answer 15

shallow breathing, poor positioning, atelectasis/collapse with complete obstruction of airway, hyperinflation (empheymma), obesity/ very muscular patients, pleural effusion, pneumothorax, spondylitis

Question 16

what is added sound

Answer 16

they are superimposed on top of breath sounds, they are sometimes more obvious and can mask the breath sound, in order for them to be an added sound they must be respiratory in origin and must be confused with non-respiratory sound such as vocal and abdomen noises or water in oxygen tubing

Question 17

3 types of added sounds

Answer 17

crackles/ creoutatubilis/ rales, wheezes, pleural rub

Question 18

added sounds- crackles

Answer 18

it is suggested that the primary source of crackling during to the explosive equalisation of gas pressure between 2 components of lung, when a closed section of airway separating them suddenly open (can only occur in inspiration- cant hear lungs collapsing down), other suggestions are that crackles are due to seperation in the airways being audible as air passes through them

Question 19

2 groups of cracking

Answer 19

coarse- 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[7].
and fine- Fine crackles could suggest an interstitial process; e.g pulmonary fibrosis, congestive heart failure

Question 20

crackles- what does it indicate

Answer 20

can happen anywhere in the respiratory cycle (inspiration, expiration or both), mostly indicative of sputum although absence of crackles does not necessarily indicate the absence of sputum, if you hear crackles that are sputum in origin- where is important- target treatment to a specific area

Question 21

crackles and the respiratory cycle

Answer 21

the timing of when crackles are heard in the cycle can indicate their position in the bronchial tree
early inspiratory crackles- proximal airways, late inspiratory crackles- peripheral airways, early expiratory crackles- proximal airways, late expiratory crackles- peripheral airways

Question 22

added sounds- wheeze

Answer 22

wheezing sound caused by air passing through narrowed airways. pitch varies depending on the amount of narrowing- the greater the narrowing the higher the pitch, can occur on inspiration and expiration

Question 23

2 types of wheeze

Answer 23

monophonic is generated by one airway, single note, same position in respiratory cycle
polyphonic is generated by several airways giving different notes- sounds musical,

Question 24

added sounds- rub

Answer 24

clearly leathery sound, pleural surfaces rubbing together, usually heard in late inspiration and early expiration, often identical on inspiration and expiration, crickey sound- opposite sound between 2

Question 25

examples of crackles

Answer 25

reopening of collapsed. atelatic airways, sputum, pulmonary oedmea, fibrosis

Question 26

examples of wheezes

Answer 26

bronchospasm, airway oedema, sputum, tumor, foreign body

Question 27

auscultation technique

Answer 27

should be conducted in a systemic manner, comparing one side to the other whilst visualising the underlying lung structure, should not be placed on clothing, sheet, should be cleaned in between patient use, the patients should be asked to sit upright where they can breathe through the mouth to reduce the nose turbulence- hear more, warn the patient to inform you if they feel dizzy, document what you heard,

Question 28

auscultation technique

Answer 28

the stethoscope should be placed in a methodical order comparing the lobes on one side to that of the other lung, even though there is no middle lobe in the left lung, the corresponding area should still be compared to that of the right middle lobe

Question 29

auscultation- different lobes

Answer 29

upper lobes- assessed anteriorly, middle lobes- assessed anteriorly or laterally, lower lobes- posteriorly

Question 30

lung markins

Answer 30

2.5cm above medial clavicle, 4th CC, 6th CC (midclavicular line on left), 8th rib on axillary line, T2 and T10

Question 31

things that can interfere with assessment

Answer 31

movement of stethoscope on skin, oral cavity sounds, clothing/ sheets, hair skin (use bell part), water in tubing, shivering, external sound