Breath Sounds

Question 1

Adventitious breath sounds

Answer 1

Are abnormal sounds that occur over the lungs and airways.

Additional audible lung sounds during auscultation.

Question 2

Abnormal lungs sounds (adventitious breath sounds) include…

Answer 2

Crackles (rales)
Wheezes
Rhonchi
Stridor
and Pleural friction rubs

Question 3

Wheezes

Causes of abnormal breath sounds

Answer 3

Air moving through narrowed airways due to swelling or obstruction

Question 4

Rhonchi

   Causes of abnormal breath sounds

Answer 4

Airways obstruction due to accumulation of mucus secretions, lesions, or foreign bodies

Question 5

Crackles

Answer 5

Fluid accumulation in the small airways or atelectasis (lung collapse).

Question 6

Stridor

Answer 6

Obstruction of the upper airway.

Question 7

Pleural friction rub

Causes of abnormal breath sounds

Answer 7

Rubbing of inflamed pleural surfaces against each other during respiration.

Question 8

Additional causes for abnormal breath sounds

Answer 8

Certain lung and heart problems

Question 9

Bronchial breath sounds

Answer 9

are tubular, hollow sounds produced during the inspiration and expiratory phase as a result of abnormal increase in the transmission of airway sounds to the chest surface.

Sounds similar to blowing through a hollow tube.

Question 10

Bronchovesicular breath sounds

Answer 10

are normal sounds heard in the mid-chest area or over the scapula (shoulder blade). Sounds has a tubular quality and are a combination of bronchial breath sounds near the trachea and vesicular sound in the alveoli.

Bronchovesicular breath sounds have equal I:E of 1:1.
Differences in pitch and intensity are often audible during expiration phase.

Question 11

Diminished breath sounds

Answer 11

are soft, distant lung sounds of lower intensity.
Normally heard in patients with decreased air volume- critically ill/obese/increased muscle mass/air or fluid around the lungs/increased chest wall thickness/lung hyperinflation.
Ratio of inspiration to expiration phase is 3:1.

(also known as diminished vesicular sounds)

Question 12

Coarse breath sounds

Answer 12

are clicking, bubbling, or rattling sounds that occur during the inspiration process when air opens closed spaces in the lungs.

Coarse breath sounds are louder, low-pitched and have a longer duration.

Heard in patients w/copious amounts of secretions.

a type of crackles/rales.

Question 13

Pneumonia breath sounds

Answer 13

May hear crackling, bubbling or rumbling sound as well as wheezing in some areas of the chest during auscultation.

A respiratory infection caused by harmful microorganisms and is characterized by a productive cough, often with greenish to yellowish mucus secretions.

Crackles in patients with pneumonia are often heard only on one side of the chest or when lying down. In addition to crackles and wheezes, low pitch lung sounds call rhonchi also audible during the expiratory phase in patients with pneumonia.

Question 14

Stridor breath sounds

Answer 14

Is a high-pitched lungs sound created by airway obstruction and is mostly audible during inhalation but can also be heard during exhalation and patience with deteriorating condition.

Commonly occur in extubated patients as a complication of endotracheal intubation. In children Stridor is very audible when lying on the back (supine position).

Common causes of Stridor are croup, pertussis, aspirations, epiglottis, choking, severe shock (anaphylactic shock), tonsillitis, laryngitis, lung cancer, deviated septum, and blood transfusion reactions.

Question 15

Steps in performing a proper auscultation:

Answer 15

1. explain the procedure to the patient to establish trust and rapport.
2. stand close to the patient to gain access to the target body part.
3. place the ear tips of the stethoscope in your ears and adjust them as desired.
4. use the diaphragm (flat part at the end of the tubing which has a thin plastic) to check for a high-pitched sounds.
5. use the bell (smaller round device attached to the diaphragm) to check for low pitched sounds.
6. hold the diaphragm or bell firmly against the patient’s skin with enough pressure (must have a round mark on the skin after placement to ensure high-quality sounds).
7. listen to the sounds and try to identify their intensity, location, strength, pattern, and duration.
8. locate normal and abnormal sounds by gliding the diaphragm or a bell over the body area.
9. compare one side with the other (e.g. compare the sound on the front of the patient’s chest with his or her back).
10. document findings.