Breath and Voice Sounds

Question 1

What is the purpose of assessing lung sounds?

Answer 1

to assist in diagnosis and to evaluate the effects of treatment

Question 2

How are lung and breath sounds characterized?

Answer 2

by pitch, intensity, quality, and the duration of the inspiratory and expiratory phases

Question 3

What is the procedure for taking breath sounds?

Answer 3

• place the diaphragm of the stethoscope in firm contact with the patient’s unclothed chest wall
• start at the apices and work downward, comparing symmetrical points sequentially
• have a patient breathe in and out through the mouth, a little deeper than normal
• listen to at least one cycle of inspiration and expiration in each pulmonary segment

Question 4

If abnormal breath sounds are suspected how would the procedure of taking breath sounds be different?

Answer 4

• compare the intensity, pitch, and quality of the sounds heard on one side with the sounds heard in the same location on the contralateral side
• identify the breath sounds as vesicular, bronchovesicular, bronchial, or absent by the duration of the inspiration and the expiration and by the quality and pitch
• note the presence or absence of adventitious (extra) sounds

Question 5

What are the qualities of tracheal and bronchial breath sounds?

Answer 5

• loud tubular sounds normally heard over the trachea
• inspiratory phase is shorter than the expiratory phase and there is a slight pause between them

Note: bronchial sounds heard over distal airways are abnormal and represent consolidation or compression of lung tissue and facilitates transmission of sound

Question 6

What are the qualities of vesicular breath sounds?

Answer 6

• high pitched, breezy sounds normally heard over the distal airways in healthy lung tissue
• inspiratory phase is longer than expiratory phase and there is no pause of respiration

Question 7

What are adventitious breath sounds?

Answer 7

abnormal breath sounds heard with inspiration and/or expiration that can be continuous or discontinuous

Question 8

What are the qualities of a “crackle (rales)” abnormal breath sound?

Answer 8

-an abnormal, discontinuous, high-pitched popping sound heard more often during inspiration. May be associated with restrictive or obstructive respiratory disorders

Question 9

What is the difference between wet and dry crackles?

Answer 9

-movement of fluid or secretions during inspiration (wet crackles) vs. sudden opening of closed airways (dry crackles)

Question 10

What do crackles that occur during the latter half of inspiration typically represent?

Answer 10

-atelactasis, fibrosis, pulmonary edema, or pleural effusion

Question 11

What are the qualities of crackles from pulmonary edema?

Answer 11

fine crackles as air bubbles through fluid in the distal small airways

Question 12

What conditions can typically produce crackles in the bases of the lung?

Answer 12

interstitial lung disease, atelactasis, pneumonia, bronchiectasis, and pulmonary edema

Question 13

What are the characteristics of a “pleural friction rub” abnormal breath sound?

Answer 13

• dry crackling sound heard during both inspiration and expiration
• occurs when inflamed visceral and parietal rub together
• heard over the spot where the patient feels pleuritic pain

Question 14

What are the characteristics of a “rhonchi” abnormal breath sound?

Answer 14

• continuous low-pitched sounds described as having a “snoring” or “gurgling” quality that may be heard during both inspiration and expiration
• caused by air passing through an airway which is obstructed by inflammatory secretion or liquid, bronchial spasm or neoplasms in the smaller or larger airways

Question 15

What are the characteristics of a “stridor” abnormal breath sound?

Answer 15

• continuous high-pitched wheeze heard with inspiration or expiration
• indicates upper airway obstruction

Question 16

What are the characteristics of a “wheeze” abnormal breath sound?

Answer 16

• continuous “musical” or whistling sound composed of a variety of pitches
• heard during both inspiration and/or expiration, but variable from minute to minute and area to area
• arise from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm, or foreign body

Question 17

What are the characteristics of a “bronchial breath sounds” abnormal breath sound?

Answer 17

-abnormal breath sounds when heard in locations where vesicular sounds are normally present. Pnuemonia may produce these sounds

Question 18

What may a less audible sound indicate when assessing breath sounds?

Answer 18

severe congestion, emphysema, or hypoventilation

Question 19

What would absent breath sounds indicate when assessing breath sounds?

Answer 19

pneumothorax or collapsed lung