Auscultation

Question 1

Auscultation

Answer 1

Process of using a stethoscope to listen to and interpret lung/ breath sounds generated by airflow through the airways
Help identify a range of problems in conjunction with other assessment findings
Part of B (listen) in the A-E assess
Guide treatments
Listening for normal, abnormal (wheeze, crackles, bubbly) or absence of breath sounds

Question 2

Before listening with a stethoscope

Answer 2

Hear from the mouth - noisy breathing indicates increased air flow turbulence due to obstructed upper airways
Crackles, wheezes or snores may be heard from the bedside
Stridor - monophonic wheeze in the upper airways, serious sign denoting laryngeal or tracheal narrowing to a diameter as small as 5mm

Question 3

Patient preparation and position

Answer 3

Before you begin - clothing, position of patient, patient comfort, instructions to patient

Question 4

Stethoscope

Answer 4

Ear-pieces facing forwards before inserting them into your ears
Ensure the diaphragm is receiving the sound
Press diaphragm firmly on the chest to minimise extraneous sounds
Listen for a full inspiratory and expiratory phase
Listen alternating between left and right sides of the chest, compare your findings for each lobe
Bell - low frequency/ pitch e.g. heart
Diaphragm - high frequency/ pitch e.g. lungs
Can ask them to take deep breath in and out - increases air flow turbulence which will dislodge and move mucus in the airways

Question 5

Auscultation points

Answer 5

10 possible points anteriorly
12 possible points posteriorly
Access to points will vary between male and female patients
Need to know which lobe you’re listening to
Babies - use smaller stethoscope

Question 6

Normal breath sounds

Answer 6

Normal turbulence of air flowing in and out of the lungs produces ‘breath sounds’
Louder and longer on inspiration and faded/ minimal on expiration
What’s considered ‘normal’ depends on where you’re listening - over the trachea; bronchial, over the lung field; soft and muffled, becoming quieter as you move to the base of the lungs

Question 7

Abnormal breath sounds

Answer 7

Bronchial breath - increased density, due to; lobar collapse, consolidation, loud and clear sounds, might hear the expiration for longer, sounds rustly and catchy
Breath sounds may be diminished - shallow breathing; quieter, poor positioning, hyperinflation; airflow is not good, filtered by the pleura or chest wall

Question 8

Added sounds

Answer 8

Result of physiological changes in the conducting airways, the lung or the pleura
Wheezes
Crackles
Pleural rub
When in the breath cycle they are heard and also the pitch of them to understand what they indicate

Question 9

Wheezes

Answer 9

Musical sounds due to vibration of the wall of narrowed or compressed airways
Primarily during expiration
Expiration can be prolonged
Monophonic wheeze - same note, usually lower pitched, due to compression or obstruction of a large, central airway
Polyphonic wheeze - multiple notes simultaneously, usually higher pitched, due to diffuse small airway obstruction or compression

Question 10

Crackles

Answer 10

Short, non-musical, popping sounds
Can be described as fine or coarse
Consider when in the breathing cycle they are heard

Question 11

Fine crackles

Answer 11

Like rubbing hair next to your ear
Re-opening of airways, due to atelectasis or secretions
End inspiratory - opening of smaller airways and suggests fibrosis or pulmonary oedema

Question 12

Coarse crackles

Answer 12

Like pouring milk over Rice Krispies
Suggests obstruction due to sputum in more proximal, larger airways
Early expiratory - more central airways
Late expiratory - more peripheral airways

Question 13

Pleural rub

Answer 13

Creaking/ rubbing sound like boots walking on fresh snow
Sound like sand paper rubbing against each other
Sounds the same on inspiration and expiration
Usually localised
As a result of inflamed pleura and decreased production of pleural fluid
Pleurisy/ pleuritis
Usually as a result of infection
Often associated with pleural chest pain

Question 14

Voice sounds

Answer 14

Tactile vocal fremitus - vibrations of the spoken word can be felt by the hands
Vocal resonance - vibrations of the spoken work can be heard through a stethoscope
Ask patient to say 99
Whispering pectoriloquy - Vowels are filtered through air filled lungs but if the lung is consolidated or there is atelectasis with a patent airway then they are heard more clearly through the dense medium a whispered 99 can be heard
Reduced voice sounds heard when there’s atelectasis with a blocked airway or a pneumothorax or pleural effusion