dam93732_ch15.

qxd 12/7/05 9:00 AM Page 378

378

CHAPTER 15

Respiratory System

TECHNIQUES AND NORMAL FINDINGS

ABNORMAL FINDINGS
SPECIAL CONSIDERATIONS

1. Instruct the client.

Explain that you will be listening to the clients breathing with the stethoscope.
The client will be in the same position as during percussion. Ask the client to
breathe deeply through the mouth each time the stethoscope is placed on a new
spot. Tell the client to let you know if he or she is becoming tired or short of
breath and if so you will stop and allow time to rest.
2. Visualize the landmarks.
Visualize the landmarks as you did before percussing the posterior thorax.
3. Auscultate for tracheal sounds.
Auscultate at the vertebral line superior to C7.
4. Auscultate for bronchial sounds.
Start at the vertebral line at C7 and move the stethoscope down toward T3. The
sound will be bronchial.
5. Auscultate for bronchovesicular sounds.
The right and left primary bronchi are located at the level of T3 and T5. Auscultate at the right and left of the vertebrae at those levels. The breath sounds will
be bronchovesicular.
6. Auscultate for vesicular sounds.
Auscultate the lungs by following the pattern used for percussion. Move the
stethoscope from side to side while comparing sounds. Start at the apices and
move to the bases of the lungs and laterally to the midaxillary line. The breath
sounds over most of the posterior surface are vesicular.

Table 15.2
SOUND

Adventitious Sounds
OCCURRENCE

Q UA L I T Y

CAUSES

Fine

End inspiration, dont

clear with cough

High-pitched, short,
crackling

Collapsed or fluid-filled
alveoli open

Coarse

End inspiration, dont

clear with cough

Loud, moist, low-pitched,

bubbling

Collapsed or fluid-filled
alveoli open

Wheezes
(sibilant)

Expiration
Inspiration when
severe

High-pitched, continuous

Blocked airflow as in
asthma, infection, foreign
body obstruction

Ronchi
(sonorous)

Expiration/inspiration
Change/disappear with
cough

Low-pitched, continuous,
snoring, rattling

Fluid-blocked airways

Stridor

Inspiration

Loud, high-pitched crowing

heard without stethoscope

Obstructed upper
airway

Friction rub

Inhalation/exhalation

Low-pitched grating,
rubbing

Pleural inflammation

Rales/
Crackles

Ronchi

2007 Pearson Education, Inc.

Auscultation of diminished but normal breath

sounds in both lungs may indicate emphysema,atelectasis, bronchospasm, or shallow breathing.

Breath sounds heard in just one lung indicate
pleural effusion, pneumothorax, tumor, or mucous plugs in the airways in the other lung. Finding bronchial or bronchovesicular sounds in areas
where one would normally hear vesicular sounds
indicates that alveoli and small bronchioles are affected by fluid or exudate. Fluid and exudate decrease the movement of air through small
airways and result in loss of vesicular sounds.

Added or adventitious sounds are superimposed on normal breath sounds and often indicative of underlying airway problems or diseases of
the cardiovascular or respiratory systems.
Adventitious sounds are classified as
discontinuous or continuous. Discontinuous
sounds are crackles,which are intermittent,nonmusical, and brief. These sounds are commonly
referred to as rales. Fine rales are soft, highpitched, and very brief. Coarse rales/crackles are
louder, lower in pitch, and longer. Continuous
sounds are musical and longer than rales but do
not necessarily persist through the entire respiratory cycle. The two types are wheezes/sibilant
wheezes and rhonchi (sonorous wheezes).
Wheezes (sibilant) are high-pitched with a shrill
quality. Rhonchi are low-pitched with a snoring
quality (see Table 15.2).