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Asculatate along bare skin.doctor and patient 25 image by Paul Moore from Fotolia.com
Prepare your chart or paper to take notes. Listen to a complete respiratory cycle (inspiration and expiration) at each site. Listen to quiet respiration and then ask the patient to take deep breaths.
Dr. Richard Rathe, a professor at the University of Florida College of Medicine, advises students to note the intensity of lung sounds, the symmetry between sides and the length of inspirations and expirations. Note the difference between upper and lower chest sounds when the patient is sitting upright and when lying down. Take note of the absence or presence of adventitious or extra lung sounds. - 2
Lung sounds cannot be heard through the scapula or shoulder bones.bare back image by msw from Fotolia.com
Place the stethoscope in 12 places along the back, switching from the left side to the right in a symmetrical fashion. Start at the bottom and work your way up. Listen to lung sounds at eight places along the middle back, under the scapula bones, from the outer rib cage inwards in two tiers of four. Listen to lung sounds between the scapula bones at their lower portion on either side of the spine. Listen to lung sounds below the base of the neck on both sides of the spine. - 3
Listen at center points along each lung.an xray of a chest image by alma_sacra from Fotolia.com
Ascultate the chest from side to side and top to bottom in 12 spots, recommends Rathe. Listen to lung sounds down four spots on each side of the chest beginning at the collarbone and ending at the breast or pectoral muscle. Listen to two spots on the outer sides of the rib cage below the breast bone. - 4
Warm your stethoscope before placing it on the patient.Stethoscope on blue image by Monika 3 Steps Ahead from Fotolia.com
Interpret your findings. Larger airways emit louder and more high-pitched the sounds according to Stritch School. Bronchial sounds are high-pitched, inspiration and expiration are of equal length and a pause should be heard between inspiration and expiration.
Vesicular sounds are normally low-pitched and inspiration is normally longer than expiration and you should hear no pause between inspiration and expiration. Breath sounds are louder at lower position.
If you hear bronchial breathing in abnormal spots, no ventilation is passing into alveoli. This may be due to alveolar atelectasis, cavitation, consolidation, pleural effusion, pneumothorax or a mass. - 5
Rales resemble the sound your hair makes when rubbed between your fingers.brunette hair image by robert mobley from Fotolia.com
Identify adventitious lung sounds. Adventitious or extra lung sounds consist of rales, rhonchi, stridor and wheezing.
Rales are also known as crackles. They are high-pitched and discontinuous. They make a clicking, bubbling or rattling sound and occur when air opens closed air spaces. They produce a sound somewhat like what rubbing your hair between your fingers does. Rales can sound dry or moist, fine or coarse.
Rhonchi lung sounds resemble snoring, according to the Medline Plus website. Air that is blocked or travels roughly through large airways makes these sounds. Rhonchi sounds can also sound like gurgling reports Rathe.
Wheezes are high-pitched sounds heard during exhalation. Narrowed airways produce wheezing sounds.
Stridor is a type of wheeze heard during inspiration. It is caused by blockage of airflow in the trachea or back of the throat. - 6
Ask the patient to whisper a number or word to check for whispered pectorloquy.doctor and patient 25 image by Paul Moore from Fotolia.com
Identify pleural friction rubs and whispered pectoriloquy.
When the inflamed and roughened pleural membranes stick together, the patient stops breathing for a moment because of pain. As the membranes pull apart and slip past each other, a sound like leather-on-leather may be heard during both inhalation and exhalation. This is a pleural friction rub, reports East Tennessee State University (ETSU).
Whispered sounds are not heard through the chest wall normally according to ETSU. If you ask the patient to whisper a word and you hear it through the stethoscope when it is place on the chest wall, fluid buildup in the lung is transmitting the sound clearly. This is known as whispered pectorloquy.
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