Can you hear me: Breath Sounds

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You look back to when you were kid watching a television show with a doctor checking up on a patient using his all-time trusted stethoscope. You see him concentrating and listening as he asks the patient to inhale and exhale. You found it quite cool actually and looked forward to the day that you could actually do such.

Now that you’re a Registered Nurse and is now in the position to perform what you always longed to do, to listen to breath sounds and look all cool, you don’t even know what to do. What do you look for when you’re auscultating? What are the different breath sounds to look for? How would you know if a particular sound is normal or abnormal?

What are breath sounds?

Lung sounds, also known as respiratory sounds or breath sounds, can be auscultated across the anterior and posterior chest walls with a stethoscope. They are the noises produced by the structures of the lungs during breathing.

Breath sounds can be classified into two categories: normal and abnormal (adventitious). Breath sounds come from the large airways where air velocity and turbulence make vibrations in the airway walls and are then transmitted through the lung tissue and thoracic wall to the surface where they may be heard readily with the aid of a stethoscope. Normal breath sound production is directly related to air flow velocity and airway lumen architecture.

Normal breath sounds

  • Bronchial sounds.

These sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx.

  • Bronchovesicular Sounds

These breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase.

  • Vesicular Sounds

These consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung field.

Absent or decreased sounds can mean:

  • Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion)
  • Increased thickness of the chest wall
  • Over-inflation of a part of the lungs (emphysema can cause this)
  • Reduced airflow to part of the lungs

Abnormal breath sounds

  • Rales

These are small clicking, bubbling, or rattling sounds in the lungs and are heard when a person inhales. They are believed to occur when air opens closed air spaces. Rales can be further described as moist, dry, fine, and course.

  • Rhonchi

These are sounds that resemble snoring. They occur when air is blocked or air flow becomes rough through the large airways.

  • Stridor

Wheeze-like sound heard when a person breathes. Usually it is due to a blockage of airflow in the trachea or in the back of the throat.

  • Wheezing

High-pitched sounds produced by narrowed airways. They are most often heard when a person breathes out (exhales). Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.

Beneath abnormal breath sounds may lie certain conditions causing them, such as:

  • Acute bronchitis
  • Asthma
  • Bronchiectasis
  • Chronic bronchitis
  • Congestive heart failure
  • Emphysema
  • Interstitial lung disease
  • Foreign body obstruction of the airway
  • Pneumonia
  • Pulmonary edema
  • Tracheobronchitis

Assessment is part of the responsibilities of the nurse. As health professionals, we must be knowledgeable enough to know what to look out for in certain types of conditions for us to be aware if there is something wrong and needs immediate attention. We must take every opportunity to improve our auscultation and assessment skills, since with accurate assessment come accurate interventions.

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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