What are adventitious sounds and give some examples.
- added sounds not normally present
- rhonchi, crackles
Differntiate between rhonchi and crackles.
rhonchi: clear with coughing and crackles do not
- rhonchi are deeper, more prolonged, more rumbling, more pronounced during expiration
What are crackles, fine and coarse crackles?
- sounds like a velcro opening
- produced when there is fluid inside a bronchus causing a collapse of distal (smaller) airways and aveoli. Crackles occur when there is sudden equalization of pressure causing some of the airways to pop open.
- Heard on inspiration; doesn't clear with coughing- causes (atelectasis, pneumonia, fibrosis, heart failure, pulmonary edema)
fine crackles: (high pitched, short duration, cracking and popping sounds)
coarse crackles (low-pitched, longer duration, bubbling and gurgling sounds)
What is rhonchi?
- airflow through airway obstructed by thick secretions, spasm, or tumor (bronchitis, decreased cough reflex, etc.)
- loud, low, coarse sounds (like a snore or rumble) most often heard continuously during inspiration or expiration
- often clears with coughing or suctioning
What is wheezing and how is it caused?
- airflow through a constricted airway (bronchospasm associated with asthma; acute or chronic bronchitis)
- high-pitched sqeaking sound (like a whistle)
- primarily heard on expiration, but, may also be heard on inspiration
- assess breath sounds with forced expiration in an asthma patient to check for bronchoconstriction.
What is stridor and how is it caused?
- a sign of respiratory distress
- r/t partial airway obstruction (foreign body)
- louder in the neck than chest
What is pleural friction rub?
- caused by inflammation of pleural surfaces (pleurisy)
- coarse, rubbing or grating sound during inspiration or expiration (disappears with breath holding)
Name the voice sounds and how you assess them.
Bronchophony (repeat "99" or "blue moon")
- Norm ("99" muffled and indistinct)
- ABN (clear "99)- increased lung density
Egophony (repeat "E")
- Norm ("eee" sound)
- ABN ("E" to "A" changes)- consolidation
Whispered pectoriloquy (whisper 1-2-3)
- Norm (sounds faint, muffled, almost inaudible)
- ABN (sounds clear and distinct)- consolidation
What are 10 objective data factors of the anterior thorax?
1. Skin (pallor, cyanosis)
2. Nails (clubbing)- r/t chronic fibrotic lung changes
3. Pursed lips (seen in obstructive disease)- prolongs expiration to allow for exhalation of trapped air
4. Splinting- shallow breaths to control pain
5. quality of respirations (quiet, easy and non labored)
6. Tracheal Position
- tension pneumothorax-trachea shifts (called tracheal tug) to the opposite
side of lung collapse
8. Costal angle < 90 degrees (barrel chest >90)
9. LOC (drowsiness r/t cerebral hypoxia)
10. Retraction or bulging of ICS- unilateral vs bilateral
- retraction (obstruction or increased respiratory effort)