Lung Auscultation Landmarks, Sounds, Placement Nursing | Assessing Lungs Part 1

hey everyone it's Sarah dredge Turner sorry and calm and in this video I'm going to be going over long auscultation specifically the sites of where you auscultate and I'm going to be going over normal breath sounds versus abnormal breath sounds and as always you can access the quiz and the notes over here or in the description below now in the next video I'm going to be performing an assessment on a patient and show you how to listen with your stethoscope to these sites so let's get started first let's talk about our objectives of this lecture what I want you to learn is lung anatomy because it's really important you know what you're listening to the specific auscultation size I'm going to give you some landmarks to make your job easier so you'll know what intercostal space correlates with which lobe of the one and we're going to go over some audio clips of normal breath sounds and where you should hear them out so that's a big thing you should know where you should hear wrong field verses vesicular and we're going to go out over abnormal breath sounds and I'm going to let you listen to the end and you can compare the two so first let's go over lung Anatomy whenever your auscultate in you're going to be listening to the anterior part of the test and the posterior part of the chest now one thing you want to remember whenever you're listening to anterior mostly what you're going to be hearing a lot of because it's predominantly in the anterior part are the upper lobes however on the posterior part what is predominately made up on this is the lower lobes so first let's take a look of the anatomy of the anterior part of the chest in this illustration you have your right lung and your left lung and how I set up this illustration is that I wanted you to be able to see what is over the lungs because whenever you're listening with your stethoscope you need to know where clavicle is and certain intercostal spaces because they correlate to which lobe of the lung you're listening to for instance if you're listening down in the sixth intercostal space mid-axillary you're assessing the lower lobes of the right and left lung which we'll go over in depth whenever I cover these auscultation sites so first let's cover the right lung your right lung is made up of three lobes very important so you have your right upper lobe then you have your right middle lobe and right here you have the horizontal fissure and then you have the oblique fissure and this just separates the middle lobe from your upper and your lower and then down here you have your right lower then over here you have your left lung you have your left upper lobe and B in your left lower lobe and if you notice in the drawing mainly whenever you're listening to your lungs you're mainly going to be assessing because you can see more of it of your upper lobe then we have our trachea which is up here and it goes down and it branches off into your bronchus your bronchi and then your bronchi go even further and branch off into bronchioles with your IV Oller sacs and this is where gas exchange occurs and then of course you have your breastbone and all your ribs right here now let's look at the posterior view of the lung here is the posterior view of the patient's back if you were to look inside look at the lungs you'll have the clavicle on the front then it comes around and it forms into your scapula and you have your less lung and your right lung they were on their flip then compared to the anterior view and here as you can see you have mostly lower lobe that you're assessing and it's separated by your fissures here so you have your right upper lobe and you have your right lower lobe notice you can't really assess the middle lobe like as you can with anterior view and then over here you have your left upper lobe and your left lower lobe and you have your spine in the middle and it's really important you find c7 to t10 whenever you're assessing which we'll go over in the auscultation site because this will help you where to place your stethoscope in between the spine and the scapula on those intercostal spaces right in between the ribs where you start listening to a patient's lung let's talk about some tips to make your job easier so you can get the best sound possible be able to assess those lungs correctly okay first tip listen directly on the patient's chest with the diaphragm of your stethoscope that is the big part of the sub scope which you'll see a little bit later and the reason you want to listen directly on the skin and not over close is because a lot of times your diaphragm can rub up against the patient's clothes and that can make like a rustling sound sound like one there's adventitious lung sounds and it'll muscle and decrease the sound quality of what you're trying to hear also whenever you're listening on women you'll want to have the woman raise up her breast so you can get underneath those sites so you can hear those lungs sounds because the tissue will muffle the noise and you won't be able to hear that so remember that whenever you're listening on a female patient also whenever you're listening to the chest you're going to listen to the both the front and the back side and whenever you're listening you're going to note a full cycle of inspiration and expiration and what you're listening for is you're listening to the pitch is it highs in a medium or low pitch what's the sound quality and its duration is is inspiration longer than expiration or vice versa or are they equal which are characteristics of normal breath sounds and on that sound that you're hearing is there any extra adventitious sounds that shouldn't be there maybe on inspiration or expiration so you really want to note that and whenever you listen you're going to start from the top and work your way down and you're going to compare sides so be something like this I'm going to start up here at the apex of the lung listen here and then you're going to go over and with on the other side to compare it then you're just going to drop down a little bit listen here and then you're going to go over here and compare sides drop down again and just keep repeating until you've reached the bottom another thing what you want to do to help get the best sound quality is have the patient sitting up so you can get to the front and the back of that chest post cheerily because this is an area that may give you trouble because as we went through the anatomy you have your spine here and you have the scapula here so if you have the patient sort of move their arms forward maybe in their lap to separate those shoulder blades you can get in those little intercostal spaces better so you can put your diagram and listen to those sounds also whenever you're having the patient breathe you want them to breathe in and out through their mouth slowly so you can hear those lungs inflate and deflate however and a lot of patients who may have breathing difficulties you'll have to take your time within because they can hyperventilate easily and make sure your patient doesn't get dizzy and just take your time while you're having them breathe now let's go over the auscultation sites okay first we're going to assess the anterior part of the chest first and what I like to do is I find the clavicle and we're going to start at the apex of lungs and talk to the lungs and we're going to get our diaphragm which is the big part of your stethoscope and you are going to place it right slightly above that clavicle where the apex is you're going to listen there for a full inspiration and expiration and then you're going to go over and compare on the other side and this is listening to the apex of the lungs then you're going to find your second intercostal space this is one of those landmarks we're talking about because this is going to assess our upper lobes of our right and left lung and this is found midclavicular Lise in the middle of where the clavicle is in the second intercostal space so you listen here compare your side and then just go a little bit lower maybe into the third intercostal space and just keep listening to those upper loads then we're going to go down to our fourth intercostal space this is another big landmark for specifically the right middle lobe so we're going to go down to our fourth intercostal space we're still in the left lobe in the upper lobe and now we're going to go over here and compare sides now we're in the right middle lobe and this again is mid clavicular lis and we're listening in here and then we'll just inch a little bit down maybe in the fifth and still assess our right middle lobe and then we'll go over and compare sides still being in the upper lobe on the left side now we will inch down to the sixth intercostal space but mid axillary so we're there armpit is go Midway and we're down in the lower lobe of the lungs and we'll have them inhale and exhale and then we'll go over and compare it on the other side which we're in the right lower lobe here and assessing this and then we'll just into a little bit down maybe to the seventh space down the lung and just listen and those lower lobes a little bit more and compare sides and then we're done now let's look at our sites on post ears just like with anterior and the posterior we're going to start from top to bottom and compare sides and work our way down and we're going to start right above the scapula right where the apex is so we're going to listen here and then we're going to go over to the other side and compare and remember to get the best sound quality so you can hear so you're not listening over the shoulder blades because that won't muffle your salmon you won't be able to hear have your patient put their arms in their lap or just separate those shoulder blades from each other so you can get in between that spine and shoulder blade area then what we're going to do we want to assess first your upper lobes so from c7 to t3 your cervical and thoracic spine that is where your upper lobes or and you can see here's your Fisher's right here and you have the upper lobes there so what you want to do is just go in between where the shoulder blades and the spine are and just work your way down so we're going to listen to your upper lip so we'll go here and then we'll compare over here and then we'll go down a little bit towards where t3 is listen here still being in the upper lobe then we'll go over and compare sides now from t3 to t10 that will allow us to assess our lower lobes so we'll start around t3 and work our way down again just staying in between where the scapula and the spine is and we will just compare sides and enter way down and you want to move around almost mid-axillary where you were moving before on interior so you can just get a good feel for what's happening in those lower lobes or so sorry not talking about normal breath sounds okay there's three different types a tip for whenever you're trying to learn these normal breath sounds is to get a stethoscope listen to yourself or listen to others and get a rhythm down for how long inspiration expiration is and where these are located because that's the key with these three different sounds because they're heard in different areas throughout the lung field so let's go over them the first one is bronchial this is heard anteriorly only you're not going to hear this posteriorly anteriorly why because they are mainly heard over the tracheal area with the stethoscope so up here in this area they are high-pitched and loud and you will notice when you listen to them that the inspiration will be slightly shorter than the expiration and this is what bronchial breath sounds sound like next is bronchioles acicular these are heard both anteriorly and post eerily and they post eerily you will hear these at the first and second intercostal space so about in this area right in here with your stethoscope is where you're going to hear them anteriorly now post cheerily you're going to hear them in between the scapula so about right here where t3 t4 in the small little areas where you will hear those and they will have a medium pitch to them and inspiration and expiration will be equal and here's what Bronco vesicular sounds like and the third breast sound is called vesicular this is heard again and both anteriorly and posteriorly and it is heard throughout the peripheral lung field so you're going to be hearing these all throughout in this area over here anteriorly and post tearily and it will have a low pitch that will be sort of soft and inspiration will be greater than expiration and here is what vesicular sounds like now let's talk about those abnormal breast films that you could hear that may be thrown in with those normal breath sounds okay they are separated into continuous and discontinuous now first let's go over continuous what does continuous mean this is a extra sound that you're hearing that is lasting more than 0.2 seconds with a full respiration okay the first type is called a high pitch polyphonic wheeze let the name help you okay so what is it it is mainly heard in expirations when the patient's breathing out but it can be an inspiration as well and it is a high-pitched musical instrument sound with many different sounds to it that's why it's polyphonic and this is what a high pitch polyphonic wheeze sounds like another type of ways you can have is called a low pitch monophonic wheeze and this is again heard mainly an expiration but you can hear at any time but a lot of times you'll hear it whenever the patient's breathing out it is a low pitch whistle so instead of being high-pitched like the high-pitched wheezing to be low and it's going to be made up of one sound quality that's all you're going to be hearing and it can sound like a whistle or a whine and this is why a low pitch monophonic wheeze sounds like and the third type of continuous adventitious breath sound is called Strider and this is heard on inspiration because what's happening is that the airway is being obstructed by inflammation or some foreign objects something like that and once you hear this you will never forget it's very unique sounding it is a high pitch whistling or gas with a very harsh quality to it and on patients like pediatric patients if they get the croup or a cute epiglottitis or you have a patient who has an airway obstruction you will hear this sound and this is what Strider sounds like now let's get over the second type of breath sound abnormal breath sounds called discontinuous this is an extra sound that you're hearing that is lat lasting less than 0.2 seconds okay first type is coarse crackles crackles formerly have been known as rels so if you hear that that's what it means crackles rels they're interchange just like rhonchi and weaves so coarse crackles they are mainly heard in inspiration when the patient's breathing in and can extend into expiration and what it will sound like is a low pitch wet slash bubbling sound and this is what course crackle sounds like the second type of discontinuous abnormal sound is called fine crackles this is heard on inspiration and it is a high pitch crackling sound compared to the coarse crackle this is like low pitch like a bubbling noise this fine crackles is high pitch it sounds completely different than coarse crackles and it has like a crackling of a fire sound to it and the key with this is that it does not clear when you have the patient call so you listen you hear that yes patient the coffin it's still there that would be fine crackles and this is what it sounds like and the last sound is called a pleura friction rub this is heard both on inspiration and expiration and it is a low pitch harsh grating sound and what's causing this is that your pleura on your lungs those two layers are rubbing against them each other and they normally have this little thin layer of serous fluid around the lung but it doesn't right now due to all that inflammation going on so you can actually hear that when that patients breathing in and breathing out so that's why you're hearing it an inspiration and expiration now it can sound similar to a pericardial friction rub how do you tell the difference and if you are wanting stones this the lungs or is this the heart just listen have the patient hold their breath and if you can still hear the harsh grating sound it's the heart because they're holding their breath their lungs aren't moving so you ruled out the lungs and this is what it sounds like okay that is one auscultation and normal breath sounds versus abnormal breath sounds don't forget to take the free quiz on the website and check out the other videos in this series to help you with lung auscultation and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

Views: 2,017,621

Keywords: lung auscultation, lung auscultation landmarks, lung auscultation sounds, lung auscultation placement, lung auscultation nursing, lung auscultation points, assessing lung sounds, assessing lung sounds part 1, assessing lungs, assessing lung sounds part 2, lung assessment, lung assessment nursing, heart lung assessment, lung health assessment, thorax and lung assessment nursing, nursing assessment lung sounds, chest and lung assessment, lungs sounds

Id: KNrcG077brQ

Length: 20min 17sec (1217 seconds)

Published: Thu Oct 13 2016