Melissa Lewis, RN Allied Health Sciences I 4th Block Lung Sounds Melissa Lewis, RN Allied Health Sciences I 4th Block

Respiratory Movements 1 inspiration + 1 expiration = 1 respiration Normal adult = 14 – 20 respirations per minute Increases with exercise, body temperature, certain diseases Decreases with sleep *** Emotions can increase or decrease rate Normal newborn rate = 40 – 60 respirations per minute

Respiratory Movements cont… Coughing: deep breath followed by forceful expulsion of air to clear lower respiratory tract Hiccups: Spasm of diaphragm Sneezing: Air forced through nose to clear respiratory tract Yawning: Deep prolonged breath that fills the lungs, increases oxygen within the blood

Patient Assessment Listening to a patient’s lung sounds (breath sounds) is extremely important You can hear someone breathe with your ears, especially if it is not normal However, the best way is to listen with a stethoscope (auscultation)

How do you listen to breath sounds accurately? Make the environment as quiet as possible The patient should be sitting up if possible and comfortable The patient will breathe in and out through their mouth The stethoscope’s diaphragm should be warmed with the hands before placing on patient It is best to listen to the lung sounds with the stethoscope placed directly on the skin (if not possible you can hear through thin clothing)

How do you listen to breath sounds accurately? Listen to the lungs symmetrically (listen in one area on the right and then listen to the same area on the left, etc) Remember…the lungs are as high as your collar bones and as low as your diaphragm (anterior and posterior) Listen from top to bottom Describe what you hear (rate, rhythm, etc.)

How should lungs sound normally? The sound changes as you go from upper to lower because the airways go from big to small The main objective is to make sure that the right and the left sound the same If there is a change from one side to another there is probably a problem

Abnormal Lung Sounds Abnormal lung sounds are caused by obstruction, narrowed airways, fluid, etc. These abnormal sounds could sound like bubbles, crackles, or rubbing Lots of different diseases/illnesses that can cause abnormal lung sounds temporarily or permanently

Respiratory Disorders

Common Cold Contagious viral respiratory infection Indirect causes: chilling, fatigue, lack of proper diet, and not enough sleep Rx = stay in bed (rest), drink warm liquids Also called an upper respiratory infection (URI) Handwashing = best preventative measure

Laryngitis Inflammation of the larynx or voice box Often secondary to other respiratory infections Symptoms = sore throat, hoarseness or loss of voice, dysphagia (difficulty swallowing)

Sinusitis Infection of the mucous membrane that lines the sinus cavities Caused by bacteria or viruses Symptoms = headache or pressure, thick nasal drainage, loss of voice resonance Rx = symptomatic, surgery for chronic sinusitis

Pharyngitis Red inflamed throat Sore throat Difficulty swallowing

Bronchitis Inflammation of the mucous membranes of the trachea and bronchial tubes which produces excessive mucous Acute or chronic Acute bronchitis is characterized by cough, fever, sub-sternal pain and rales (raspy sound) Chronic bronchitis is caused mainly by cigarette smoking***

Influenza Viral infection*** Symptoms = fever, nasal discharge, muscular pain, extreme exhaustion Complications = pneumonia, neuritis, otitis media (ear infection), and pleurisy Rx = treat symptoms (rest, fluids, etc)

Pneumonia Infection of the lung Bacterial or viral Alveoli fill with thick fluid Symptoms = chest pain, fever, chills, dyspnea Rx = give oxygen and antibiotics if bacterial

Tuberculosis Infectious bacterial lung disease Tubercles (lesions) form in lungs Symptoms = cough, low-grade fever in afternoon, weight loss, night sweats Diagnosis = TB skin test If skin test positive – follow up with chest x-ray and sputum sample Rx = antibiotic (HC providers worry about foreigners bringing this into the United States)

Asthma Inflammatory airway obstruction Caused by allergen or psychological stress 5% of Americans have asthma Symptoms = Difficutly exhaling, dyspnea, wheezing, tightness in chest Rx = anti-inflammatory drugs, inhaled bronchodilator

Emphysema Alveoli become over-dilated, lose their elasticity, cannot rebound, may eventually rupture Air becomes trapped, cannot exhale – forced exhalation required Reduced exhange of oxygen and carbon dioxide Dyspnea increases as disease progresses Rx = alleviate symptoms, decrease exposure to respiratory irritants, prevent infections, restructure activities to prevent need for oxygen

THE END!