Auscultation – Respiratory Assessment (Nursing)

00:00 Now, there's usually a specific order there that we recommend you auscultate the lung sounds.

00:05 You'll see anteriorly, we have a diagram for you where we set that up for you to see how you work your way down the chest.

00:11 And then posteriorly, we recommended the order for you to go in.

00:16 So it would be a good opportunity when you're done watching the video to make sure you practice this on yourself, on a roommate, on a child or friend, anybody you can get to stand still long enough.

00:26 Practice auscultating lung sounds or at least the placement.

00:30 It'll be much better for you to listen in all those different areas to start to get the feel for how lung sounds change from the top, from the bottom, from the back and to the front.

00:41 So these are the steps when you can finally get someone to work with you.

00:45 These are the steps I want you to practice.

00:47 First, ask your patient for their permission to listen to their lungs.

00:52 Anytime you touch a patient or you're going to touch a patient, before you do it, you ask their permission.

01:00 It's just a sign of respect, developing a therapeutic relationship.

01:04 It's pretty invasive to touch someone else's body.

01:06 So if you ask permission from them, patients will usually always say "yes." If they don't, you need to have a little bit more conversation.

01:14 So you've asked permission.

01:15 Second step is, you place the stethoscope in your ears and then you adjust them.

01:21 So you do that first. I've got their permission.

01:23 Don't talk to a patient with stethoscopes in your ears, it's rude.

01:28 So, ask them first for their permission, then put the stethoscope in your ears and adjust them to what's comfortable for you.

01:36 Then, place the diaphragm of the stethoscope firmly on the patient's chest and encourage the patient to take deep breaths as you listen for high-pitched sounds. Okay? So we're using the diaphragm for the high-pitched sounds.

01:51 Next, use the bell. Now, you either have to flip it to use the bell side of the stethoscope or you need to use a different level of pressure on your stethoscope to listen for the lower pitch sound.

02:02 So diaphragm; higher pitch sound. Bell; lower pitch sounds.

02:08 Now, as you're listening to the lung sounds, listen for some abnormal sounds.

02:12 You're listening for things like fine or coarse wheezes, crackles, rhonchi, or even an absent of sounds or diminished sounds.

02:22 So you have to be a real investigative reporter when you're doing this. Right? I often have to close my eyes so I can really focus and I don't get distracted by other things.

02:32 And I'm listening for anything that is outside of normal.

02:37 So, note the differences we talked about. Comparison will really help you.

02:41 Note the differences between the anterior, the posterior, the right side, the left side, the upper and the lower.

02:47 It's not uncommon if someone has consolidation that you're not gonna hear lung sounds over that very well.

02:53 They're gonna be diminished or absent.

02:55 If the patient has a lung collapsed, little areas of atelectasis or larger areas of atelectasis, you won't hear breath sounds over that area.

03:05 Comparing right to left, patient might have a right-sided pneumonia.

03:09 I'm gonna hear some really nasty rhonchi on the side of where they have this pneumonia, might not hear it on the left side.

03:16 Also make note that you have inspiratory or expiratory.

03:21 Do you hear these wheezes or rhonchi in inspiration or expiration? Make sure you carefully document that in your notes.

03:29 And you don't wanna do one and done.

03:31 You're doing at 12 hour shift, you don't wanna listen to a patient's lungs once and say, "Well, I've check that off." This is something you want to frequently reassess based on the patient's progress and any other symptoms that you might observe.

03:45 But the more you listen, the more you'll get to know what that patient's baseline in and you will recognize the change much quicker.