Pediatric Respiratory Assessment Step 5: Auscultation (Nursing)

00:01 The technique involves using a pediatric stethoscope as indicated.

00:04 If the tool is too big, you won't be able to isolate the breath sounds.

00:09 You'll ask the patient to open their mouth and you're going to listen directly on their skin.

00:13 You don't want to be listening over a gown or clothing because this can cause sounds similar to rhonchi.

00:20 You want to make sure the patient is sitting up, if they're able, and this is going to allow them to fully expand their lungs.

00:26 In each position, you're going to listen for 1 complete respiratory cycle.

00:30 That includes a full inhalation and a full expiration.

00:36 Don't forget about the apices of the lungs, and these are found above the clavicles.

00:41 You also want to listen all around the rib cage under the axilla, so that you get every lung field.

00:47 You're going to compare the sounds bilaterally and you're going to be listening for any adventitious or abnormal breath sounds.

00:54 You're also going to be checking, during this exam, does your patient cough? When you listen to a child, you're going to be comparing the equality of the breath sounds and you're always comparing the right with the left in the same level of the lung.

01:08 You're going to be listening for diminished sounds, and this can show up in the setting of a pneumothorax or a consolidation.

01:14 And you're going to be checking for air exchange bilaterally.

01:19 The normal breath sounds.

01:20 We have bronchial, bronchovesicular, and the vesicular.

01:23 The bronchial sounds are a tubular and hollow sound heard over the trachea and sometimes, the mediastinum.

01:30 The expiratory phase and bronchial sounds is slightly longer than the inspiratory phase.

01:36 The next, as you move down the chest, is the bronchovesicular sounds.

01:39 These sounds are heard over the main bronchus region.

01:42 These are the normal sounds in the mid-chest area and these are heard also on the back between the scapula.

01:47 In this phase, the inspiration and expiration are of similar duration.

01:53 Last, you'll listen for vesicular sounds, and these are found over the lesser bronchi, the bronchioles, and the actual lobes of the lung.

01:59 The inspiratory phase is longer than the expiratory phase.

02:02 And these are low frequency, non-musical, and they're barely audible at rest.

02:09 Next, you're going to listen for wheezing, and similar to turbulent wind and airflow whistling through a chimney, the airway can also cause a whistle.

02:16 And this is a high-pitched sound that's flow-dependent, and it can be present on inspiration, on expiration, or both.

02:24 Next, you'll listen for crackles and these are high-pitched, short-duration sounds.

02:28 They can indicate that the patient is trying to move secretions.

02:32 You're also going to listen for rales, and these are discontinuous rattling, bubbling, or clicking sounds, heard usually during inspiration.

02:41 Next, you'll check for rhonchi, and these are low-pitched wheezes.

02:44 They're continuous and they often sound like snoring.

02:47 They can be present on inspiration and expiration, and sometimes, these clear with a cough.

02:53 Last, you're going to check for stridor, and this is a high-pitched wheezing sound caused by a disruption of airflow in the upper airway.

03:01 There may be a foreign body obstruction, mucus, or edema that blocks the airflow through the upper airway.

03:07 And this can usually be heard on the other side of the room without needing your stethoscope.

03:13 Next, you're going to listen for a cough.

03:15 Is it present or absent? You can also ask the parents about this if the patient isn't currently coughing in the clinic.

03:21 Characteristics.

03:22 You want to ask, "Is this a wet cough, or is it a dry cough?" Certain conditions are associated with each.

03:28 Is it paroxysmal? Does the patient get coughing spasms? And we worry about this in the setting of pertussis.

03:35 Is the cough worse at night? This is typically the condition, and it's usually from the post-nasal drip.

03:40 As the patient lays flat, the cough will worse at night.

03:43 This is really frustrating for patients and for their parents.

03:46 They're always asking, "What can I do to help my child stop coughing at night?" And we encourage symptomatic care as propping pillows, honey in warm water or tea, or taking sips of water.

03:57 Is the cough barking or does it sound croupy? These patients may have croup, which is a tightening of the upper airway.