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.
The lecture Pediatric Respiratory Assessment Step 5: Auscultation (Nursing) by Paula Ruedebusch is from the course Respiratory Disorders – Pediatric Nursing.
What respiratory assessment technique typically employs a stethoscope to compare sounds bilaterally?
What types of normal breathing sounds are assessed through auscultation? Select all that apply.
What is included in the nurse’s auscultation technique when performing a respiratory assessment on a pediatric client? Select all that apply.
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