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Listen to the entire Nursing Show episode with news, commentary and the Lung Sounds tip of the week.

Wheezes

You also next have wheezes. Wheezes are the result of constriction of the smaller air passageways. And the constriction is usually as the result of some form of bronchial constriction resulting from an allergic reaction, an asthma attack, or an underlying lung disease related to something like emphysema or chronic bronchitis as a result of something like smoking or other ongoing chronic lung illness.

And in this situation you’re going to have the airway kind of collapse and it’s going to create a wheezing or a whistling sound as the air rushes past that suddenly smaller space. So air moves down into the larger passageways, starts to branch out into the smaller and smaller air passages, and it reaches a point where the smaller passages begin to have constrictive capabilities and that constriction is going to cause a wheezing sound.

And this is a musical tone that tends to change in pitch with the amount of air rushing past. It’s like kind of a whistling sound and you may hear this as well. This is a sign of air trapping because the air is getting in but not necessarily escaping effectively as it’s trapped behind these restricted passageways.

Stridor

Similar to wheezing, because it’s a similar high-pitched sound from constricted airway, is stridor. But stridor’s not really a lung sound; it’s a breath sound associated with the upper airway and the location of the trachea and the larynx and is related to the constriction of that airspace by usually a foreign body, although it can be restricted by inflammation related to a disease process like epiglottitis or croup. And this is that high-pitched, almost like a seal bark sound that is heard sometimes so often in children and can be signs of an impending or ongoing airway blockage, either by a foreign object or inflammation. And so that’s the sound that you might hear. That’s stridor. And that’s often audible to the ear without the use of a stethoscope because you can actually hear it when they breathe from across the room.

Absent Breath Sounds

The final abnormal finding for lung sounds that I’ll talk about here before we close out is the finding of absence of breath sounds. And this can be the result of many different things. It can be the result of ongoing atelectasis from a patient who has been in bed too long and hasn’t had an opportunity to expand their lower lobes of their lungs. You may hear decreased sounds in the basis.

Absence unilaterally of breath sounds is an indication of a pneumothorax or, in the case of a patient who has a history of lung cancer, the removal of one of their lungs. This patient’s not going to have breath sounds on one side. And yet if you were not aware of this from their history it would be a startling finding indeed.

So again, absence of breath sounds in any field would be indicative of some kind of an occlusion or a difficulty in that particular area of the lungs. In the bases this often related to a patient’s process of disease where they’ve been on prolonged bed rest and have lost or had diminished capacity in the bases as a result of laying around too long.

Nursing Interventions

And you can use your interventions like coughing and deep breathing, the use of the inspirometer and generating that cough response in order to assist these patients in opening their airways more fully and being able to fully inflate the places that have been affected by atelectasis.

Resources

So that’s a look at the abnormal lung sounds. It’s a quick review. I have a couple of websites linked to in the show notes for you to go and listen to specific sounds.

Some of them are better than others and because that’s kind of mixed on both sites I think the two sites I’ve provided you give you a good representation of what you’re listening for.

And there are other resources out there that you can find. If you check Google, you can Google “breath sounds” or “lung sounds” or auscultation and find a whole lot more information out there.

And that’s this week’s tip and trick of the week.

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