EARS/LUNGS/THORAX

• Crackles

  -short popping discountinued sound

  -may be affected by cough

  -prominent on inspiration

  -located at periphery

  may indicate

  -pneumonia

  -CHF

  -Pulmonary fibrosis
• Wheeze

  • HP musical sound
  • May be mild/mod/severe
  • continous
  • prominent at expiration
  • Located at smaller airways

  may indicate

  • asthma
  • cardiac asthma
• Friction rub

  • HP scratching/squeking
  • continous
  • located at the affected area
  • Prominent both on I/E

  may indicate

  • pleuritis
  • pleurisy
• Bronchi- prominent at exhalation located just above the clavicles at each side of sternum

  normal sound

  P- high pitched

  Q- harsh/hollow

  A-loud

  D-S/I L/E

  L-trachea/thorax
• Bronchovesicular- prominent both I/E continous, located next to sternum between scapula

  P- moderate

  Q- mixed

  A-moderate

  D-same in I/E

  L- over major bronchi(A), around upper sternum (P)
• Vesicular- L/E S/I located at the remainder of lungs

  P-low

  Q- breezy

  A-soft

  D-LESI

  L-P.L.F
• Bronchopony

  1. ask client to say 99/blue moon while auscultating chest

  normal

  • 99 is soft, muffled, indistinct
  • sound is heard but phrase is indistinct

  deviation

  • 99 is clear and distinct in steth
  • louder in areas with lung density

  may indicate

  consolidation,pneumonia, atelectasis, tumor
• Tactile fremitus

  1. place ball of ur hand with fingers hyperextended or the ulnar surface of ur hand on pt’s chest
  2. as u move your hand ask pt to say 99
  3. assess all areas for symmetry intensity of vibrations

  note: fremitus is palpable/diminished/increased/absent

  normal

  -symmetric vibrations easily identified in the upper regions of lungs

  deviation

  increased: fluid in lungs

  decreased: fluid around lungs

  atelectasis

  pulmonary; fibrosis, edema, infarction

  lung tumor

  emphysema/asthma
• Egophony

  • ask pt to say E while you auscultate the chest

  normal

  • voice soft, muffled
  • e is distinguised

  deviation

  • e sounds like a in areas with consolidation/lung density
• Whispered pectroriloquy

  • ask pt to say 1-2-3 while u auscultate chest wall

  normal

  • sound is faint and muffled
  • may be inaudible

  deviation

  • in some areas it seems as if the pt is whispering directly at the steth
  • 1-2-3 is loud clear and distinct