Health Assessment, part 32: Assessing Breath Sounds

Hi, I'm Meris, and in this video, I'm going to be talking to you about auscultation of breath sounds over the posterior chest, along with different types of normal breath sounds and where you can expect to hear them. I'm going to be following along with our health assessment flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself, or if you prefer a digital product, I would invite you to check out Flashables, which is our digital version of all of our flashcards. All right. Let's go ahead and get started.

So first up, I want to show you one of the images on our flashcards here, which shows you where to auscultate different lung fields when you are listening to lung sounds on the posterior chest. And the thing that I want to draw your attention to with this image is showing you that it has this snaking S-like pattern, where it is showing you that we assess side to side. So if I'm listening to the topmost lung fields, I'm going to listen to one and then the other. I don't listen to the entire right lung, for instance, and then go and listen to the entire left lung. I want to compare symmetrical structures. I want to listen to each one and make sure that the sounds are the same. That I'm hearing normal breath sounds on both sides. That I'm able to hear them with the same intensity. And then also, this allows me to compare if all of a sudden, I'm like, "Is that an adventitious sound?" And adventitious is an abnormal or an unexpected sound. "Is that an adventitious sound?" Well, then I'm going to move to the other side in that same area and listen again, and say, "Yeah. That was adventitious because I don't hear it over here on this side," for instance. So we are always moving in this S-like, snake-like pattern versus all the way down, all the way down, okay?

All right. Now moving on, I want to talk to you about the different breath sounds, and we do have a nice chart here on our flashcard that goes into depth with these. So I'm going to talk to you about these. We have three different breath sounds that are considered to be normal or expected findings for breath sounds. So three different ones because they are three different qualities found in three different areas. So bronchial sounds. These are going to be loud and low-pitched, and these would be auscultated over the trachea, okay? Then I have bronchovesicular sounds, and these are going to be medium volume and pitch, and these are going to be auscultated over the bronchi. So if I were to place my stethoscope immediately to either side of the sternum here, right where I would expect my bronchi to split from the trachea, I would expect to hear bronchovesicular sounds. Contrast this with our last sound, which is vesicular sounds. And these are going to be heard specifically over the peripheral lungs, and these are going to be quiet, low-pitched sounds. So bronchial, vesicular, bronchovesicular, okay? So I think of this as going kind of in ABC order, right? It's alphabetical. I have bronchial, bronchovesicular, vesicular.

And remember, bronchovesicular is a mix of the bronchial and the vesicular sounds, so I would expect it to be where the lungs and the trachea kind of come together, which is going to be through the bronchi. And we have a really nice illustration here in our flashcards as well, which shows you where you can expect to auscultate these different sounds when you are listening to your patient's anterior and posterior chest. So it's a nice illustration there to demonstrate to you where you could expect to hear these different sounds. Now, all of these, remember, are considered normal, expected breath sounds. I expect to hear these sounds if I auscultate in these different areas. These are not adventitious sounds. Adventitious sounds are those unexpected or abnormal sounds such as crackles, wheezes, rhonchi, stridor, etc., which we will talk about in a future video, but these are expected in all of your patients who have average, normal, healthy lungs.

All right. That is it for this video. I'm going to test your knowledge of some key facts I provided with these quiz questions. The nurse expects to auscultate which breath sounds over the peripheral lungs? Vesicular. When auscultating over the trachea, which breath sounds should the nurse anticipate? Bronchial. All right. That is it for this video. I hope you found this review helpful. If you did or if you learned something, I would love for you to leave me a comment so I can hear about what you liked or what you learned. And if there is some great way that you have to remember these things, please leave us a comment. I want to hear it, and I know that other learners do as well. Thanks so much, and happy studying.