LUNG SOUNDS

Diaphragm nerve:

Phrenic

Diaphragm innervation:

C3-C5

Weak diaphragm can cause:

Increase in URI

External intercostals:

Rib cage

Rib cage innervation:

T1-T12

Quiet breathing:

Intercostals contribute up to 1/2 of active inspiratory, diaphragm does the rest

Diaphragm is normally highly:

Fatigue-resistant

Contains large # of mitochondria

Dense capillary beds

Muscles of expiration:

Abdominals (T6-L1)

Expiratory muscles usually inactive in quiet breathing

Needed for forceful exhale

Distensibility or the ease with which the lung can be inflated, change in volume for a given change in pressure:

Compliance

Responsible for lung coil:

Surface tension

Chemical that helps surface tension, present beginning around 28-32 weeks of gestation:

Surfactant

Art of listening to sounds produced by the body:

Auscultation

Need to have for ausciltation:

Functional stethescope

Proper technique

Knowledge of lung sounds

Knowledge of different categoreis of heart sounds and murmurs

Normal breath sounds are:

Bronchial

Bronchovesicular

Vesicular

Bronchial:

High-pitched

Heard on inspiration and expiration

Heard over trachea

Pause between phases

Noise ______ pause _____ noise

Bonchovesicular:

High-pitched

Heard on inspiration and expiration

No pause

Heard over bronchi or central lung disease

Vesicular:

Heard over peripheral lung fields, primarily during inspiration

Abnormal breath sounds:

Occur when sound transmission changes as result of underlying pathology

3 types:

- bronchial

- decreased

- absent

Adventitious breath sounds:

Extraneous noises produced over the bronchopulmonary tree

Classified as crackles (rales), ronchi, and wheezes

Crackles:

Discontinous

Low pitched

Mostly heard on inspiration

May sound like velcro popping or rubbing hair between fingers

Ronchi:

Low-pitched but continous

Occur during inspiration and expiration

Wheezes:

Continous but high-pitched

Has whistling or hissing quality

Extrapulmonary sounds:

Friction rub is nonpulmonary

Caused by visceral pleural lining rubbing against the parietal pleura

Heard on inspiration and expiration

Voice sounds:

Vibrations produced by the speaking voice as it travels down the tracheobronchial tree

Heard through stethescope

Bonchophany:

Increased vocal transmission, words or letters are louder and clearer

Causes are conditions where there is an increased lung density such as pneumonia

Patient repeats blue moon or one two three

Whispered pectoriloquy:

When these whispered voice sounds become distinct and clear

Have patient say one two three or ninety nine

Helps to identify a smaller or patchy areas of lung consolidation

Normal RR infant:

30-50

Normal RR adult:

12-18