NUR160 Wk6 Notes (Day1)

Introduction to Lung Auscultation

• Lung sounds can indicate various respiratory issues.

• Understanding the type of sounds can aid in diagnosis.

Common Lung Sounds

Wheezing

• Whistling sound caused by obstruction in air passage.

• Associated with conditions like COPD, emphysema, asthma, and chronic bronchitis.

• Can be high-pitched (polyphonic) or low-pitched (monophonic).

• High-pitched wheezes are primarily heard during expiration.

• Low-pitched wheezes typically sound like snoring; clear with a cough.

Stridor

• Harsh, vibrating noise indicating upper airway obstruction.

• Occurs during inspiration.

• Common in conditions such as croup or acute epiglottitis.

Crackles

• Sounds additional to normal breath sounds indicating inflammation or infection in bronchioles or alveoli.

• Heard in conditions like pneumonia and pulmonary edema.

• Coarse Crackles: Low pitch, wet noise typically heard in inspiration.

• Fine Crackles: High-pitched crackling sound heard in inspiration, does not clear with a cough.

Anatomy of the Lungs

Spatial Awareness for Auscultation

• Auscultation is performed on the anterior and posterior aspects of the chest.

• The anterior aspect mainly contains upper lobes.

• The posterior aspect predominantly consists of lower lobes.

Lung Structure

• Right lung: Three lobes (upper, middle, lower).

• Left lung: Two lobes (upper, lower).

• Importance of knowing intercostal spaces correlating with lung lobes for effective assessment.

Normal Breath Sounds

Types of Normal Breath Sounds

1. Bronchial Sounds

   • High-pitched; loud; only heard anteriorly over trachea.

2. Vesicular Sounds

   • Lower pitched; soft; heard in lower lobes during normal breathing.

Abnormal Breath Sounds

Continuous Sounds

• High-Pitched Polyphonic Wheeze: Multiple pitches in expiration.

• Low-Pitched Monophonic Wheeze: Single pitch in expiration.

• Stridor: High-pitched; occurs during inspiration.

Discontinuous Sounds

• Coarse Crackles: Low pitch; heard during inspiration.

• Fine Crackles: High pitch; persistent even after coughing.

Identifying Pneumonia

Characteristics of Pneumonia

• Acute inflammation of pulmonary tissue; common symptoms include fever, cough, and dyspnea.

• Primary causative agent: Streptococcus pneumoniae (bacterial).

• Diagnosed via chest X-ray and CBC; management includes antibiotics and supportive care.

  • Elevated WBC count indicates infection.

Chronic Obstructive Pulmonary Disease (COPD)

Overview

• COPD includes chronic bronchitis and emphysema; characterized by chronic airflow limitation.

• Common cause: Cigarette smoking.

  • Other irritants include air pollution and chemical fumes.

Emphysema

• Destruction of alveoli leading to decreased gas exchange.

• Symptoms: Shortness of breath, cough, barrel chest, clubbing of fingers.

• Diagnostic tests: Chest X-ray, pulmonary function test (PFT).

Chronic Bronchitis

• Chronic productive cough persisting for three months per year for two consecutive years.

• Pathophysiology includes inflammation, scarring of bronchial tubes, and excess mucus production.

• Symptoms: Cough, dyspnea, use of accessory muscles for breathing, cor pulmonale.

Management of COPD

Common Management Strategies

• Smoking cessation; use of bronchodilators and corticosteroids.

• Maintain hydration; humidified air; encourage cough and breathing exercises.

• Supplemental oxygen is given at low flow rates (2 to 3 L) to prevent hypercapnia.

Nursing Considerations

• Positioning (semi-Fowler's or tripod) to ease breathing.

• Educate on the importance of medication compliance, hand hygiene, and vaccinations."