Let's test you on how well you can identify lung sounds so with our first scenario we have a patient who has heart failure and while you're listening to those lungs particularly the bases of the lungs you hear the following sound so what do you think you heard the answer is fine crackles so let's talk a moment about fine crackles whenever you're trying to remember this lung sound remember the following characteristics you are going to hear a high-pitch sound toward the end of inspiration it's going to be brief so short discontinuous and they're not going to clear with coughing in addition these lung sounds tend to be in the bases of the lung so those bottom parts of the lung Fields if you're trying to think of a sound to compare it to think of the sound that you hear whenever you have firewood on a campfire that light crackling of that wood or high pitch popping toward the end of inspiration now these lung sounds tend to occur of course in heart failure like in our scenario but it can also occur in acasis pulmonary fibrosis and some cases of pneumonia now what is the reason for this sound what is creating it well whenever the patient is inhaling air into the lungs and it hits those smaller Airways particularly like the Alvi which are going to be just like these deflated collapse little structures are sort of just like flopping there whenever that air rushes into those it's going to cause those to explode open or crackle open and this creates that high-pitch crackling noise that you're picking up with your stethoscope so as a nurse what is our role with this type of lung sound first we want to make sure we know why this patient is having fine crackles is it due to heart failure or pneumonia whatever the cause those interventions are going to be tailored to it so one thing of course is maintaining proper oxygen levels by administering the prescribed amount of oxygen by the healthcare provider we also want to make sure that the patient can breathe easy and that their lungs can fully expand so positioning can help with this like having the head of the bed elevated up and fowers or high fowers now patients who have heart failure this is particularly important in this position because it helps reduce Venus return which is going to hopefully decrease the amount of fluid that's accumulating in our lungs we also want to encourage coughing and deep breathing techniques to help move secretions around incentive spirometers are really helpful with this also administering medications per the healthc care provider's orders such as diuretics that's going to help remove extra fluid from the body and help dry out those lungs like in cases of heart failure heart medications so our heart can pump more efficiently andless fluid enters lungs Bronco dilators to help open those Airways up monitoring fluid intake and output making sure the patient isn't taking in too much fluid which in the end could end up in our lungs and monitoring their daily weight because remember monitoring daily weight is a great indicator of the patient's fluid status here you have a patient who is experiencing a fever of 102.2 De F and the patient reports that whenever they breathe in deeply or they cough they experience some serious pain plus they report that they're having some shortness of breath and a dry cough so you decide to take a listen to their lungs and you hear this so what did you hear the answer is plural friction rub with this lung sound in most cases your patients already going to have these abnormal signs and symptoms that you're going to see and they're going to report before you even listen to their lung sounds and it's sort of going to tip you off that hey we might have a plural friction rub here so in the scenario you already sort of seen those signs and symptoms your patient had a fever they reported pain when they were breathing in and coughing and they were having some shortness of breath and a dry cough that is classic with this type of lung sound so with this lung sound you are going to hear this harsh grading noise that is going to be present on inspiration and expiration it's going to be low pitched and it can be continuous or discontinuous depending on the severity and what's actually causing it now the reason that this sound is occurring is because you have some major inflammation of the plural layers of the lungs so normally these two layers as the patient breathes in and out they should just Glide over each other and you don't know any different because they're working like they should but whenever they are inflamed whoa they cause some major pain because those layers all of a sudden they don't Glide anymore they rub up against each other and that's going to create that grading harsh noise that you're hearing now this can be caused by many different things a huge cause is puracy which another word is platus and that's just a fancy way of saying you have inflammation of those plural layers now this can be from a viral cause bacterial cause or even an autoimmune cause in addition it can be caused by pneumonia tuberculosis a pulmonary embolism and in some cases lung cancer and as a nurse we play a huge role in number one helping the patient manage their pain and inflammation because if we can do that the patient is going to be a lot more comfortable and breathe easier so the healthcare provider can order medications that we can give such as incets corticosteroids plus we want to teach the patient on doing chest splinting when coughing because that's going to promote them to breathe deeper and expand those lungs out also teach them about positioning so a lot of patients find it easier to breathe whenever they're setting up or they're lying on their side particularly that side that is affected with pain other interventions include let's say they have an infection we would administer antibiotics or if they have a pulmonary embolism we play a role with administering anti-coagulation and and educating them about that and then in some cases patients have fluid in there so they may need a chest tube to help drain that fluid out next you have a patient who is admitted with bronchitis and whenever you take a listen to their lungs you hear this okay so what do you think you heard the answer is ronai so with ronai once you remember the falling character istics you're mainly going to hear on expiration it's going to be continuous low pitched and loud it's going to be similar to like a snorting or snoring sound and the reason for this is because whenever the patient is exhaling because remember you mainly hear it on expiration this air is going it's passing through the broncus the trachea and it's colliding with fluid and mucus and whenever it does that that's when you hear that noise now one thing about this sound is that whenever the patient coughs or there suction this sound can decrease in its intensity or completely go away now ronai tends to occur in cases where you're going to have this mucousy fluid stuff in there so that can occur like with our patient here who has bronchitis in cases of pneumonia and COPD and the nurse's role is around making sure that those Airways stay open and clear we need that in order for our patient to get proper oxygenation so you want to make sure you have the patient coughing and deep breathing every 1 to two hours while they're awake using that incentive spirometer if you don't know how to use one of those I have a whole video that tells you about it you also want to make sure the patient stays hydrated to keep those secretions thin so they don't build up and become thick and sticky also in severe cases they may need chest Physiotherapy and this will help remove secretions and improve lung function in addition they may benefit from breathing treatments and medications like Bronco dilators corticosteroids mucco litics or oral medications to help thin the secretions like guinin here we have a patient who has a lowgrade fever increased respiratory Ray and voice horseness and as you're in the room you hear this sound coming from the patient's respiratory system and you don't even need your stethoscope to hear it so what did you hear the answer is Strider with Strider you want to remember that this is a high pitch sound during inspiration now in severe cases it can occur during expiration and the reason it's occurring is because we have air flow obstruction in this upper Airway and that's why you're mainly hearing this sound originating from the throat area and a lot of times like I said earlier you can hear it without your stethoscope it's like pronounced and the reason this obstruction is occurring is a lot of times due to swelling of this upper Airway from an infection like in cases of cou epiglotis it can also occur that swelling because of an immune response your immune system is really stressed out like in Anais and if you have a foreign object stuck here in your throat it can cause it now whatever the cause is if you hear this sound know it is a medical emergency and the patient needs treatment immediately so the nurse's role with this type of lung sound is about keeping that airway open a lot of times when you're going to encounter strer is in the Pediatric population like when they have C or epig itis so these interventions I'm about to go over remember them cuz it's probably going to help you for your pediatric exams as well so you want to help keep the patient calm we don't want them crying and stressing out that Airway anymore so we want to keep them with their parents no invasive procedures we also want to keep them hydrated so prevent dehydration we also want to soo that inflammation in those upper Airways so that can be achieved through cool humidified air and administering oral corticosteroid per the healthcare provider's orders now if your patient has severe swelling or they're just in outright like respiratory distress we got full-on stroter kicking in full gear you want to administer nebulize epinephrine this is going to quickly reduce that Airway inflammation and you want to think about positioning you want to make sure that they're in the best position possible to help promote good breathing so you want to avoid the Supine position so on their back this actually increases distress and makes it harder for them to breathe a lot of patients find that leaning forward may help so you may hear of the tripod position this is where they sit leaning forward with their arms supported especially in cases of epiglottitis in this next scenario you have a patient that you are doing a head to toe assessment on and you were listening to their lung sounds particularly those peripheral lung fields and you hear the following sound so what did you hear well this one was a little bit tricky because it's actually a normal lung sound it's known as a vascular lung sound and the reason we know that we're dealing with this type of lung sound is based on where we heard it and its characteristics so from the scenario we talked about that it was from the peripheral lung field so that was the clue that this might be a normal lung sound so that's where you tend to hear it and it has a characteristic where it's going to be soft low pitched and it tends to be longer and louder on inspiration rather than expiration here we have a patient who has been admitted with shortness of breath and they have a history of asthma when you take a listen to their lungs you hear this so what do you think that was well that was high pitched wheezing characteristics that you want to remember about this type of lung sound is that you can hear it during inspiration expiration but it tends to be loudest during expiration it's going to be continuous and it's going to be high pitched mainly in that lower part of the respiratory system and if you want to compare it to a sound it would be like a squeaky musical whistling sound and sometimes if a patient is having a severe asthma attack you can hear this high pitch wheezing without a stethoscope and this sound is occurring because those lower Airways have narrowed so instead of being nice and open and air just flows right through it they've shrunken down so whenever air flows through that narrow Airway it's going to create that musical tune to it so it can occur of course in asthma like with the scenario but it can also occur in COPD and in lung infections where those Airways tend to swell like in viral infections and the nurse's role is about keeping those narrow Airways from further narrowing and helping improve ventilation so oxygen therapy to maintain oxygen levels position ing the patient and fowers or high fowers to help with breathing administering Bronco dilators to dilate those narrow Airways and those short acting Bronco dilators are best when you need fast relief like if you're dealing with an asthma attack also you want to educate the patient on avoiding triggers that can narrow those Airways like environmental infections and even certain medications that can cause bronos spasms like the beta blockers that are non- selective next we have a patient who's receiving treatment for a case of pneumonia you listen to their lung sounds and you hear this so what do you think you heard the answer is co crackles so some characteristics you want to remember about this lung sound is that it's going to be low pitched it's going to be longer and louder than those fine crackles that you heard earlier and it's going to be discontinuous now when you tend to hear this will be at the beginning of inspiration but it can extend into expiration and you're mainly going to hear it in those larger Airways and if you have the patient cough it's typically not going to clear it so if you're trying to compare this sound to something think of it sounding like a bubbling or gurgling noise now the reason course crackles is occurring is because as a patient takes air into their lungs and this air flows through the large Airways like the large broni they're going to be partially blocked with thick mucus or fluid and whenever the air tries to pass through that it's going to create that bubbling or gurgling sound now this can occur in cases of heart failure where you have pulmonary edema so you have fluid in the lungs or cases of pneumonia where you have issues with thick sticky mucus and cases of bronchiectasis where those Airways are dilated and when they dilate due to damage over time it causes the patient not to be able to clear mucus effectively therefore whenever we're talking about the nurse's role it really depends on what's causing your patient's coar crackle so some things that can be done for this patient is coughing and deep breathing techniques so incentive spherometer is really helpful for this maintaining hydration to make sure that those secretions stay thin not thick so they can clear them oxygen therapy and if your patient has fluid overload let's say with pulmonary edema they may be prescribed diuretics and cardiac medications just to help that heart pump more effectively so we don't get the fluid in the lungs corticosteroids for any infl antibiotic therapy for infections Bronco dilators postural drainage and making sure you're positioning the patient so they can breathe easier so having that head of the bed in fowers or high fowers position okay so that wraps up this video and if you'd like to watch more videos in this series you can access the link in the description below