Overview
This lecture reviews the top five most commonly tested abnormal lung sounds, their key characteristics, associated diseases, and priority treatments relevant for nursing exams and clinical practice.
Wheezes (Whistle)
- Wheezes are high-pitched, musical sounds heard mainly during exhalation.
- Caused by narrowed airways due to bronchoconstriction or inflammation.
- Common in asthma attacks and COPD exacerbations.
- Key treatment: AIM (Albuterol for immediate relief, Ipratropium for drying secretions, Methylprednisolone as a steroid).
Crackles (Rales)
- Crackles sound like bubbling or crackling and indicate “crazy fluid” in the lungs.
- Fine crackles: high-pitched, like hair being rubbed together; coarse crackles: low-pitched, like velcro.
- Heard at the lung bases, often from alveoli popping open.
- Associated with pulmonary edema (e.g., heart failure) and pneumonia.
- Treatment: Diuretics (e.g., furosemide) for fluid; antibiotics for infection.
Stridor (Serious Squeak)
- Stridor is a high-pitched, harsh inspiratory sound near the throat.
- Indicates upper airway obstruction (larynx/trachea), seen with choking, epiglottitis, croup, or post-thyroid surgery.
- Medical emergency; treated by endotracheal intubation or surgery.
Rhonchi (Rumble)
- Rhonchi are low-pitched, rattling or snoring sounds in the bronchi.
- Result from mucus secretions or obstructions, often seen in bronchitis, COPD, pneumonia, and cystic fibrosis.
- Treated with chest percussion and fluids to mobilize mucus.
Pleural Friction Rub (Pebble Rub)
- Sounds like low-pitched dry rubbing or two stones grinding together.
- Heard during inhalation and exhalation on the lung’s front side.
- Indicates pleural inflammation, often from worsening pneumonia.
- Treatment includes turning, coughing, deep breathing, incentive spirometry, and antibiotics.
Cheyne-Stokes (Death Rattle)
- Characterized by periods of rapid, deep breathing alternating with apnea.
- Signals impending death, seen in critically ill or end-stage patients.
- No cure; managed with intubation and mechanical ventilation.
Key Terms & Definitions
- Wheezes — High-pitched, musical lung sound due to airway narrowing.
- Crackles (Rales) — Bubbling/crackling lung sound from fluid in alveoli.
- Stridor — High-pitched inspiratory sound due to upper airway obstruction.
- Rhonchi — Low-pitched, rattling or snoring sounds from airway mucus.
- Pleural Friction Rub — Grating/rubbing sound from inflamed pleural surfaces.
- Cheyne-Stokes Respiration — Abnormal breathing with cyclical patterns of depth and apnea.
Action Items / Next Steps
- Memorize the five key abnormal lung sounds and their associated treatments.
- Write down and review the AIM intervention for asthma.
- Practice identifying lung sounds and matching them to diseases.
- Complete quiz questions and case studies related to abnormal lung sounds.