now we're going to listen to lung sounds what's known as auscultation so we're going to listen for vesicular crackles wheezes Strider really anything going on inside the lungs here and we're going to show you a quick assessment of really how to do it but always remember we're going between the ribs in the intercostal space basically meaning in between the ribs here so normal breath sounds you are hearing that air open and close in the alveoli so we want that good air exchange so let me show you how we're going to be doing the assessment always remember keep the basics correct we want the little ear thingies here to be pointed this way to go right into the ear trust me you'll see it a lot in movies where they go the opposite way and doesn't really work okay so put it into the ear right here and Allison how are we doing this assessment so you're going to use the diaphragm of your stethoscope an easy way to remember that is it's the lung auscultation so with your lungs use your diaphragm to breathe oh so you're using the large side the diaphragm of the stethoscope and you're going to start up at the apices so you start up high on the back and again you're going to do that side to side zigzag pattern having the patient breathe in and out every time you move your stethoscope and so we want to have that in and out with every movement so you hear both the inspiration and the expiration okay because some sounds only happen on inhale and some sounds only happen on exhale and so lots of times we'll see we move a little bit fast in this so we want to take our time and not hyperventilate our patient and you guys know how this this looks you've been to the doctor's office where they like put a really cold stethoscope on you take a deep breath and relax okay deep breath and relax and we're just trying to go down and then across right and this is listening to those upper middle and lower lobes of the lungs mm-hmm and you always want to make sure that you're putting it on bare skin so that way you don't get any extra sounds that come from that gown and that you always auscultate on the front and the back of the patient because a lot of times you can better hear the lower lobes from the back and more here the upper lobes from the front so it gives you that more complete picture so let's do the front then hey there nursing student listen up did you know only 20 of our videos are here on YouTube you're missing out on over 900 videos not on YouTube plus 500 visual study guides that follow along every video and a massive quiz Bank to test your knowledge all neatly organized in our new app try it for free visit simplenursing.com today all right now for the anterior lung sounds here it's almost very similar to the back but Allison's going to show us how to do it here so and again just like the back you're going to start at the top and you're going to place the bare stethoscope on the patient's skin and you're going to be moving in that side to side zigzag pattern going to one side then the other then moving down then going over and again you want to hear that inhale exhale with every placement of the stethoscope so that way you don't miss something and what we're expecting to hear is that soft clear vesicular lung sounds heard throughout those lobes of the lungs and that again like you said before it shows us that the patient's getting good gas exchange now when you assess the side you want that arm to be lifted up yes there we go and the side is a great location on that mid-axillary point and on the axle of the patient because it's also where you can hear a few lobes at once so great if for some reason you can't get to the patient's back like if you're worried they have a cervical spine injury so you don't want to rotate them side to side just yet and so you can use that in the meantime all right now let's talk about bronchiole bronchopicular and even vesicular so Allison how do we assess these very good so for the bronchial sound so we talked about the vesicular over those lobes of the lungs and over those lung Fields that's going to be softer kind of musical sometimes they say but so if we were listening with our stethoscope and listening over the client's trachea it's going to sound very loud kind of like air going through a big tube because your trachea is a big tube yeah it's the air pipe one pipe so we call those bronchial and those are going to be loud okay bronchiole is booming and Loud okay yes and then if we were listening over the sternum or even nearby the sternum that is going to be called bronchovesicular okay which makes sense if this is bronchial and this is vesicular in the middle is bronchophosine combine the two of bronchovicular so if this is loud and this is soft what do you think bronchovasicular is oh loud and soft together very good medium okay okay what about fascicular just soft just soft and so you're going to hear that basically air moving in and out of the alveoli oh and where do we usually hear those at so that would be over those lobes that you just demonstrated yeah those lungs or the lobes the lung fields and just listening over those alveoli fantastic now for a few practice questions while auscultating a client's trachea the nurse hears a high har sound with short inspiration and long expiration how should the nurse document this finding bronchial breath sounds and question number two the nurse is preparing to auscultate the lung sounds of a client which sound will the nurse expect to hear over most of the client's lungs vesicular and the last question here what are normal breath sounds vesicular sounds which are soft low pitched and Breezy heard over most of the peripheral lung fields that was actually from Kaplan all right now let's cover abnormal lung sounds we have a really great segment with all the lung sounds that you need to know so let's cut to that right now