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EQA

Unit III Promoting Physiologic Health

TABLE 12-4

Normal and Adventitious Breath Sounds

TYPE/NAME

DESCRIPTION

CHARACTERISTICS/CAUSES

LOCATION

Normal Breath Sounds

Vesicular

Soft-intensity, low-pitched,gentle
sighing sounds created by air
moving through smaller airways
(bronchioles and alveoli)

Best heard on inspiration, which is

about 2.5 times longer than the
expiratory phase (5:2 ratio)

Over peripheral lung; best

heard at base of lungs

Bronchovesicular

Moderate-intensity and
moderate-pitched blowing
sounds created by air moving
through larger airways (bronchi)

Equal inspiratory and expiratory

phases (1:1 ratio)

Between the scapulae and

lateral to the sternum at the
first and second intercostal
spaces

Bronchial (tubular)

High-pitched, loud, harsh sounds

created by air moving through
the trachea

Louder than vesicular sounds; have

a short inspiratory phase and long
expiratory phase (1:2 ratio)

Anteriorly over the

trachea; not normally
heard over lung tissue

Adventitious Breath Sounds

Crackles (rales)

Fine, short, interrupted crackling

sounds; alveolar rales are high pitched.
Sound can be simulated by rolling a
lock of hair near the ear. Best heard on
inspiration but can be heard on both
inspiration and expiration. May not
be cleared by coughing

Air passing through fluid or mucus

in any air passage

Most commonly heard in the

bases of the lower lung lobes

Gurgles (rhonchi)

Continuous, low-pitched, coarse,

gurgling, harsh, louder sounds with
a moaning or snoring quality. Best heard
on expiration but can be heard on both
inspiration and expiration. May be
altered by coughing

Air passing through narrowed air

passages as a result of secretions,
swelling, tumors

Loud sounds can be heard

over most lung areas but
predominate over the trachea
and bronchi

Friction rub

Superficial grating or creaking sounds

heard during inspiration and expiration.
Not relieved by coughing

Rubbing together of inflamed

pleural surfaces

Heard most often in areas of

greatest thoracic expansion
(e.g., lower anterior and lateral
chest)

Wheeze

Continuous, high-pitched, squeaky

musical sounds. Best heard on
expiration. Not usually altered by
coughing

Air passing through a constricted

bronchi as a result of secretions,
swelling, tumors

Heard over all lung fields

The mouth is the beginning of the gastrointestinal (GI)

system (digestive system) and should be assessed carefully. The
Centers for Disease Control and Prevention recommends that
nurses wear gloves when in contact with the buccal mucosa
(Figures 12-11A and B ). A tongue blade can be used to aid
inspection.
The nurse should note any difficulty swallowing and
obtain further information about the cause. The nurse also notes
any subjective indications of discomfort or nausea and records
the clients statement of when these manifestations began and
how long they have persisted. Any abnormal findings or change

in client condition should be reported to the team leader. (See a

full discussion of GI system disorders in Chapter 28.
)

Abdomen. To assist in obtaining valid observations and to

enhance client comfort, as mentioned previously, the nurse
asks the client to urinate before beginning the assessment. If
necessary, the nurse assists the client to a supine position,
with arms placed comfortably at the sides. The nurse also
places small pillows beneath the knees and the head. This
position and an empty bladder prevent tension in the abdominal muscles. By contrast, the abdominal muscles tense when