Auscultation of the pulmonary system, or listening to lung sounds with a stethoscope, is crucial for identifying potential abnormalities in the lungs and airways. It helps in diagnosing various respiratory diseases and conditions by detecting changes in the normal breath sounds or the presence of adventitious (abnormal) sounds like crackles, wheezes, and rubs.
Normal breath sounds: soft breath sounds that can be heard at all parts of the thoracic cavity including collarbone to bottom of lungs
Includes bronchial breath sounds that can be heard primarily over the bronchioles that produce a more hollow echoing sound
Adventitious breath sounds: abnormal sounds heard that can be directly related to pathology
Crackles: crackling sound heard during inspiration that is typically indicative of atelectasis, fibrosis or pulmonary edema
Wheezes: high pitched sounds heard during expiration typically related to obstructive lung disease such as asthma, chronic obstructive pulmonary disease, or pneumonia
Stridor: harsh, vibratory sound that typically occurs during inhalation due to blockage in airway (typically occurs when chocking)
Differential diagnosis of pulmonary system
Obstructive lung disorders
Types of obstructive lung disorders
Chronic obstructive pulmonary disease (COPD)
Progressive, chronic disease caused by dysfunction of alveoli which results in decreased expiration
Development of COPD is primarily due to environmental factors such as smoking or pollutants
Chronic inflammation of bronchioles causing increased mucus production with cough, dyspnea, fatigue
Diagnosed after 3 months of chronic cough for up to 2 years
Emphysema
Progressive alveolar deterioration with subsequent enlargement of distal airway which limits expiratory flow
Asthma
Chronic inflammation of the trachea and bronchioles which cause smooth muscle constriction and increased mucus production leading to limited expiratory airflow
Caused by pollutants allergies, exercise, viral infections
Wide category of multiple diseases that cause permanent scarring and fibrotic changes to the lungs
Examples of diseases are pulmonary fibrosis and sarcoidosis
Other pulmonary pathologies
Pulmonary edema
Excessive fluid removal from pulmonary vascular system to pleural spaces
Can be caused by failure of left ventricle, mitral valve disease, aortic valve disease, narcotic overdose, hypervolemia associated with kidney dysfunction, sepsis, pneumonia, trauma
Diagnosis confirmed through chest x-ray or MRI and blood test
Subjective information is important in recognizing this diagnosis such as previous history of DVT, recent surgical procedure, recent long flight, or discontinuation of anti-coagulant medications
Pleural effusion
Excessive fluid accumulation between visceral and parietal pleura secondary to an inflammatory disease processes, congestive heart failure, lung cancer, pneumonia, cirrhosis, or ascites
Mycobacterium tuberculosis is spread through droplets
Incubation period (disease lays dormant system): 2-10 weeks
Disease can last 10 -14 days
Increased incidence for occurrence in those immunocompromised
Symptoms: cough with purulent or bloody sputum, chest pain, dyspnea, weight loss, fatigue
Diagnosis confirmed through chest x-ray, blood test, sputum test
Lines and tubes
Vascular access devices
Peripheral intravenous line (PIV)
A short catheter inserted into a peripheral vein, typically in the arm or hand, used to deliver fluids or medications.
Precautions: Avoid dislodging or kinking the line. Monitor for infiltration (coolness, swelling).
Mobility: No restrictions; ensure tubing is secure during mobility.
Central venous catheter (CVC)
Includes: peripherally inserted central catheter (PICC), Hickman catheter, and Port-a-Cath
Definition: A longer catheter placed into a large central vein (e.g., subclavian or jugular) for long-term medication or nutrition.
Precautions: Avoid BP on the arm with PICC. Avoid tugging or shoulder ROM without clearance.
Mobility: Limited mobility; avoid excessive movement on the PICC side, no blood pressures take on PICC side
Arterial access devices
Arterial line (A-Line)
A catheter placed in an artery (commonly radial or femoral) to measure blood pressure continuously and draw blood samples.
Precautions: Avoid dislodging; radial wrist should remain neutral.
Mobility:
Radial line: limited but possible
Femoral line: typically bedrest—always check with physician or nurse
Urinary and digestive tubes
Foley catheter
A tube inserted into the bladder to drain urine into a collection bag.
Precautions: Keep bag below bladder to prevent backflow.
Mobility: No restrictions; secure tubing and use a portable holder.
Nasogastric tube (NG Tube)
Inserted through the nose into the stomach for feeding or gastric decompression.
Precautions: Keep head of bed >30° during feeding; risk of aspiration.
Mobility: Limited; pause feeding if needed for mobility. Secure during activity.
