![]() ![]() If the oxygen saturations are low, apply oxygen if you are permitted to do so. Otherwise, follow the steps of the primary survey (check airway patency, measure respiratory rate, work of breathing, and oxygen saturation, assess pulse rate/rhythm, blood pressure, assess level of consciousness). If you think the stridor is caused by a foreign body that you can quickly remove, do so. ![]() Absence of air entry and presence of stridor are considered urgent situations: you should call for assistance and notify the physician or nurse practitioner. The priorities of care related to auscultation of the anterior thorax are the same as those for the posterior thorax. Video 3.9: Auscultation of anterior thorax Abnormal findings might be documented as: “Absent air entry in right lower lobe anteriorly with mild wheezing heard upon expiration in the upper lobes bilaterally.”.Vesicular sounds heard throughout peripheral lung field.” Bronchovesicular sounds heard in upper lobes close to sternum. Normal findings might be documented as: “Good air entry, equal bilaterally, no adventitious sounds throughout all lobes on anterior thorax.Identify clear air entry or the presence, quality, and location of any adventitious sounds.(Note: in young children particularly under two and threes of age, vesicular sounds are typically not heard because of their small thoraxes. Vesicular breath sounds are quiet and low-pitched inspiration is longer than the expiration phase, and heard in the periphery of the lung fields and near the smaller airways in an older child and adult.Bronchovesicular breath sounds are moderate in loudness inspiration is equal to the expiration phase, and heard on the upper thorax close to the sternum and near the bronchi.If you place your stethoscope over the tracheal region, you should hear bronchial sounds (loud harsh sounds).Identify the location of normal breath sounds including bronchial, bronchovesicular, and vesicular.Equality: Note whether air entry is equal bilaterally.Quality: Note whether it is good, decreased, or absent.In each location, listen to one full respiration (inspiration and expiration) and compare air entry bilaterally. Photo by Armin Rimoldi from Pexels (image was cropped and illustrated upon for the purposes of this chapter)Ĥ. Toward the bottom, listen close to the sternal line and also move laterally.įigure 3.17: Stethoscope placement pattern when auscultating anterior thorax You may need to ask the client to reposition their breasts to place the stethoscope flat against the thorax. As you move down the thorax, place your stethoscope close to the sternal line to avoid listening over the breast tissue. On the anterior thorax, begin at the lung apices, which are supraclavicular, moving from one side to the other side.Also remember that the anterior thorax has more upper lobes and that the right lung has three lobes while the left lung has two lobes. Remember the number of locations depends on the size of the thorax fewer locations are needed on a client with a smaller thorax (e.g., infants). See Figure 3.16 for stethoscope placement pattern. Place the stethoscope’s diaphragm on the chest in about three to six locations on each side of the anterior thorax so that you listen to all lung lobes. Ensure the client is in an upright position and ask them to take a big breath in and out through the mouth each time they feel the stethoscope on their chest.ģ. Perform hand hygiene and cleanse the stethoscope.Ģ. Auscultating the anterior thorax involves the following steps (see Video 3.9):ġ.
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