 Welcome to nursing school explained in this video in the assessment series about auscultating the patient's lungs. Now whenever we assess the patient's lungs, we have to make sure that we assess the front anteriorly as well as their back posteriorly. And we always want to make sure that we compare the right and the left sides. And so again, like everything that we do in nursing, we want to approach this in a very methodical way, and we always want to make our way from the top to the bottom and then compare right to left or left to right at the same time. And really, you should anteriorly and posteriorly have at least 10 locations each. So that would mean 5 on the left and 5 on the right side, compare right and left sides, and then listen for a full breath cycle. That is probably the most important part, because you want to make sure that you listen for the full inspiration as well as the expiration, because certain lung sounds may only be heard on the expiration. So if you're hurrying through it and you only listen when the patient inhales, you might miss some abnormalities. And it's also very important to give the patient clear instructions. And patients sometimes they try and help us and make our job a little bit easier and they sometimes breathe in and out through their mouth and they make some sounds with it. So if they do that, it's really impossible for us to detect the lung sound abnormal because they're making those sounds with the voice box. So what I recommend is that you tell the patient, I'm going to place my set of scopes on your chest in different locations to listen to your lungs. Every time I place my set of scopes on your chest, please inhale through the nose and exhale through the mouth. Take slow deep breaths and in case you start to feel dizzy, please let me know and we'll take a little bit of a break. And the slow breaths are very important because if you do it too quickly and we're going to have about 20 locations each, the patient might be actually hyperventilating and then that might make them dizzy. So take your time, listen and make sure you give your patient correct and precise clear instructions. And then as for the location, so here we have the front and the backside of the patient. We really want to stay away from any bones because if we listen over bones, we're not going to really listen to the patient's lung. So in the front, we have to stay away from the sternum and then also we have to stay in between the ribs and these intercostal spaces so that we really listen to the lungs. Also we need to make sure that we have good contact with the set of scope on the patient's skin so that we can make sure that we get the best sounds possible. And believe it or not, but the first location that you should listen to is right here in this triangle above the patient's clavicle because the lungs go all the way up to the chest cavity here. So if you're not listening here, you might miss something. So in this case here we would start with the patient anteriorly, right and left above the clavicle and then just work our way down comparing right to left. And then once we get to the end of the sternum here, we want to move out to the sides because the lungs take up the entire chest cavity of the patient. So then we want to move out to the sides and we also want to stay away from breast tissue because that might make the sound more dull because there's more tissue in the way between the set of scopes and the lungs. So then we move our way out and here on the sides I've kind of drawn a half circle and that means we need to make sure we address this mid-clavicular line. Remember since the heart sits mostly on the left side of the chest, the left side of the lungs has two lobes where the right lung has three lobes and the right middle lobe is the best location to ascoltate for it is in that mid-clavicular line on that right side. So if you don't take your time and listen to that you might mean you might miss an abnormality there and right middle of pneumonia is fairly common so make sure that you address the mid-clavicular line on both sides and you kind of wrap your way around the patient's chest all the way to the sides of the ribs here. Now posteriorly we want to avoid the scapula, the shoulder blades because just like the sternum we're not going to be listening or hearing the sounds conducted in the way that it's going to be able to allow us to identify any abnormalities. Again we want to stay away from the rib area so going to these intercostal spaces and there's the other anatomical landmark we need to stay away from is the patient's spine because again that's bone so really we want to again start above the shoulder blades here in the patient's back and then walk our way down between the shoulder blades and the spine and again comparing right to left left to right as we march our way down and then as we come to the lower lobes here we again want to march out to the sides on the patient's back and then address that mid-clavicular line either on the front or back or maybe even it's best if you do it both front and back and a little caveat here if the patient is able to sit up that's perfectly fine have them sit up listen to their back if they're unable to for whatever reason you can ask them to turn to their sides so that they're now laying on their back and you can be behind them listening to their lungs it might be a little bit challenging to get into this mid-clavicular line on the patient that the on the side of the patient is lying on so you might need a little bit of extra help maybe somebody else can help you to tilt the patient a little more so you have access to that side or maybe address it when they're still flat and put your stethoscope on that side that they're eventually going to lay on so just something to think about now what are we listening for there are three different lung sounds that we can hear and those are bronchial bronchial vesicular and vesicular lung sounds and they really relate to the anatomy of the respiratory system so here we have our trachea and then the bronchioles the bronchi and then the bronchioles and the alveoli so it really goes from a diameter of the trachea that is fairly thick down to the bronchi down to the bronchioles and then the alveoli are the smallest airways where the gas exchange happened so if you've ever been snorkeling for example and you breathe through the snorkel tube then that is a fairly thick tube and the sound that you're going to hear is going to be very loud and kind of harsh and hollow sounding it's very similar here with the trachea the larger the airway the more hollow it's going to sound but if you breathe through a straw for example it's much narrower and less air can pass through therefore the sound won't be as loud and as hollow sounding so the same principle applies here so our bronchiole breath sounds are over the large and upper airways they are high pitched and hollow sounding because of that larger airway diameter typically the inspiration is shorter and the expiration is longer then when we move down we have broncho vesicular breath sounds so they are kind of in the medium medium-sized airways here in the bilateral bronchi so the ones that actually already split off the trachea and they have that medium pitch and because they're in the middle here inspiration and expiration the length of the two respiratory cycles is going to be equal so same amount of time inspiration versus expirations with what we're going to hear now down in the very lower lung fields the alveoli we're going to hear vesicular breath sounds which are in the lung periphery so all the way on the diameter and they're going to be more low pitched because now the airway diameters are very small the inspiration is longer and the expiration is shorter and that's just because it takes a longer time for the air to enter the lungs that's the inspiratory cycle is longer then it takes less time to exhale thank you for watching this video on the oscultation of the lung sounds please also watch my other video on oscultating heart sounds as well as other assessment techniques such as percussion you can find those in the physical assessment technique playlist thanks so much for watching nursing school explain and I'll see you soon