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Abnormal breath sounds such as wheez-
adventitious breath sounds
ing, stridor, rhonchi, and crackles.
- Low pitch
- Loud
- Long duration
- Sounds like blowing through a staw into
a drink
series of long-duration, discontinuous,
course crackles
low pitched sounds caused by air pass-
ing through airway intermittently occlud-
ed by mucus, unstable brochial wall or
fold of mucosa; evident on inspiration
and, at times, expiration; similar sound
to blowing through straw under water; in-
crease in bubbling quality with more fluid
- Higher pitched
- Short duration
- softer in noise
- Sound like fire crackling
fine crackles
high-pitched, discrete, discontinuous
crackling sounds heard during the end of
inspiration; not cleared by a cough
- Sounds like Scooby doo
- upper respiratory
- screching/squawking sound
- high pitch
Strider sounds like
- caused by swelling of the airway - tra-
chea
- caused by croup, anaphalxsis, object
stuck in throat
- mostly expiration
Wheezing sounds aka rhinchi
- can be high and low pitched
- inspiration and expitation
Pleural friction rub - grating sound
continuous, dry grating sound caused by
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inflammation of pleural surfaces and loss
of lubricating pleural fluid
- location,
- pitch (e.g., high, low),
Lung assessment - duration of sound, and
- whether the sound is heard on inspira-
tion, expiration, or both.
Metabolic acidosis low pH, low HCO3
DKA, severe diarrhea, renal failure,
metabolic acidosis causes
shock
an increase in pH due to vomiting and
excessive antacid intake in which caus-
metabolic alkadosis
es hypoventilation and less retention of
bicarbonate
severe vomiting, excessive GI suction-
metabolic alkalosis causes
ing, diuretics, excessive NaHCO3
Normal Range-- pH: 7.35-7.45,
ABGs (arterial blood gases) CO2: 45-35,
HCO3: 22-26
Absent fremitus may occur with pneumothorax or atelectasis
vibration of the chest wall produced by
fremitus
vocalization.
- bacterial pneumonias
vibration that is perceptible on palpation:
can use ball of hand, ulnar surface of
hand, ulnar surface of fist
start with posterior, repeat on anterior
tactile fremitus/vocal fremitus can do both sides simultaneously to
compare
tell the pt "every time I move my hands
say 99" feel the vibrations they are mak-
ing; compare chest @ rest and as the
person says 99; move hands laterally as
you get further down