Chest auscultation

According to the Nursing and Midwifery Council (NMC, 2018) nurses need to have proficiency with performing chest auscultations. 

What is chest auscultation?

The skill itself involves using a stethoscope to help the nurse to hear and interpret lung sounds which - alongside an accurate history - enables the correct information to be recorded (Mehta, 2010) to aid in accurate diagnosis. The process is a systematic approach that enables the nurse to compare sounds from both left and right lungs.

The stethoscope

Modern stethoscopes are of a binaural design with a two-sided head, which enables a range of sounds to be heard from a range of organs including heart, lungs, intestines and blood in veins and arteries.

1. Bell – for listening to low pitched sounds (this is the smaller section of the stethoscope head)
2. Diaphragm is for listening to high pitched sounds – this is the most frequently used head (the larger section of the stethoscope head) for chest auscultation

Performing chest auscultation requires some knowledge of anatomy.

1. Anatomy - lung sounds are caused by the vibrations of the vocal cords during inspiration and expiration which are transmitted to the trachea and the bronchi.
2. Inspection and percussion - before using the stethoscope the nurse inspects and feels the chest to identify any potential issues that the person has with their breathing.
3. Inspection of the chest – this is everything that the nurse sees when the person is breathing and should be performed with the patient sitting up (it is recommended that this is completed both the back and front of the patient).

Inspection – consider the following points

• Is the movement symmetrical? – is one side expanding more than the other? Is one part of the rib cage expanding or collapsing?
• How fast is their breathing? – Count their respirations. This gives a clue as to their respiratory rate.
  • Eupena – Normal respirations
  • Tachypnoea – an abnormally fast rate of breathing
  • Orthopnoea – shortness of breath when the person lays down (usually person sleeps with more than one pillow)
  • Paroxysmal Nocturnal Dyspnoea - shortness of breath that occurs when the person has fallen asleep, and it is sudden
• Is their inhale and exhale of equal duration? Exhalation is usually about twice the duration of inhalation, and this is known as the respiratory rhythm.
• How is the person breathing? Are they elevating their shoulders, chest or otherwise which may indicate laboured breathing? Is the person

Chest auscultation is a worthwhile technique giving the opportunity to listen to a patient’s respiratory system. It is a skill that is required by all nurses to enable them to accurately listen to the patients respiratory system and interpret lung sounds. Early diagnosis on chest auscultation may help to identify the pathophysiology of an illness (Moran-Mendozam et al, 2012; Bohadana et al, 2014).

References

Bohadana A, Izbicki G, Kraman S. Fundamentals of lung auscultation. N Engl J Med. 2014; 370(8):744-51 https://doi.org/10.1056/NEJMra1302901

McLellan KE, Arora M, Schwarze J et al. Auscultatory chest signs in children with bronchiolitis: are they related to age and viral aetiology? Archives of Disease in Childhood. 2012;97(Suppl1): A21-A22

Mehta, M. Performing a respiratory assessment. Nursing Critical Care. 2010;5(3):45-47. https://doi.org/10.1097/01.CCN.0000372214.97143.f8

Moran-Mendozam O, Ritchie T, Aldahaerie S. Fine Crackles on chest auscultation in the early diagnosis of idiopathic pulmonary fibrosis: A prospective cohort study. BMJ Open Respir Res. 2021;8(1): e000815. https://doi.org/10.113/bmjresp-2020-000815

Nursing and Midwifery Council. Standards of proficiency for registered nurses. [online] Nmc.org.uk. 2018. https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/ (accessed 16 June 2021)

Proctor J, Edwards J. How to perform chest auscultation and interpret the findings. Nursing Times. 2020;116(1):22-26.

Ausmed.com. A Basic Guide to Chest Auscultation. 2020. https://www.ausmed.com/cpd/articles/chest-auscultation (accessed 29 November 2022)

Sakar M. Auscultation of the respiratory system. Ann Thorac Med. 2015;10(3):158-68. https://doi.org/10.4103/1817-1737.160831

Simpson H.