› Auscultate Lung Sounds

Fine Tune Your Ears To Important Lung Sounds

When you listen to a patient’s lungs, you need to know when it’s time to call the doc with a problem. While you are not necessarily expected to know all the nuances of what you hear, the basics are important to recognize.

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Where To Listen

These photos show where to place the diaphragm (flat side) of your stethoscope. While the posterior (the back) photo shows multiple areas, I honestly feel comfortable listening to 3 areas on each side to get an idea of how the lungs are functioning.

Normal Breath Sounds

The easiest way for me to verbally explain normal lung sounds, is that the pitch may change depending on where you are listening or how thick a fat layer I am listening through, but it still has the same quality. It sounds like unobstructed air rushing through a tunnel.

I'm not fond of the last of the rhonchi sounds in the video below. Sound too normal to me.

Wheezes

This is, to me, an easy sound to recognize, it is a whiny, whistle sound and can be either on inspiration (breathing in) or expiratory (breathing out). It is caused by the airways being squeezed closed by any of several etiologies (cause or origin of the problem).

I'm still not happy with the rhonchi sounds....

Stridor

Similar to a wheeze but usually in the tracheal area (between the mouth and the bronchus), is this lung sound. 

Children with croup have their upper airway squeezing shut. Also, a person who has choked on a piece of food and is struggling for air is another good example. It is also high pitched.

Rales Or Crackles

The newer of the two terms is crackles. That is further divided into fine or coarse. From your perspective, I don’t think it is important to differentiate them. 

Rales are lung sounds caused by fluid in the lungs. It is common with people who have CHF (Congestive Heart Failure) and are going into fluid overload.

Sometimes minimal crackles can disappear after a few good coughs by the patient. 

Important regarding rales is that they can increase pretty rapidly and the doc needs to know this. So, if you evaluate a patient with rales at the very bottom of the posterior lung fields in the morning and by afternoon those sounds are half-way up the lung field, you have someone literally beginning to drown in their own fluids. 

Time to call the doc. Time to review salt intake with the patient. 

Crackles sound somewhat like cellophane crumpling or if you have long hair, take some of the ends and twist them around the inside of your ear.

This is what I'm used to hearing: Rales at the end of the inspiration. So make sure you listen to the whole breath cycle!

Rhonchi

Rhonchi are lower toned, “thick” sounds to me. It is caused by mucus obstructing the upper airways.

Imagine what it would sound like to have air in a tube flowing over thick mucus and disturbing it. Not quite a bubbling sound, but close.

It appears that some places now calling rhonchi either coarse rales or wheezes instead. I'm not sure why, since rales are fluid and rhonchi is mucus and wheezes are due to decreasing the size of the airway from inflammation.

So it may just be a term falling out of favor with the medical community. I figured I'd pass that along just in case. Meanwhile I pick the brain of other experienced nurses on this strange phenomena...

Pleural Friction Rub

This one reminds me of when you sit down on a fake leather chair and get that deep squeaking noise. 

Diminished Breath Sounds

This just means that the sound of air moving in and out is much lower than you would normally expect of a healthy lung. There are no other unusual sounds.

A final Word About Lung Sounds

You can listen to lungs and think you hear nothing but air. The patient will get an x-ray and will be told they have pneumonia. Don’t feel bad. A stethoscope is only one tool to evaluate lungs. 

You won’t always pick up everything. That’s why they use x-rays as an additional evaluation. 

Examples of Documentation

Common Abbreviations & Terms

  • CTA: Clear to Auscultation. Only air moving in and out, no abnormalities.
  • RLL: Right Lower Lobe
  • RML: Right Middle Lobe
  • RUL: Right Upper Lobe
  • LLL: Left Lower Lobe
  • LUL: Left Upper Lobe
  • SOB: Short of Breath, or Shortness of Breath
  • Expiratory: when breathing out
  • Inspiratory: when breathing in
  • SATS: Oxygen Saturation
  • >: greater than
  • <: less than
  • Non productive cough: cough without sputum
  • Productive cough: Cough with sputum
  • L: Liters - liters of oxygen (in a respiratory assessment)
  • Cyanosis: Blue-gray color of skin indicative of low oxygen
  • RA: Room air

Example of a Narrative Nurses Note

Respirations 24, patient with scattered rhonchi bilateral posterior fields, occasional productive cough with copious amounts of green sputum, oxygen SATS <90% on RA, SATS >90% on 2L 02 continuous, SOB on exertion, No cyanosis.

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