Nursing Knowledge 2: Review of auscultation and adventitious lung sounds

Auscultation & Lung Sounds

This chart is intended to provide you with some listening tips for lung sounds potentially heard
in clinical practice. Please add to the list as you continue to assess clients with impaired gas
exchange

Audio link for lung sounds:

https://www.easyauscultation.com/lung-sounds-reference-guide

Lung sound DESCRIPTION OF LOCATION HEARD DURING

SOUND INSPIRATION OR
EXPIRATION
Bronchial Hollow, tubular Considered abnormal if Distinct pause in the sound
sounds that are heard over the between inspiration and
higher pitched. peripheral lung fields. expiration. Inspiration to
expiration ratio of 1:2 or
Loud and harsh. You do not want to 1:3. 
hear these sounds at
the bases or mid lung
fields. It could mean
something abnormal.

Coarse Course crackles are Caused by fluid in large More common during
crackles discontinuous, brief, airways inspiration. 
popping sounds.
(also Similar to the sound Sometimes during
referred to of a hook and loop expiration
as rales) fastener being pulled
apart. They have also
been described as a
bubbling sound.

Gurgling, rattling,
Ex: Pneumonia, heart
bubbling sounds (like
failure, pulmonary edema,
blowing air through a
restrictive pulmonary
straw into a glass of
diseases (where lungs
water).
cannot fully expand)
Fine Fine crackles are Caused by a snapping of More commonly heard
crackles brief, discontinuous, collapsed alveoli or fluid during inspiration. 
popping sounds that in/around alveoli
are high-pitched.
 Similar to wood
burning in a fireplace.
Ex. Bronchitis, asthma,
Sounds like hair emphysema, pneumonia
rolled between your
fingers near your
ears.
Wheezes Wheezes are Created by air moving Typically more pronounced
continuous, musical through narrowed on expiration.
High sounds, high or low (constricted) airways.
pitched pitched. But can be heard on both
wheezes
Ex: Bronchitis, COPD,
asthma
Rhonchi Rhonchi are Bronchial tubes that More common during
continuous, low contain mucus or fluid expiration. 
Low pitched pitched sounds with a
wheezes gurgling, snoring or Ex. Heard in disorders
rattle-like quality. causing obstruction of the
trachea or bronchus such as
bronchitis or COPD.

 How do lung sounds from COPD compare with those of pneumonia?

COPD (expiratory wheeze most evident)
Pneumonia (inspiratory crackles most evident)

References:

MedEdu LLC. (2017) Retrieved from: https://www.easyauscultation.com/lung-sounds-

reference-guide

Potter, P.A., Perry, A. G., Stockert, P.A., Hall, A.M. (2014) Canadian Fundamentals of Nursing (5th
ed). Toronto: Elsevier Canada

Wilson, S., Giddens, J. (2017). Health Assessment for Nursing Practice, 6th Edition. Mosby-
Elsevier, Missouri.