Respiratory Assessment


Lobes of the Lungs

Counting Respirations

Begin the respiratory assessment by counting your patient’s respiratory rate and simply observing his breathing pattern. Don’t tell the patient you are counting his respirations, as that may alter his breathing pattern.

Lung Sounds

  • Vesicular: Normal (low pitched rustling quality)
  • Crackles: Fluid Buildup (Popping lung sounds, sounds similar to wood burning)
  • Late Inspiratory Crackles: Seen in Pneumonia, Congestive Heart Failure, Atelectasis
  • Wheezes: Airway Constriction (Sounds similar to squeaking, snoring, or moaning)
  • Rhonchi: Occur over bronchi, not over alveoli, can clear with cough (snoring, gurgling, rattle  like sound)
  • Pleural Rub: Pleurisy (sounds like walking on fresh snow; sound stops when holding breath) If sound continues it may indicate a pericardial friction rub

Lung Sounds Expanded

Vesicular breath sounds are soft and low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over the most of the lung surface.

Fine crackles are brief, discontinuous, popping lung sounds that are high-pitched. Fine crackles are also similar to the sound of wood burning in a fireplace, or hook and loop fasteners being pulled apart or cellophane being crumpled. Crackles, previously termed rales, can be heard in both phases of respiration. Early inspiratory and expiratory crackles are the hallmark of chronic bronchitis. Late inspiratory crackles may mean pneumonia, CHF, or atelectasis.

Coarse crackles are discontinuous, brief, popping lung sounds. Compared to fine crackles they are louder, lower in pitch and last longer. They have also been described as a bubbling sound. You can simulate this sound by rolling strands of hair between your fingers near your ear.

Wheezes are adventitious lung sounds that are continuous with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction.

Low pitched wheezes (rhonchi) are continuous, both inspiratory and expiratory, low pitched adventitious lung sounds that are similar to wheezes. They often have a snoring, gurgling or rattle-like quality. Rhonchi occur in the bronchi. Sounds defined as rhonchi are heard in the chest wall where bronchi occur, not over any alveoli. Rhonchi usually clear after coughing.

Pleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound. Coughing will not alter the sound. They are produced because two inflamed surfaces are sliding by one another, such as in pleurisy. During auscultation, pleural rubs can usually be localized to a particular place on the chest wall. They also come and go. Because these sounds occur whenever the patient’s chest wall moves, they appear on inspiration and expiration. Pleural rubs stop when the patient holds her breath. If the rubbing sound continues while the patient holds a breath, it may be a pericardial friction rub.

Auscultation Points