Page 378 - Saunders Comprehensive Review For NCLEX-RN

5. Percussion
a. Starting at the apices, percuss across the
top of the shoulders, moving to the
interspaces, making a side-to-side
comparison all the way down the lung
area (Fig. 12-2).
b. Determine the predominant note;
resonance is noted in healthy lung
tissue.
c. Hyperresonance is noted when
excessive air is present and a dull note
indicates lung density.

6. Auscultation

a. Using the flat diaphragm endpiece of
the stethoscope, hold it firmly against
the chest wall and listen to at least 1
full respiration in each location
(anterior, posterior, and lateral).
b. Posterior: Start at the apices and move
side to side for comparison (see Fig.
12-2).
c. Anterior: Auscultate the lung fields
from the apices in the supraclavicular
area down to the 6th rib; avoid
percussion and auscultation over
female breast tissue (displace this
tissue), because a dull sound will be
produced (see Fig. 12-2).
d. Compare findings on each side.
7. Normal breath sounds: Three types of breath sounds
are considered normal in certain parts of the thorax,
including vesicular, bronchovesicular, and bronchial;
breath sounds should be clear to auscultation (Fig. 12-
3).
8. Abnormal breath sounds: Also known as adventitious
sounds (Table 12-3)
9. Voice sounds (Box 12-8)
a. Performed when a pathological lung
condition is suspected
b. Auscultate over the chest wall; the
client is asked to vocalize words or a
phrase while the nurse listens to the
chest.
c. Normal voice transmission is soft and
muffled; the nurse can hear the sound
but is unable to distinguish exactly
what is being said.

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