Adherence to local infection prevention and control policies, including the cleaning of equipment between every patient contact, is essential. The stethoscope is an important tool for clinical assessment, but can become contaminated by micro-organisms (Longtin et al, 2014). Fig 3 illustrates parts of the stethoscope. The bell of the stethoscope is generally used to detect high-pitched sounds – at the apex of the lungs above the clavicle its diaphragm is used to detect low-pitched sounds in the rest of the chest (Dougherty and Lister, 2015).

Mid zone: level of the hilar structures.

Upper zone: below the clavicles and above the cardiac silhouette.Using the four chest X-ray zones can, therefore, be helpful: It is not always possible to determine from which lobe of a lung a sound is emanating. Chest auscultation involves listening to these internal sounds to assess airflow through the trachea and the bronchial tree (Sarkar et al, 2015).įamiliarity with the normal vesicular breath sounds found at specific locations on the chest enables health professionals to identify abnormal sounds, which are often referred to as adventitious. These sounds are audible when auscultation is performed using a stethoscope. Vesicular breath sounds occur when the vocal cords vibrate during inspiration and expiration, when the vibrations are transmitted to the trachea and bronchi. Cedar (2018) provides further information on the physiology of breathing. Fig 1 illustrates the anatomy of the lungs and Fig 2 highlights the location of the lung lobes from an anterior chest perspective. To undertake a thorough assessment of the chest, including auscultation, it is essential to understand the anatomy and physiology of the respiratory system. The Nursing and Midwifery Council (2018) has included chest auscultation and interpretation of findings in the Standards of Proficiency for Registered Nurses, and student nurses now learn this skill as undergraduates. This is an example of a systemic assessment tool but other tools are available (Simpson, 2015) The procedure should always form part of an holistic assessment and must be viewed alongside the patient’s clinical history (Box 1).Ī commonly used acronym in clinical examination of the chest is IPPA: Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)Īlthough the first stethoscope for auscultation was invented in 1816 by René-Théophile-Hyacinthe Laennec, the use of auscultation dates back to Hippocrates, who would place his ear to his patient’s chest and listen for sounds.Īuscultation is an important part of an assessment of the respiratory system and is also used for cardiac and gastrointestinal examination.This article has been double-blind peer reviewed.Nursing Times 116: 1, 23-26.Īuthors: Jaclyn Proctor is respiratory advanced nurse practitioner at Warrington and Halton NHS Foundation Trust Emma Rickards is respiratory nurse consultant at Liverpool Heart and Chest Hospital NHS Foundation Trust and Knowsley Community Respiratory Service.

This article explains the clinical procedure for chest auscultation and provides a guide to interpreting findings.Ĭitation: Proctor J, Rickards E (2020) How to perform chest auscultation and interpret the findings. Chest auscultation is frequently used in the clinical examination of patients.

Describe lung sounds