Where can bronchial breath sounds be heard? o This sound is heard over the trachea and larynx areas What type of adventitious sound is created by narrowing of the bronchi? o Wheezing What does a rhonchi finding represent? o low pitched snoring or moaning sounds heard in bronchitis Understand what tactile fremitus assesses o Also, the nurse can palpate for vocal (or tactile) fremitus which is vibration that is felt when the client says something like “ninety-nine”. The vibration should feel symmetric in intensity and decrease as you move your hands downward over the posterior thorax. The ulnar surface of the hand is most sensitive to the sensation of vibration but the palm can also be used. If you feel increased fremitus over a particular area, it may indicate consolidation such as pneumonia as sound conducts better through a dense structure rather than a porous one. Decreased fremitus can indicate a problem such as pneumothorax or emphysema. Know why side-to-side pattern is used during a respiratory assessment o Auscultation of the lungs should be performed in a systematic manner, listening side to side, either right to left then right to left or right to left then left to right. o To make sure sounds are symmetrical Know what course crackles, stridor, and wheezes are and what they sound like o crackles (crackling and popping sounds heard in issues like pneumonia) o stridor (high pitched, inspiratory crowing, heard with croup or upper airway obstruction from foreign body).