Advanced Health Assessment and Diagnostic Reasoning by Rhoads Jacqueline;Petersen Sandra Wiggins; & Sandra Wiggins Petersen

Author:Rhoads, Jacqueline;Petersen, Sandra Wiggins; & Sandra Wiggins Petersen [Неизв.]
Language: eng
Format: epub
Publisher: Jones & Bartlett Learning LLC
Published: 2021-04-12T20:00:00+00:00

Auscultation

Because children younger than 5 or 6 years of age may not be able to give enough of an expiration to satisfy the healthcare provider (particularly when subtle wheezing is suspected), ask them to “blow out” a flashlight or to blow away a bit of tissue in the provider’s hand to bring out otherwise difficult-to-hear end-expiratory sounds.

Ask the child to run around; it is easier to hear the breath sounds when the child breathes more deeply after running.

Note physiologic differences. Because children’s chests are thinner and ordinarily more resonant than adults’ chests, the intrathoracic sounds are easier to hear, and hyperresonance is common in young children.

Because of the thin chest wall, the breath sounds of the young may sound louder, harsher, and more bronchial than those of the adult.

Bronchovesicular breath sounds may be heard throughout the chest.

Seize the opportunity a crying child presents. A sob is frequently followed by a deep breath. The sob itself allows evaluation of vocal resonance and permits you to feel for tactile fremitus; use the whole hand—both palm and fingers—gently. The crying child may pause occasionally, and the heart sounds may be heard. These pauses may be a bit prolonged as the breath is held, giving you the chance to distinguish a murmur from a breath sound.

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