Breath sounds, respiratory patterns, SpO2 interpretation, and COPD monitoring
Respiratory assessment is one of the highest-yield clinical skills in home care. Identifying abnormal breath sounds, recognizing dangerous respiratory patterns, and correctly interpreting SpO2 relative to client baseline enables early detection of deterioration and timely clinical intervention across a wide range of diagnoses.
Before auscultation, observe the client's breathing at rest. Note rate (12–20 breaths/min normal), depth, rhythm, and effort. Signs of increased respiratory effort include: use of accessory muscles (sternocleidomastoid, scalene, intercostal), nasal flaring, pursed-lip breathing, tripod positioning (leaning forward on hands), and paradoxical movement (chest collapses on inhalation). Any of these in a client who did not display them before warrants immediate clinical notification.
Cyanosis — bluish discoloration of lips or fingertips — indicates hypoxia and requires urgent response. Central cyanosis (lips, tongue) is more severe than peripheral cyanosis (fingertips) and may precede dangerously low SpO2 readings.
Vesicular breath sounds — soft, breezy, heard throughout most lung fields. Bronchial breath sounds — louder, hollow, normal over the trachea but abnormal over lung tissue (suggests consolidation). Bronchovesicular — intermediate, normal near the mainstem bronchi.
Crackles (rales): Discontinuous, popping sounds — fine crackles suggest pulmonary fibrosis or early fluid; coarse crackles suggest secretions or pulmonary edema. Wheezing: High-pitched continuous sounds from narrowed airways — bronchospasm, asthma, COPD exacerbation. Rhonchi: Low-pitched continuous sounds from secretions in larger airways — often clear with coughing. Stridor: Harsh, high-pitched inspiratory sound indicating upper airway obstruction — a potential emergency. Pleural friction rub: Grating, leathery sound — indicates pleural inflammation (pleuritis).
Tachypnea (RR >20): fever, pain, anxiety, pulmonary embolism, heart failure. Bradypnea (RR <12): narcotic overdose, CNS depression. Cheyne-Stokes: cyclical crescendo-decrescendo breathing with apneic periods — heart failure, brain injury. Biot's respiration: irregular periods of apnea — severe CNS pathology. Kussmaul: deep, rapid, labored — metabolic acidosis (DKA). Apneustic: prolonged inspiration with brief expiration — pontine lesion.
For clients with chronic respiratory conditions like COPD, compare current SpO2 to the established individual baseline rather than to population norms. A client with a chronic baseline of 91% and a current reading of 85% has had a significant decline requiring immediate notification — even though 85% would also trigger concern in any client. Always assess and document client baseline at intake and reference it at subsequent visits.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.