Rhonchi
Rhonchi are continuous adventitious breath sounds detected by auscultation. They’re usually louder and lower pitched than crackles — more like a hoarse moan or a deep snore — though they may be described as rattling, sonorous, bubbling, rumbling, or musical. However, sibilant rhonchi, or wheezes, are high pitched.
Rhonchi are heard over large airways such as the trachea. They can occur in a patient with a pulmonary disorder when air flows through passages that have been narrowed by secretions, a tumor or foreign body, bronchospasm, or mucosal thickening. The resulting vibration of airway walls produces the rhonchi.
History
Begin with a history: Does the patient smoke? If so, obtain a history in pack-years. Has he recently lost weight or felt tired or weak? Does he have asthma or another pulmonary disorder? Is he taking any prescribed or over-the-counter drugs?
Physical assessment
If you auscultate rhonchi, take the patient’s vital signs, including oxygen saturation, and be alert for signs of respiratory distress. Characterize the patient’s respirations as rapid or slow, shallow or deep, and regular or irregular. Inspect the chest, noting the use of accessory muscles. Is the patient audibly wheezing or gurgling? Auscultate for other abnormal breath sounds, such as crackles and a pleural friction rub. If you detect these sounds, note their location. Are breath sounds diminished or absent? Next, percuss the chest. If the patient has a cough, note its frequency and characterize its sound. If it’s productive, examine the sputum for color, odor, consistency, and blood.
During the examination, keep in mind that thick or excessive secretions, bronchospasm, or inflammation of mucous membranes may lead to airway obstruction. If necessary, suction the patient and keep equipment available for inserting an artificial airway. Keep a bronchodilator available to treat bronchospasm.
Medical causes
Acute respiratory distress syndrome
Fluid accumulation with acute respiratory distress syndrome (ARDS) — a life-threatening disorder — produces rhonchi and crackles. Initial features include rapid, shallow respirations and dyspnea, sometimes after the patient’s condition appears stable. Developing hypoxemia leads to intercostal and suprasternal retractions, diaphoresis, and fluid accumulation. As hypoxemia worsens, the patient displays increased difficulty breathing, restlessness, apprehension, decreased level of consciousness, cyanosis, motor dysfunction and, possibly, tachycardia.
Aspiration of a foreign body
A retained foreign body in the bronchi can cause inspiratory and expiratory rhonchi and wheezing due to increased secretions. Diminished breath sounds may be auscultated over the obstructed area. Fever, pain, and cough may also occur.
Asthma
An asthma attack can cause rhonchi, crackles and, commonly, wheezing. Other features include apprehension, a dry cough that later becomes productive, prolonged expirations, and intercostal and supraclavicular retractions on inspiration. The patient may also exhibit increased accessory muscle use, nasal flaring, tachypnea, tachycardia, diaphoresis, and flushing or cyanosis.
Bronchiectasis
Bronchiectasis causes lower-lobe rhonchi and crackles, which coughing may help relieve. Its classic sign is a cough that produces mucopurulent, foul-smelling and, possibly, bloody sputum. Other findings include fever, weight loss, exertional dyspnea, fatigue, malaise, halitosis, weakness, and late-stage clubbing.
Bronchitis
Acute tracheobronchitis produces sonorous rhonchi and wheezing due to bronchospasm or increased mucus in the airways. Related findings include chills, sore throat, a low-grade fever (rising up to 102° F [38.9° C] in those with severe illness), muscle and back pain, and substernal tightness. A cough becomes productive as secretions increase.
With chronic bronchitis, auscultation may reveal scattered rhonchi, coarse crackles, wheezing, high-pitched piping sounds, and prolonged expirations. An early hacking cough later becomes productive. The patient also displays exertional dyspnea, increased accessory muscle use, barrel chest, cyanosis, tachypnea, and clubbing (a late sign).
Emphysema
Emphysema may cause sonorous rhonchi, but faint, high-pitched wheezing is more typical, together with weight loss, exertional dyspnea, accessory muscle use on inspiration, tachypnea, grunting expirations, and a mild, chronic, productive cough with scant sputum. Other features include anorexia, malaise, barrel chest, peripheral cyanosis, and late-stage clubbing.
Pneumonia
Bacterial pneumonias can cause rhonchi and a dry cough that later becomes productive. Related signs and symptoms — shaking chills, high fever, myalgias, headache, pleuritic chest pain, tachypnea, tachycardia, dyspnea, cyanosis, diaphoresis, decreased breath sounds, and fine crackles — develop suddenly.
Other causes
Diagnostic tests
Pulmonary function tests or bronchoscopy can loosen secretions and mucus, causing rhonchi.
Respiratory therapy
Respiratory therapy may produce rhonchi from loosened secretions and mucus.
Special considerations
To ease the patient’s breathing, place him in semi-Fowler’s position and reposition him every 2 hours. Administer an antibiotic, a bronchodilator, and an expectorant. Also, provide humidification to thin secretions, to relieve inflammation, and to prevent drying. Pulmonary physiotherapy with postural drainage and percussion can also help loosen secretions. Use tracheal suctioning, if necessary, to help the patient clear secretions and to promote oxygenation and comfort. Promote coughing, deep breathing, and incentive spirometry.
Prepare the patient for diagnostic tests, such as arterial blood gas analysis, pulmonary function studies, sputum analysis, and chest X-rays.
Pediatric pointers
Rhonchi in children can result from bacterial pneumonia, cystic fibrosis, and croup syndrome.
Because a respiratory tract disorder may begin abruptly and progress rapidly in an infant or a child, observe closely for signs of airway obstruction.
Patient counseling
If appropriate, encourage increased activity to promote drainage of secretions. Teach deep-breathing and coughing techniques and splinting, if necessary. Encourage the patient to drink plenty of fluids to help liquefy secretions and prevent dehydration. Advise him not to suppress a moist cough.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Lung symptoms
Read excerpts from these other book chapters related to Lung symptoms:
Medical Books Excerpts
- Rhonchi
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Professional Guide to Diseases (Eighth Edition)" (2005)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Rhonchi
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- Rhonchi
- "Nursing: Interpreting Signs and Symptoms" (2007)
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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Lung symptoms
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