Listening and evaluating the breath sounds and added sounds coming from within the thorax using a stethoscope.
The use of the diaphragm of the stethoscope is preferred as it tends to pick up more sounds and slightly amplify them. Issue clear instructions to the patient. Get the patient to seat upright on a chair, on the edge of the couch or if confined to bed to sit up and lean slightly forward in order to examine the posterior chest wall. Ask then to take reasonably deep breaths with the mouth open.
Start superiorly over the apex of the lungs just above the clavicles and compare side to side. Progress inferiorly at intervals of 2-3 intercostal spaces. Listen over the mediastinum over the bronchial areas and over the lung tissues. listen to about five spaces anteriorly, three laterally and five posteriorly.
Take into account the physiological changes in sound from tracheal to bronchial to brochovesicular to vesicular. Listen for shifting and alterations of these sounds. Listen out for added sounds such as crackles crepitations, rales, wheezes and plural rubs.
Ensure the patient does not breath in through the nose. Take into consideration physiological factors. In patients with a hairy chest and using the diaphragm may produce sounds relating to the friction of hair. Patients may get dizzy especially when taking deep frequent breaths so pause your procedure and then continue.
(Full details and demonstration of the procedure is provided with the DVD/videos and associated study material)