Quiet days in the school health office are as rare as unicorn sightings. Students with various respiratory symptoms often contribute to the constant cacophony. Noisy breathing can be a sign of something temporary, minor, or serious that requires immediate attention. The ability to discern the subtle differences in students' breath sounds is crucial for effective school nurse assessment and intervention. This involves listening to the lungs and thinking about a few things, such as the timing, pitch, location, and character of the breath sounds. So, let's explore the various types of adventitious lung sounds, their underlying causes, and implications for school nursing practice.
The Expiratory Whistle
Wheezing is that high-pitched, whistling sound that's typically more noticeable on the exhale but can also be heard on the inhale in some cases. This can happen when the airways in the lungs are narrowed or inflamed. While asthma is often the primary culprit behind wheezing in children, it's important to recognize that other conditions can cause constriction of the airways that leads to wheezing, including allergies, GERD, and viral respiratory infections.
The High-Pitched Warning Sign
Stridor is a continuous, harsh, high-pitched sound that can be described as screeching or squawking. It's typically heard in the upper respiratory system, near the throat. Stridor indicates a narrowing or obstruction in the larynx or trachea. Acute conditions such as epiglottitis, croup, foreign body aspiration, and anaphylaxis can cause this sound, and it can be a sign of a life-threatening emergency.
The Congested Snore
Stertor is noisy breathing characterized by a low-pitched, snoring-like sound. It is caused by congestion in the mouth and nose. It is a familiar sound resulting from various issues, such as a common cold, allergies, or the flu. It may also be caused by enlarged adenoids or, less frequently, a structural abnormality in the posterior nasal cavity.
The Low-Pitched Rumble
Rhonchi are continuous, low-pitched sounds that often resemble snoring or gurgling. They are usually more audible during expiration but can sometimes be heard during inspiration. Rhonchi occur when air moves through large airways obstructed by secretions, such as mucus or fluid. Pneumonia, bronchiolitis, and other lung infections that increase mucus production may lead to rhonchi.
The Snap, Crackle, Pop
Crackles, also called rales, are discontinuous, interrupted, or explosive sounds described as rattling, bubbling, or clicking. Crackles in children are typically associated with fluid accumulation in the lungs' small airways. These abnormal breath sounds often result from respiratory infections such as pneumonia, bronchitis, or bronchiolitis, with the latter frequently caused by respiratory syncytial virus (RSV). These conditions lead to inflammation and fluid buildup in the lower respiratory tract, causing the characteristic crackling sound as air passes through the affected areas during breathing.
In the dynamic environment of a school health office, the ability to quickly and accurately assess respiratory distress can make a critical difference in student outcomes. By honing your skills in recognizing and interpreting these breath sounds, you'll be better equipped to provide timely and appropriate care, whether that means administering medication, contacting parents, or activating emergency services when necessary.
