An older client is admitted to an acute care facility with the diagnosis of left lower lobe pneumonia. How should the practical nurse (PN) position the client for auscultation of posterior lung fields?
A.
Lateral, semi-prone.
B.
Semi-Fowler’s.
C.
Right side-lying.
D.
Forward orthopneic.
The Correct Answer and Explanation is:
The correct answer is A. Lateral, semi-prone.
Explanation
When auscultating the posterior lung fields, especially in a patient with pneumonia, it’s crucial to position the patient in a way that allows for the optimal assessment of lung sounds. The choice of position can significantly affect the ability to listen to various lung areas clearly.
1. Positioning for Optimal Lung Sound Assessment:
- Lateral, Semi-Prone Position: This position is highly effective for auscultating the posterior lung fields, particularly in the lower lobes. In this position, the patient is turned onto their side (lateral) with a slight forward tilt (semi-prone). This posture helps to bring the posterior lung bases closer to the chest wall, improving the clarity of breath sounds. It also facilitates the assessment of both the left and right lung bases more effectively by aligning the lung fields with the stethoscope.
- Semi-Fowler’s Position: While the semi-Fowler’s position (45-degree head of bed elevation) is useful for auscultating anterior lung fields and for patients who have difficulty breathing while lying flat, it does not provide optimal access to the posterior lung bases. In this position, the lower lobes might be less accessible for auscultation, which is why it is less suitable for assessing posterior lung fields.
- Right Side-Lying: This position, with the patient lying on their right side, does not provide a comprehensive assessment of the left lung’s posterior fields. While it is useful for auscultating the right lung, it can hinder the evaluation of the left lung posteriorly.
- Forward Orthopneic Position: This position, where the patient is sitting up and leaning forward, is typically used to relieve dyspnea and improve lung expansion but does not facilitate adequate auscultation of the posterior lung fields.
In summary, the lateral, semi-prone position is preferred for auscultating the posterior lung fields because it allows better access and clearer sound transmission from the lung bases, making it easier to assess conditions such as pneumonia in the lower lobes.