How to chart a respiratory assessment

1. Have them sit up if they can. Bare skin, not through a gown. Warm the stethoscope.
2. Ask them to breathe a little deeper than usual, in and out through the mouth, one full cycle at each site.
3. Compare side to side, top to bottom. Right lung: upper, mid, and lower. Left lung: upper and lower only — there is no left middle lobe.
4. Chart the best single finding for each field. If two sounds share a field, pick the dominant one and describe the mix in comments.
5. If you hear a high-pitched sound, move the stethoscope to the neck. Stridor is louder over the neck and trachea. Wheezes are charted on the lung field where you hear them.

Bedside pearl: One “lungs CTA” line hides the field that changed. Chart each field you actually listened to.

• The right lung has three lobes — so the chart has a right mid field.
• The left lung has two lobes; the heart occupies the space where a left mid lobe would be, so left mid is not a row.
• The trachea and larynx sit in the neck — turbulence there (stridor) is heard best over the neck, not at the bases.
• Lower-airway narrowing (wheeze) is heard over the lung fields and can differ field to field.
• The bases overlie the lower lobes; fluid often shows up there first as wet popping (crackles).