Question

You are auscultating a patient's lung sounds. During your assessment, you note there is a low-pitched harsh, grating sound that sounds like a pleural friction rub. However, you're not sure if this is a pleural friction rub or pericardial friction rub. What do you do next to determine the difference?

A. Have the patient cough and see if the sound clears
B. Assess the posterior lower lobe only
C. Have the patient hold their breath and note if the sound is still present
D. Place the patient in supine position and reassess for the sound

Answer 1

To differentiate between a pleural friction rub and a pericardial friction rub, have the patient hold their breath. If the sound is still present during breath hold, it suggests a pericardial friction rub.

Step-by-step explanation:

When auscultating and you hear a low-pitched harsh, grating sound that could be either a pleural friction rub or a pericardial friction rub, the maneuver you should do next is to have the patient hold their breath and then reassess if the sound is still present. If the sound disappears when the patient holds their breath, it is more likely a pleural friction rub, as this sound is related to the movement of the pleura during respiration. If the sound persists even when the patient is holding their breath, this may suggest a pericardial friction rub, caused by the movement of the heart within the pericardial sac