How do you chart wheezing in a patient?

How to Chart Wheezing

When documenting wheezing in a patient, chart it as a clinical finding characterized by a raspy high-pitched whistling sound noted on expiration or inspiration associated with obstruction of the lower airways. 1

Key Elements to Document When Charting Wheezing

Timing and Pattern

• Document when the wheeze occurs in the respiratory cycle:
  • Expiratory only
  • Inspiratory only
  • Biphasic (both inspiratory and expiratory) - note that biphasic wheezing is typically associated with more severe obstruction 2
  • Duration within respiratory phase (early, late, or throughout entire phase)

Characteristics

• Pitch: Document as high, medium, or low pitch
• Intensity/Loudness: Document as mild, moderate, or severe
• Distribution: Document location where wheezing is heard (e.g., diffuse, localized to specific lung fields, unilateral, bilateral)

Associated Findings

• Document presence or absence of:
  • Accessory muscle use
  • Respiratory distress
  • Cyanosis
  • Tachypnea
  • Reduced oxygen saturation
  • Other adventitious lung sounds (crackles, rhonchi)

Quantification

• Consider using a scale to quantify wheezing severity:
  • 0 = No wheezing
  • 1 = Mild wheezing (end-expiratory)
  • 2 = Moderate wheezing (throughout expiration)
  • 3 = Severe wheezing (audible without stethoscope, inspiratory and expiratory)

Response to Interventions

• Document any changes in wheezing after interventions:
  • Response to bronchodilators
  • Response to positioning
  • Response to coughing or deep breathing

Example Documentation Format

Respiratory: Lungs with [mild/moderate/severe] [high/medium/low]-pitched [inspiratory/expiratory/biphasic] wheezing [throughout/early/late] [inspiration/expiration], [diffuse/localized to (specific area)]. [With/without] accessory muscle use. Respiratory rate [number] breaths per minute. O2 saturation [percentage] on [room air/oxygen delivery method]. Wheezing [improved/worsened/unchanged] after [intervention].

Common Pitfalls to Avoid When Charting Wheezing

1. Confusing wheezing with other adventitious sounds: Stridor is a high-pitched sound heard primarily on inspiration and indicates upper airway obstruction, while wheezing typically indicates lower airway obstruction 3.

2. Failing to document response to treatment: Always document whether wheezing improves, worsens, or remains unchanged after bronchodilator administration or other interventions.

3. Assuming all wheezing is asthma: While asthma is a common cause, wheezing can result from various conditions including COPD, bronchiolitis, heart failure, foreign body aspiration, and malignancy 4.

4. Inadequate characterization: Detailed characterization of wheezing correlates with severity of airway obstruction. High-pitched, loud wheezing that spans the entire respiratory phase typically indicates more severe obstruction 2.

5. Relying solely on subjective assessment: When possible, include objective measurements like peak expiratory flow rate (PEFR) or spirometry values alongside wheezing description 2.

By following this structured approach to documenting wheezing, you'll provide a comprehensive clinical picture that aids in diagnosis, treatment decisions, and monitoring of respiratory conditions over time.