Pulmonary auscultation troubleshooting

As a pulmonary nurse, I’ve gotten very used to listening to lung sounds and knowing what I am hearing in each lobe. Not everyone has such an easy time hearing anything at all.

I got a question from a listener about this and wanted to share it here for the students and newbies who may be having the same problem.

Q:  How do you hear breath sounds with the noise of the room? I have a hard time hearing anything at all and I'm afraid I'm going to miss something.

A. I think the first step is having a good stethoscope. While I don't think every nurse needs a crazy expensive one, it's certainly best to have the most upscale one you can afford. I upgraded from a $40 steth to a $140 steth and the difference is profound. The hospital-issue ones hanging at the bedside are cheap and not great for general use, in my opinion. 

Second, make sure the earpieces are seated properly in your ears. You want the earpieces to be tilted slightly forward; imagine them both pointing through your head to the tip of your nose. I love the Nurse Nook, so here’s her video on using a stethoscope.

Third, make sure you're putting it in the right places on the patient. If you’re listening over fabric, you’re going to hear the rustling of the fibers, so be sure to listen on skin, and if the patient is very hairy also try moving over a bit. If you're over bone, like the scapulae or ribs, you won't hear as well. Move over a little. Have the patient take deep breaths if able. Maybe on your break cruise Pinterest for an image of auscultation landmarks on the human body.  

And also, minimize any noise you can if you still can't hear well. Ask the patient if you can turn off the television while you assess them, for example. 

If all else fails, there are very expensive electronic stethoscopes as well as amplifying adapters for traditional stethoscopes. I did an unsponsored review of the Eko stethoscope amplifier, which I own and use on my Littmann Cardiology IV.  You can find it below.

I hope this helps!  

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