Assessment Blues

I just feel like I am still lacking in the basics. We're talking lung and heart sounds. I know it sounds silly, but I just feel really stupid for not getting it. I mean, I listen for apical pulse, sometimes I have a hard time finding it. I listen to see if it's regular, right? Make sure that you are listening in the best spot (b/tw the 5th and 6th intercostal space) if you can't hear it anywhere else. Also make sure your stethoscope is a good one (cheapies are hard to hear from sometimes). Listen for regular rhythm, but also listen for abnormal sounds. You may not know what it is but you probably know if it sounds different than "normal".I'm not counting, because the BP cuff does it auto. Now, if it's tachy or brady or something similar, I check the radial pulse to confirm findings.

Then I listen to the lungs. Here comes my anxiety. I am afraid that I am going to miss something, my patient is going to go to the ER with his CHF. Sometimes I can't hear anything! Or they always sound clear! CTA! I don't think I am doing it wrong, per se, I just wouldn't know crackles if I heard it on an actual person. Is that my fingers creaking ever-so-slightly on the stethoscope, or it that some coarse crackles? I can't tell! ( I love the Auscultation Assistant, btw. Google it.) Lung sounds are a mystery to some nurses. I always wonder if I am hearing everything correctly as well. Sometimes I hear something but wonder if it is just a slight movement over their shirt. or truely adventitious breath sounds. Until you know what the pts normal sound is you might get second opinions.
And I do have some common sense; don't get me wrong. If someone has 2+ ankle edema, the BP is 241/128 (actually happened today!) I would know to listen extra careful and maybe get a 2nd opinion if I thought I heard something. I just hope that I am doing a good job, that's all I guess. I don't want somebody to suffer because I didn't recognize a sign!