Quote from lisa41rn
It seems like all I see on flowsheets is "lung sounds diminished" or "clear" for the older folks (and others) who have a hard time taking a deep breath. I see docs go in and listen on the front of the chest for patients who are difficult to turn, but that just doesn't work well for me. I have a great electronic stethoscope, but really want an idea from other nurses out there!! There are some great websites where you can hear crackles, etc., but when a patient doesn't take deep breaths, it makes it tough sometimes to hear accurately. Any ideas? Thanks.
You didn't mention, but do you work in a hospital? If so, respiratory techs can be your friends! I will sometimes ask them what they heard when I'm having a hard time with a patient. They seem to really like being asked for their expertise, especially from a nurse. One guy told me he's got a pre-wheeze, before his asthma kicks in. So I got behind him and listened. I didn't hear the wheeze but he corrected me on my auscultation technique.
It is possible to get a pretty good idea of lung sounds from the front, but it's more difficult in women and for me, complicated by telemetry wires (darn things are where I wanna put my scope!). If you get a little extra time, try it with coworkers for practice. One big thing to remember when listening from the front is to not forget the right lower lobe that you can access from under the arm in the front. Same for left lower lobe but you'll need to listen to heart sounds first to make sure you don't mistake some funky multi-valve regurg for a friction rub in the lungs.
When you are just stumped, ask someone else, also maybe look up the doctor's h & p and see what they heard. Note: That may not be accurate for acute care as lung sounds can and do change dramatically sometimes. If you don't hear much, it might be diminished. If you don't hear squat, check the battery in your scope, check again, then ask for someone else to listen - you might have a collapsed lung or a post lobectomy, or pulmonary edema. Don't be afraid to say what you hear.
What type of electronic do you use? I have the littman 4000 thing that runs on AAA's, but I started with a phillips.