New nurse struggling with assessment techniques

[livRN2012]

I'm a new nurse, I've been on the floor for 4 months. I work on a busy surgical GI/GU and trauma floor. I am struggling with lung sounds, mainly the difference between clear and diminished. I can tell when there is fluid and other obvious noises but for some reason I just can't quite grasp clear and diminished. It's something that's very important on the floor where I work and I'm really trying to focus on the sounds when I listen but I'm not 100% sure what I'm trying to hear if that makes sense.

[TU RN, DNP, CRNA]

Well practice listening to your own breath sounds with some good deep breaths. Of course you should clean your stethoscope before and after touching it to your skin, and then again after patient contact.

Besides that I would say make sure you keep your patient sitting upright (HOB at least 45°) while assessing them. If they have poor effort or can't move too well and you have to roll them to their side to listen, make sure you understand that the lungs are going to be diminished due to effort and position and not physiologic insufficiency.

[thisdoll]

Youtube is a great source to learn diff lung sounds. Repeat listening to audio over and over you will master the difference.

[sunshyne17]

I had that same issue in nursing school. I was listening to a 4yr old with diminished BS. My clinical instructor helped me distinguish the difference. We listened to her lungs at the top. It was audible, slight expiratory wheezing. As we traveled down, the sound itself kept getting fainter until you could barely hear anything at the bases. So it was greatly diminished, which was too be expected bc she was admitted r/t RSV.

The previous poster was correct - you want them upright so their lungs can fully expand and let that air in so you can hear it!

I hope that helps.