[ltrnkoczy]

Help! I've learned all of the heart assessment auscultating spots ... but sometimes, I just can't hear a darn thing? I'll hit all the marks ... and still nothing... the stethoscope is working ... the patient is breathing, so I know the heart is beating. I mean, I hear nothing ... even if they turn toward the left? It doesn't matter if the pt is obese, though that probably compounds it, or thin. There are times I just can't hear it. Is this a technique thing, a hearing loss issue on my part (I do doubt this, but am open to the possiblity), a hardware problem (standard cardiac littman), or is it possible that some patients' heart sounds are so faint that normal breathing silences it... Can I tell you how silly I feel even asking this question? So, Silly. Would appreciate any help, suggestions, or corroboration of this problem... Thanks...

[pr0metheus]

Hi there.

Don't feel silly for asking for help! I am only in my second semester and I have already learned that we have to ask when in doubt.

How about... are you auscultating over a bone(rib)? or are you in the intercostals?
Are your stethoscope earpieces too tight?
Do you have a rotating diaphragm/bell on your stethoscope? Is it rotated to the diaphragm side?

Those are a few of the things I can think of.

[EricEnfermero]

Another suggestion is to make sure the earpieces are facing forward.

[eandgsma]

I'm still a student but one trick is to have the patient sit up and forward. If they are turned to the side, you still may not be able to hear it. I still have a hard time with some patients but with practice I have been able to get almost all of them. When I can't, I ask for help.

[nursenatalie]

yes, definately make sure the earpeices are facing forward. I am embarrassed to say this but it is the truth: I was out of nursing school roughly six months before I realized I had earpeices turned the wrong way! I was very embarrassed, it wasnt that I didnt hear things before but wow I could sure hear them afterward! I usually tell this story to any new grad I am orienting. It makes them a little less timid about asking me questions. I am sure they think if I spent six months with my stethoscope turned the wrong way I am not going to laugh at them!

[tangmo]

I agree with the earpieces advice. One time in nursing school, a doctor had me listen to a murmur, and I said I couldn't hear it. He then informed me that maybe if I tried putting my stethoscope on the right way, I could hear better.

[printernurse]

I'm a new nurse, but I've found that heart sounds are hard to find on some "big" people. Some pts have a lot of muscle, bone, and fat and you can not get heart sounds in every spot.

[GermPhobe]

Take your time. Listen for lung sounds first, since they often obscure heart tones. Then listen "under" the lung sounds, and you'll hear the heart. I used to think patients knew I was incompetent when I did things slowly. I now know that they appreciate my "thoroughness."