ascultating the lungs of a female patient

[srleslie]

As a new male nurse, I am finding this more challenging than it should be. First is the issue of technique. Breasts often seem to "get in the way" and I'm not sure about the best technique to go about listening to the lungs on a female patient, partcicularly when they have the larger variety.

Then there's the issue of modesty. We are taught in nursing school to listen directly on the skin and not through a gown (though I see nurses doin this all the time). I am afraid of making my female patients uncomfortable by listening to them underneath their gown. So I'm not sure how to go about this. I'm afraid this is going to affect the quality of my assessments and don't want that to happen. I might discuss this with my preceptor but she is also female. Any advice you have would be appreciated...thanks!

[Ted]

Yes, and you do well to be concerned, I know of one Tech who was in nursing school and on his 90 days of orient was accused by a female patient of assault. Ruined his nursing career, as well as requiring a jail visit and a jury trial.

Seriously. . . that's too bad. If that person's intentions was purely professional, then I hope the hospital backed him up unconditionally. We have a job to do. Sometimes it involves getting listening to lungs on the front. Sometimes it involves putting in a foley catheter. Sometimes it involves administrating an enema. How we go about it as professionals makes all of the difference in the world. A HUGE step in lessing the anxiety of ANY patient is simply to explain the procedure. If it's appropriate, offer the patient the choice of an opportunity to have a same-sex (to the patient) nurse do the procedure and assess the patient's breath sounds anteriorly. Hopefully, there is another nurse available to help out if needed. If not, we still have a job to do. We can offer a same-sex assistant (to the patient) to watch is available. That's another option. But if not (can you guess what I'm going to say next?) we have a JOB to do.

How we approach the patient does make all the difference in the world. Thoughtful, respectful instruction and offering choices (when available) rarely fails. But what needs to get done, needs to get done.

If that person acted within his scope of practice and acted professionally, I surely hope that the hospital backed him up 100%. If that person did NOT act as one should expect a professional to act, and indeed did assualt that patient, then he deserved to be punished. If that's the case, he not only did a disservice to that patient, he did a disservice to our profession.

[Been there,done that, ASN, RN]

30 years in here... anterior breath sounds don't tell me SQUAT.

9 times out of 10 ..I need to hear the posterior bases and worry from there.

Any questions,,, check the x-ray.. or .. get one ordered.

[Ted]

Interesting. . . In recalling memories of my first few days on the job. . . I remember hearing one of my first wheezes, heard anteriorly of course. The O2 sat could have been a bit better too. Called the doctor. . . woke him up and said, "Doctor is there something we can do, I said DOCTOR to relieve the wheezing. . . . " (insert word that rhymes with "do"). Well. . . bottom line. . . albuterol helped make that wheezing go away. And yes, a chest x-ray was obtained too.

(I still prefer to hear lung sounds posteriorly.)

[DookieMeisterRN]

The only time breasts get in the way is trying to look under them for skin problems. I ALWAYS listen to lung sounds posteriorly and this solves that problem. I do listen to anterior upper lobes after the cardiac assessment but feel it's grossly inadequate to just listen to anterior lobes. It can also be a problem if you have a male pt with a hairy chest

[groundedandrooted]

Don't be sure that any hospital will back you in case of a problem, In this case the hospital turned the case over to the police. The tech had to go to jury trial to get his name cleared. I think that he had a right to turn around and sue the hospital for damages but I'm not sure that happened.