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!

[Morainey, BSN, RN]

You can always listen posteriorly - quick and easy for a cursory exam.

[srleslie]

Not practicle on many patients seen on a med/surg unit...

[hiddencatRN, BSN, RN]

If I have to listen anteriorly for some reason, I listen high on the chest and then along the axillary line. My preference is for posterior lung sounds though. I know we were all taught to listen on bare skin, but honestly, unless the cloth is thick I don't have much of an issue listening through clothing.

You have a lot of med surg patients who can't sit up or roll to the side?

[lckrn2pa]

I've always used the back of my hand to sweep them out of the way when needed. I go about it in a professional manner and don't make any type of event out of it. Move swiftly and profesionally and get it done.

[MN-Nurse, ASN, RN]

You get used to it after a while. The more comfortable and professional you appear, the more comfortable they are.

[DebblesRN, ASN, BSN, RN]

Not sure why it is not practical to listen to the patient's posterior lung fields, I always listen to them. You hear so much better from the back. I usually start with the bases on the posterior because the first few breaths will be the deepest breaths. then I listen to the bases mid axillary line, then I gow up the back. I also listen to the front below the clavicles, and just beneath the breast--you can gently pull the gown from the side, and place your stethescope just under the breast without exposing the patient. I always tell them I will touch.

Most medsurg patients need to be up in the chair at some point, so I always have them lean forward and get a listen, or you can ask them to sit up if they are in the bed or roll to the side--if they can't make it all the way over, I listen to the side that is off the bed, then have them roll over a little the other way so I can listen to the other side. I also like to listen while they do their IS--they get some good deep breaths while using that thing. :)

Hope this helps. :)

[dudette10, MSN, RN]

You can displace the breast with the back of the nondominant hand. You can even tell the patient, "I need to move your breast to listen to your lungs/heart." Sometimes, the patient will grab her boob and do it for you! If the patient is alert and oriented and able to help, you can ask her to lift her breast.

The right middle lobe and the lower half of the left upper lobe cannot be heard posteriorly.

[DixieRedHead, ASN, RN]

One side at at time. Start on the back, top to bottom. When you get to the bottom, move to the side (usually useless) but acquaints the patient with what you are doing. Then move the stethoscope around under the breast until you feel the bony prominence and there you have it.

[MinnieMomRN]

Not practicle on many patients seen on a med/surg unit...

Why? Even when I had patients who were complete assists, getting them rolled on their side enabled me to listen to lung sounds, AND do a skin check to their back side at the same time.

You said you are a new nurse -- in time you will get more comfortable doing a full head to toe, and the ease in which you do your assessment will put your patient at ease.

[psu_213, BSN, RN]

I have to go with the majority here--listen from behind. I have yet to encounter a pt where it is 100% impossible to listen posteriorly. Not only do you eliminate most of the issues with modesty, you get to hear things much bettter.

When we go EKGs on female pts, we need to lift the breast up (specifially the lt breast) for proper lead placement. I know simply saying 'sorry, but we have to do this is not going to take all the modesty issues away from all females, but to provide proper care it has to be done. If they flat out refuse, then find someone else to do it (whether "it" is applying EKG leads of listening to lung sounds). Otherwise, be professional, polite, sensative, but do what needs to be done.

[EllieBean13]

I know in my nursing program, we HAVE to listen both anteriorly and posteriorly. I agree with what was said earlier... use a sweeping motion with the back of your hand and just avoid direct eye-contact while you are doing it.