I'm having major assessment problems. Please help!!!!

[Jessica Student RN]

:uhoh21: I've got less than 2 months before I graduate and start working as an RN and I am still having problems with certain aspects of assessment (and assessments are sooo important!!!).

First of all, I always have a difficult time auscultating breath sounds. I always pick up sounds from the tubing, my finger, other bodily sounds, etc. I'm looking into getting a better stethoscope and would like some opinions on the best out there. Also maybe some tips on how you hold the stethoscope to minimize interference.

Secondly, I have the hardest time feeling pedal pulses. I even have a hard time feeling them on myself. When I do feel it, it feels like a 1+ when it feels normal to other people. And if pulses are weak, they feel absent to me. But I can feel other pulses just fine.

I appreciate any input. Thanks

[tommycher]

When doing a manual blood pressure, the stethoscope actually should be placed on the little finger side of the antecubital area.

[webblarsk]

I would add that the last time I took a manual BP was...well, I think I did one a couple of months ago to be sure I could still do it. Most places have the automated BP cuffs. As for breath sounds, sometimes it takes listening to abnormal sounds a bit before you know what you are listening for. Have you done a critical care rotation where many vented patients have a whole symphony of lung sounds? I've always felt that, once you have a good feeling for what you are listening for, the "background" sounds aren't distracting - you start to tune those out. This, like many things, comes with practice.

As for feeling pulses, try using your another hand. I struggled and struggled with pedals until I started using my LEFT (non-dominant) hand. Don't know why this works but what feels like a 1+ to my right hand feels like a 2+ to my left. Maybe it's because of all the dailiy use we put our dominant hand and fingers through???

I would add to never trust a machine to take BP. Sure they are great but machines are known to mess up!

[Tweety, BSN, RN]

I can relate. My fingers aren't as sensitive as some peoples in feeling pedals and it's important because I work with a lot of ortho tramaus. I just dopler any pedals I can't feel. I ran into that problem last night, a nurse in report said pedals are palpable and I couldn't feel them, but picked them up with a doppler.

Good luck to you!

[DenaInWyo]

Well, will wonders never cease.

I have had lots of trouble with pedal pulses, and have never, ever been able to find my own. Sitting here, I whipped my sock off, moved my big toe to find that tendon, and felt with my left hand..and..found it! Yes Virginia, you DO have a pedal pulse!

Thanks..I love this site!

Deana

[RN-PA, RN]

I also used to have a lot of problems with lung sounds and found that a good stethoscope helps. I hear them so much better since I got a Littmann Cardiology III a while back. I use the stethoscope with the soft ear tips and they really seal out background noise well. As someeone else mentioned, I sometimes close my eyes to help tune things out and really focus as I'm auscultating lungs, heart, or bowel sounds.

I started out in Med-Surg on night shift and found it difficult to learn breath sounds then since patients were in bed and sleepy (naturally) when I wanted to assess them. When I switched to 3-11 shift, I was able to really assess more thoroughly when patients were more willing and able to sit up in bed or were sitting in a chair.

Here's a great site where you can actually hear breath sounds:

http://www.pulmonaryrehab.com/lung_sounds.htm

Not the same as listening to a LOT of lungs over time, but should be of some help. All the best to you!