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- by mia Aug 31, '01Hi! I was hoping someone out there could help me. My problem is that when I try to take a blood pressure reading I have a very difficult time hearing. I don't know if I have some kind of hearing impairment or what but Im really concerned. I feel that a better stethoscope may help but Im not sure which one to get. Can anyone advise me about a good stethscope?
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- Aug 31, '01 by Allison PMia,
One of the girls in my class has a hearing impairment. The nursing department faculty was able to help her find an amplified stethoscope. It has worked wonderfully for her.
- Aug 31, '01 by BrandyBSNMy first thought would be to go and have your hearing checked. If that works out just fine, then I would look into getting a different stephoscope. I have a bit of a hearing problem too (drums in highschool and my electric guitar), and I found that there are certain types of scopes that I just cant hear a darn thing through, sprague being one of them. I have a littman Cardiology III now, and it was well worth the money. I hear everything, and it really locks into my ear canals, so i dont get environmental noise when i am trying to hear my patients.
There are several options, but first, try to have your hearing checked.
- Aug 31, '01 by anniesTry changing the eartips. I like the trasparent soft rubber ones. They seem to block out the outside world for me. I cannot hear as well with the hard tipped ones. If changing the tips doesn't work, have your hearing tested. An audiologist may be able to help you solve the problem.
An amplified one would be great, if you have a hearing problem, but they are expensive and you should be prepared to guard it with your life. They come up missing frequently.
- Aug 31, '01 by MRed94I wear hearing aides in both ears, and have found them to be useless when doing a BP. I use a double barreled Cardiac scope, and love it.
Cost me a pretty $$, but well worth it.
I don't use my hearing aids when taking a BP, and I do alright.
Check it out.
- Sep 1, '01 by MollyJIf you don't *usually* have a hearing impairment, Mia, I doubt you have developed one with a stethoscope in your ears. There was a post here several months about not being able to hear through a brand new and expensive stethoscope and lots of good tips were given at that time. One was to go to the Littmann stethoscope web site for tips on using a stethoscope and I guess I would hand that on to you. I was able to link to this web site by putting in www.littmann.com
Also, a stethoscope's ear pieces should face slightly forward (no more than 5 to 15 degreees) as you are looking down on the earpieces when they are held in front of you hanging down. It is easy to put the stethoscope on backwards because it is a little counter-intuitive to put the earpieces in to your ears this way.
Life another poster suggested, different ear pieces do help some folks and that is good. Make sure your diaphragm is clicked into place if you have a dual head stethoscope.
Someone in the other post mentioned getting focused on what you are listening to. I may close my eyes slightly and try to block out other noises or distractions.
When I have a hard to hear blood pressure, I simply palpate the brachial artery (I don't routinely do that) so that I can place the diaphragm directly over the brachial artery, slightly reposition their arm making sure it is not too rigidly hyperextended or too flexed. I move any clothing or blankets that might be interfering, [I will only rarely during the dead of winter on a "well" person even attempt a bp over clothing but what I am saying is remove anything between you and them] and then you listen very closely while or after you palpate the blood pressure. On the hard to hear patient, sometimes knowing where that systolic will kick in and repositioning your stet will give you the edge you need to hear a quiet Karotkoff sound kick in. sometimes I can improve how well I hear by looking down slightly and opening my mouth. On my stethoscope this seems to improve the seal a little better and I may hear heart sounds or karotkoff sounds I was previously unable to hear.
The bottom line is you cannot document what you did not hear and when I cannot hear a blood pressure, I try the other arm OR I document only a palpated blood pressure (documenting that it was simply a hard to hear pressure and there were no other signs of hemodynamic instability).
Doing lots of pressures on lots of patients will improve your deftness and reliability with the procedure and you will have fewer patients you cannot hear over time, but even after 23 years, I still encounter people I cannot hear well on.
- Sep 1, '01 by ADN 2002Mia,
I had the same problem when I was first learning to take a BP. I had a sprague (double barrel) stethoscope at the time, and just couldn't hear a thing, on top of which, it also hurt my ears really bad. I tried taking a BP on my friend's Littmann Classic II S.E. (the recommended stethoscope in my program) and the difference was unbelievable - I could hear EVERYTHING. I got myself one for a little under $55 at www.estethoscope.com and they even threw in the name tag for it (a must with a Littmann - we've had one stolen at school, believe it or not). The Littmann Cardio is nice, but I wouldn't recommend spending that much unless you are planning to go into maybe cardiology or something.
The website I gave you is definitely worth checking out - they have awesome deals.
- Sep 3, '01 by janlebI had the problem also. I was sure I was HOH. You will find out many nursing skills require you to use your sense,(sight, touch ect.). You will find out that the more BP you take the better you hear. It takes a trained ear. Another thing is you might want to make sure TV is off, close the door. Cut our any distraction you can. When I began the nursing program, I could not find a pedal pulse if my life depended on it. But the more practice the better you get. Hope this helps
- Sep 5, '01 by TalinoI have to think your hearing is ok. If not, all the above recommendations are sure worth a consideration.
In my years of experience with BP checks, not all of them were audible enough to convince me of an accurate reading all the time.
When you canít hear the brachial pulse after a few attempts, do the palpation technique (radial or brachial).
1. FEEL for the pulse (radial or brachial). As you inflate the cuff that pulse becomes faint.
2. As you deflate, feel for the first strong pulse and mark the reading.
3. Now put your steth back in the brachial site. Inflate the cuff about 40 mm hg above your mark.
4. Deflate slowly and listen for a brachial pulse. About 5-10 mm hg above (sometimes below) your mark you should be able to hear a pulse. It may be faint still but itís audible enough for a systole and diastole.
There is another method (the radio-brachial pulse technique) which is a little complex for a student but can be learned. Try the above first.
Frequent BP practice reading will improve hearing that elusive pulse (that is, ruling out pathology).Last edit by Talino on Sep 5, '01