Auscultating heart sounds on obese patients with limited mobility in LTC?

[pug-nurse]

Hello! I'm a second quarter nursing student and I've been doing my clinicals in LTC.

I have tried to take an apical pulse on every single one of my patients this quarter as well as last, and I am having such a tough time.

Every patient I get happens to be an obese patient, most of which have been obese female patients with very large, pendulous breasts.

It seems like no matter how high I lift their breast tissue, I can never find an apical pulse! My patient right now is obese with CHF and a pacemaker, I can't even hear her heart beat around the pericardium let alone her apical. I even borrowed my classmates $500 littman amplifying stethoscope and still could not hear a beat! I had a large male patient last time and his heart beat was very hard to hear, but I was able to auscultate it.

Any tips on hearing obese female patient's heart sounds? Am I just doing it wrong? Listening to heart sounds is so important but I've been struggling with it since my first clinical ever last quarter.

[RegularNurse]

turn the patient on their left side; it brings their heart closer to the sternum and makes it easier to hear.

[WanderingWilder, ASN]

Ask your instructor for help. They are there to teach you. When I have a hard time finding a sound or I'm not sure what I'm hearing I ask the instructor to listen and she will help me find it.