Do you carry around your stethoscope?

Nurses General Nursing

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I carried my stethoscope when I first started my job on the floor. I was being the "good new nurse" and did head-toe assx, check for PERRLA on a regardless of patient's neurostatus, checked for 4 points pulses, auscultated for breath sounds, APETM, etc etc, then I stopped using stethoscope completely for quite long time.

Especially at the ER, I feel that stethoscope was almost of no use. When I was on ER transition, I listened to breath sounds but soon recognized that it was almost waste of time mainly because almost everyone gets chest xray. But I started carrying stethoscope again recently and this is why. I feel that when I actually listen to the patients' lungs and breath sounds, it seems that patients trust me more, they like it more than me just coming in, hooking them up to monitor and asking mundane questions. That is actually the biggest reason I use my stethoscope now. In terms of outcomes, of course it serves no use because doc will order xray and know if there's effusion, atelectasis, or pneumo, but one, I like to be able to depend on skills instead of imaging tools to know what's going on, and two, patients react positively to that. I see that this is why docs put stethoscopes on patients "just as act" even though I know for sure he/she's not listening, but somehow that probably assures the patient.

Anyways, that's been my experience with stethoscopes. Do you carry yours and use them, do you think it actually matters? I don't but I use them for above reasons. What do you do?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Haha no one is starting controversy. I'm not talking about trauma situation, I'm talking about your everyday sob, cp, abd pain, etc etc. I get what you are saying. But so what if pt wheezes or has rales? Does you knowing this or charting it really have an outcome or any effect? I'm not talking about stridors or intubation, just regular situations. Ya I can tell the doc the pt is wheezing but he probably already knows that and ordered bd. Please do tell, what does it change? That I know what the lung sounds like? So what, are you going to prescribe antibiotics?
I am going to indulge you and engage in a brief conversation for I get the feeling you are tweeking my nose.....
Please do tell, what does it change? That I know what the lung sounds like? So what, are you going to prescribe antibiotics?
but no matter I''ll bite.

For SOB...I listen for breath sounds. Are they equal? Are there any adventitious sounds? Are they wheezing? How bad? Fo they have rales? Are they jut at the bases or do they sound like a washing machine? Are they having a high drama asthma attack? or are they in trouble. Do I need to think about preparing the patient for and admission for ICU to the floor?...or will this be a treat and street.

For abd pain...are there bowel sounds? What do they sound like...as I am listening...is the abdomen distended? Is it tender? Is there any evidence of trauma of surgeries?

For chest pain...is there a rub? Is there a murmur? Do they have a gallop? Are the heart tones good or are they muffled? A development of a new murmur in the presence of EKG changes is an acute finding and an indicator of a blown papillary muscle and impending cardiogenic shock.

Please do tell, what does it change? That I know what the lung sounds like?
It can change plenty....Is the patient getting better after treatment or do I need to badger the EDMD for further more aggressive intervention? I don't know about you...but I feel having this information I can affect change and help the patient. Do I actually order the meds? No....if I wanted to do that I would have become a physician.
Does you knowing this or charting it really have an outcome or any effect?
I think it does...is the EDMD able to keep up with all the patients on a busy night or is it up to the nurse to let the MD know the patient isn't getting better and requires additional intervention/assessment before they go down the tubes. How do you document whether a neb or lasix has been effective treatment in your documentation (not just for liability but for reimbursement purposes) if you have no baseline to compare.

I know you have not been a nurse for very long.....It is standard of care to document assessment that applies to the patient presentation. Do I listen to the lung sounds of a finger lac? No...I don't. However....you have a patient come in with SOB/Chest pain and the shoot the crapper and they or the family sues....you bet your sweet patooty your behind will be in a sling for delay of treatment/failure to rescue and failure to follow standards of care. If that is okay for you (never mind the responsibility to treat appropriately) the BON and your malpractice carrier...all the power to you.

We all make practice decisions. I happen to believe that assessment is imperative to the quality of care my patient receives and the timeliness of interventions.

But that is just me and my opinion...and my opinion is only important to me.

Yes almost everyone in the ER gets a chest X-ray but there are times when the doc is not immediately available to see a patient and your immediate physical assessment is necessary to determine whether the patient can wait or needs to be seen by the doc as soon as possible.

I've identified spontaneous pneumo's with my stethoscope which I would not have otherwise spotted had I not had a stethoscope. Yes the X-ray would have shown the pneumo but the diagnosis and treatment would have been significantly delayed.

I've used NG tubes per the doc based on my stethoscope alone and no xray verification.

Let's not forget that resources are generally limited and radiology may not always be able to come immediately for your X-ray orders. In cases like that, patient's lives may hang on your ability to physically assess and prioritize in the moment.

Well if you don't think it's necessary to listen to your patients (which it is), listen because it's your JOB to do so. You're the nurse. You're there to assess, monitor, and document on your patients. Plus you shouldn't rely on the doc to pick up on everything. There have been plenty of times I caught something the doc didn't. Not using your stethoscope is a very half-buttocksed way of doing your job.

Specializes in Medical-Surgical/Float Pool/Stepdown.
Haha no one is starting controversy. I'm not talking about trauma situation, I'm talking about your everyday sob, cp, abd pain, etc etc. I get what you are saying. But so what if pt wheezes or has rales? Does you knowing this or charting it really have an outcome or any effect? I'm not talking about stridors or intubation, just regular situations. Ya I can tell the doc the pt is wheezing but he probably already knows that and ordered bd. Please do tell, what does it change? That I know what the lung sounds like? So what, are you going to prescribe antibiotics?

Why wouldn't you want to listen even if to only increase your exposure to what's normal and what's not? I'm not a cardiac nurse but I am starting to get much better at differentiating normal and extra heart sounds which can let me know if the ordered interventions/disease process is putting my patient into a CHF exacerbation...or even worse...

If you aspire to be the type of nurse that does the bare minimum to get by and has a cavalier attitude about how important their role is in patient care, then carry on with the 'what difference does it make?' attitude. If you aspire to be the type of nurse that is an invaluable member to their team, respected by their peers, and looked up to as a role model by new and seasoned nurses alike, then you may want to rethink your approach to your chosen profession.

How, exactly, do you determine wheezing via chest x ray? What about response to nebs or diuretics? Do you re-scan people after lasix?

Thank you!!!

Specializes in Emergency, Trauma, Critical Care.

I am an ER nurse and I keep mine on me. I never know when we are going to tube someone and need to check tube placement. There are multuple times where I'm the only one who brought my ears to the party. My hearing sucks and almost everyones lungs sounds are diminished to me, but in an emergency I don't want to have to search for my stethoscope.

In most emergencies, you can tell looking at someone something is acutely wrong. However how will you assume treatment is effective without reassessing lungs. You need the before to evaluate the after.

Specializes in Critical Care & Acute Care.

I was always told to get a good stethoscope before going to the ICU because indepth assessment matters. Well I got my cardiology scope and then I show up and they want me using the cheap little plastic ones, I was mad and would often slip a glove over the bell and use it then. There is nothing like a good stethoscope, and then again there is nothing like a bad one. I am working a step down telemetry floor now while I'm in the first year of my DNP program and listen to all my patients at the start of the shift, but after I lay it on the nurses station on my cart. It annoys my neck to keep it on for 12 hours straight and it is great for manual BPs and a lot of our assistants use it. I personally feel any nurse that does not listen to their patients is taking short cuts, but then again I am not in your shoes. I feel it is essential because most of us have to chart how the patient sounded, right?

Specializes in Family Nurse Practitioner.

Good nurses are the "good new nurse" years later and actually do assessments qshift on each patient and use their stethoscope.

Specializes in LTC Rehab Med/Surg.

I have a routine. I load my pockets with alcohol wipes, pens, and paper. I get a clipboard and drape my stethoscope around my neck. I then go down the hall to meet and greet. Besides the obvious need for a stethoscope, it's part of my nursing persona. Like a piece of armor. It's as much a part of my uniform as my scrubs and my badge.

I also use it for that pesky little assessment I have to chart twice a shift.

Nope. I've always worked L&D and don't even own one!

(except the crappy one we got for free in nursing school)

What?!?! You got a free crappy one in nursing school? Dang. We didnt get a free anything. Lol.

Specializes in Emergency Department.

In addition to being a new grad RN, I'm also a Paramedic and while I do change out some of the things I may have on my person at any particular time, I pretty much always have four things on me all the time: gloves, stethoscope, ink pen/sharpie, and flashlight. With some very few exceptions, I can't remember a time when I didn't listen to a patient's lungs, heart, and abdomen. Sure, doing this can be comforting for the patient because they expect it as part of the "routine" of things but it can also give you a pretty good idea what's coming down the pike. Sure, the EDMD will order a CXR for some patients, but you might already have a strong suspicion of pneumonia or whatever else so you're already working on getting the right meds lined up for the patient... speeds things up.

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