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?
I work in CCU and don't always carry it but it's always near. Definitely need it to auscultate lungs and heart--my pts could have developed pulm edema or a murmur.....
I always auscultate placement of NG/OG before giving any Meds or flush....
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
What I hear when I listen to lung sounds plays a huge part in my decision making process. For example I arrive at the bedside of a hypotensive patient. If I hear crackles in the bases I will look for edema, especially in the lower legs. Crackles and or edema and I start either neo or dopamine, depending on HR and a few other factors. Clear lungs, absence of edema, I start a fluid bolus instead, or possibly 5% albumen bolus, depending on what I know about the patient.
Later I will order a chest x-ray, labs and read the patient's history and recommend to the resident (who hopefully has arrived at the bedside by now) we either continue with what we are doing, or change the plan of care.
In my job, like in an ER, I often don't really know what is wrong with the patient and I am making important decision based only on my assessments. I carry, and use my stethoscope on every patient.
I am always befuddled by your posts. As a life long (well almost life long) ER nurse...I find listening to a patients chest imperative in assessment and treatment. I am confused by your "short cuts" of things you find....unnecessary.
I can't for the life of me use my active imagination to comprehend that the use of the stethoscope is "just an act".
So you have a trauma that comes in with chest trauma from the seat belt...you actually find it unnecessary to listen to lung sounds? What do you document then?
If you were a nurse in a department I was working or in charge of...I would have to have a serious conversation about your assessment skills....or.......you just like starting controversy here.
WOW! I had to leave a comment on this one. I am a corrections nurse and depend on my assessment skills above everything. There are no mds on site ( i work overnight) and if I don't catch something, then people die. My stethoscope is another appendage I would sooner work without one of my legs than without it. This OP scares the heck outta me! I just hope they don't miss something and someone ends up dead. With the risk of beating an already dead horse, I can't even begin to understand a nurse who would rather let other people assess their pts. Or trust a machine to do a better job, or god forbid a first yr resident who can't even write for APAP without consulting some form of drug book while forgetting to check for an allergy. OK rant over. but darn that was some messed up post and like I said scary!
I find this cavalier attitude in the OP pretty surprising, and I do not consider myself a starry-eyed idealist. If you are just going to do pretend nursing assessments to make your patients feel more at ease and placate them you might as well use the pretend stethoscope that comes in the Fisher Price doctor kit.
There are many things that cannot be discerned by imaging, OP. At the end of the day you are going to have to stand by your assessment and documentation, the rad tech or physician will not. Don't ever depend on someone else's assessment in caring for your patients.
As a student nurse, this attitude scares me. How in the ER does the doc know whether or not to order a CXR if no assessment was done? Since when is a CXR done on every, single, patient? Also, what about abdominal sounds? I think maybe a little more assessment and not so many tests are needed in medicine today. There are many, many things, an assessment picks up. Plus, during an assessment you find out so much about your patient. So many things. Are nurses really like this? You just don't give a crap about the health of your patients? Because not doing a proper assessment of your sick patient, that is what you are saying. Saying oh, the doctor is going to order a test is well horsecrap. It shows that you lack critical thinking and some downright common sense.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
As we all know in many, many cases the nurse's assessment is the ONLY real physicall assessment many patients receive when they are adkitted to the hospital. We have seen several discussions on here about doctors charting an exam that we know for a fact they never preformed. While to me this is disgusting, therr is little any of us can do about it and we need to pick our battles. But is also means we RNS need to actually assess our patients cause in many cases we are the only ones that do. Like many or most nurses here I can tell many stories about things caught by RNS that were otherwise missed.
To the OP. Use imaging and other diagnostic tests to train your ear. Listen carefully then compair what you heard to what the chest x-ray or CT showed. Hear something different in the LLL? Look at the x-ray and see what was going on there. Read the radiologist report on the CT on x-rays. Pretty soon you will be an expert and your physicians will sit up and listen when you say something like "hey doc are you sure Mr.Smith doesn't need a chest CT? His lungs sounder like xyz to me". Lots of stuff gets caught that way.
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.
This part of your post is funny to me and a wrong justification of using a steth.
You should be using your steth to listen to lung and heart sounds because it's an important part of an assessment, not because it seems the patients trust you more when it's done. I'm curious, what have they done or said to give you the impression that they "trust you?"
I'm trying to picture the conversation...
Nurse tarotale: "I'm going to listen to your lungs."
Patient: "OMG, I trust you now because you did look a bit shady."
klone, MSN, RN
14,857 Posts
Yes, it was how I was taught. You should post a poll in the OB forum. Now I'm curious too!