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'm curious what a jury of your peers would say about this when you get sued for negligence. If you don't want to assess patients, why are you a nurse?
Given that the OP hasn't returned to this thread and replied to the 9 pages of posts, perhaps his original post was simply to elicit reactions from people? Or maybe, hopefully, all of the replies have opened his eyes to the fact that his original post/attitude was simply outrageous.
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.
Actually, almost every admitted patient to the hospital has a chest xray in the ED.
You are overestimating the importance of lung and bowel sounds. *You need to assess them* but they aren't going to tell you anything that's going to lead to a major clinical decision other than ordering imaging and/or labs to confirm the actual problem.
I keep mine in my pocket or my sicker pt's (I'm in ICU) room. I don't keep it on my neck, because I think that's just... icky. But I am also the nurse that wipes the whole thing down with disinfecting wipes every night before I put it in my pack. The only time I don't use my stethoscope is when my pt is on isolation - then I use the disposable one that hangs off the side of the pt's vent.
I can't imagine not having access to one at all times... that is ignoring a very important tool for information about a patient's condition.
Given that the OP hasn't returned to this thread and replied to the 9 pages of posts, perhaps his original post was simply to elicit reactions from people? Or maybe, hopefully, all of the replies have opened his eyes to the fact that his original post/attitude was simply outrageous.
Actually, almost every admitted patient to the hospital has a chest xray in the ED.
You are overestimating the importance of lung and bowel sounds. *You need to assess them* but they aren't going to tell you anything that's going to lead to a major clinical decision other than ordering imaging and/or labs to confirm the actual problem.
I would say 25% of my patients have had a chest X-Ray in the ED when they get admitted to my floor. Not most of the, but a good percentage.
How can you say that the importance of assessing bowels/lungs is overestimated? Often the physician doesn't know there is a problem until an assessment detects it. Then yes, imaging studies can be ordered to confirm. If no one had assessed the patient, then how would they know to order the imaging studies?
Should we order a chest X-Ray before and after lasix on a CHF overload patient to be sure it's effective? After a breathing tx? Chest X-Rays don't show wheezing, that needs to be assessed by auscultation. Do we order KUB's daily on post surgical patients to make sure there bowels aren't obstructed and bowel function is returning?
I don't think the importance of assessing bowel/lung sounds can be overestimated. I think it's a valuable piece of an assessment that can lead to a detection of a problem that (if needed) can be confirmed by an imaging study/test.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
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?
What about asthma attack? Are you saying that you wouldn't auscultate? I have been in the ER for asthma multiple times, and never had imaging done to guide treatment. Steroid use was always determined based on lung sounds.
Actually, almost every admitted patient to the hospital has a chest xray in the ED.
You are overestimating the importance of lung and bowel sounds. *You need to assess them* but they aren't going to tell you anything that's going to lead to a major clinical decision other than ordering imaging and/or labs to confirm the actual problem.
I'm overestimating the importance of these? No, I don't think you understand the importance of them. Also, so you are telling me everyone gets a CXR? Your MI patients, your stroke patients, a head laceration? No, they don't. A broken ankle does not get a CXR.
Let me give you an example as to why this is important. I went to the ER with terrible abdominal pain. I had N/V and was in terrible pain. I immediately got an abdominal X-ray. Nobody assessed me or listened to my sounds. I was told I was constipated and to go home and drink some MOM. Wrong thing to do! I was so much sicker on Monday and got an emergency appt with a gastroenterologist. Who guess what, assessed my bowel sounds. Turns out I had gastropariesis a horrible disease. He says I know what is wrong with you. Then a test was done to confirm. Assessing bowel, lung, and heart sounds are important. Plus, like I stated earlier you get up close and personal with the patient. You learn more about them that way.
Momma1RN, MSN, RN, APRN
219 Posts
I'm curious what a jury of your peers would say about this when you get sued for negligence. If you don't want to assess patients, why are you a nurse?