Do you carry around your stethoscope?

  1. 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?
  2. Visit tarotale profile page

    About tarotale

    Joined: Apr '11; Posts: 455; Likes: 460
    from US
    Specialty: 1 year(s) of experience

    102 Comments

  3. by   calivianya
    Oh yeah, I definitely carry mine. It even has a little "sweater" around it so I can wear it around my neck at all times without my neck oils messing it up. There are always times that pop up that someone needs it - auscultating a heart beat for time of death, new NG/OG insert, change in breathing pattern, etc. in addition to q4h assessments. I can see why in the ER you might not need it as much, but if a patient doesn't have routine CXRs ordered, a change in lung sounds would be the only alert for newly developing fluid overload, effusions, and things like that. I would constantly be running in and out of the room for it if I didn't have it on me.
  4. by   Esme12
    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.
  5. by   blondy2061h
    No, in our transplant unit the patients all have their own crappy stethoscope in the room that we use for that admission and throw out when they're discharged. I keep my Littmann in my work bag and Lysol it and use it if I can't hear well or suspect there's more going on than what I hear.
  6. by   tarotale
    Quote from Esme12
    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.
    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?
  7. by   adpiRN
    Nope. I've always worked L&D and don't even own one!
    (except the crappy one we got for free in nursing school)
  8. by   OCNRN63
    Quote from Esme12
    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.
    Exactly. I remember working in the ED one night, taking care of a cardiac patient. The ED doc said the patient's heart sounds were WNL. When I listened to them, I heard something different. Before we knew it, we were shipping the patient across town for interventional cardiac cath. What was really great was the doc's attitude; he was very thankful for my assessment.

    I consider listening to heart and lungs a crucial part of pt. assessment. Sometimes you pick things up that would otherwise not have been discovered.
  9. by   RescueNinjaKy
    Just out of curiosity, what do you document for lung sounds then? I mean do you make it up or something?
  10. by   blondy2061h
    How, exactly, do you determine wheezing via chest x ray? What about response to nebs or diuretics? Do you re-scan people after lasix?
  11. by   BSNbeauty
    I use mine daily at work and I am a postpartum nurse. However, if I am swamped and have to do a more focused assessment I will skip the auscultation parts of my assessment. I would only do this on mom that is a vaginal on her way out the door without any health hx or complications.
  12. by   BSNbeauty
    Btw- I do not chart anything I don't do.
  13. by   SierraBravo
    Quote from blondy2061h
    Do you re-scan people after lasix?
    OK, this literally made me laugh out loud.

    But seriously, to the OP, are you kidding me? Like Esme said, is this thread just to create drama or do you need some remediation in terms of why it's important to do an assessment?

    I realize that you ED nurses do things differently than the way we do things on the floor for the most part, but come down off your high horse for a second and realize that doing an assessment is part of your job AND your duty to your patient.

    Imagine this, you get a patient in the ED who looks like a walkie-talkie, but all of a sudden develops a spontaneous primary pneumo. You mean to tell me that knowing there was no breath sounds in one lung wouldn't be important to know or document? I'm having flashbacks from the thread about how some nurses don't do an assessment at all during their shifts...
  14. by   Esme12
    Quote from tarotale
    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.
    Last edit by Esme12 on Dec 29, '14

close