I'm having major assessment problems. Please help!!!!

  1. :uhoh21: I've got less than 2 months before I graduate and start working as an RN and I am still having problems with certain aspects of assessment (and assessments are sooo important!!!).
    First of all, I always have a difficult time auscultating breath sounds. I always pick up sounds from the tubing, my finger, other bodily sounds, etc. I'm looking into getting a better stethoscope and would like some opinions on the best out there. Also maybe some tips on how you hold the stethoscope to minimize interference.
    Secondly, I have the hardest time feeling pedal pulses. I even have a hard time feeling them on myself. When I do feel it, it feels like a 1+ when it feels normal to other people. And if pulses are weak, they feel absent to me. But I can feel other pulses just fine.
    I appreciate any input. Thanks
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    About Jessica Student RN

    Joined: Jan '05; Posts: 9
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    16 Comments

  3. by   snowfreeze
    You sound kinda tense. Relax, take a deep breath, chat about something with your patient. Pretty flowers, the afghan on the bed, the really awesome slippers on their feet. 'Tense' de-sensitizes your nerve endings and your perception of the incoming sounds and sensations. Those ear ends of the stethescope need to be facing forward like your ear canals, put your fingers in your ears and feel how the direction is not just straight in from each side.
    With blood pressures, look in the vital signs part of the chart, find what everyone else hears. If the pressure is usually 110/60 then don't run the cuff pressure over about 150. If you still don't hear anything then go above to 180.
    If you can't hear the pressure on one arm then check the other one.
    If you can feel a radial pulse then they have a life sustaining blood pressure for now.
    If that pulse is very bold and what is called bounding, then you need to get someone else to check the pressure.
    Running a cuff up 2 or 3 times isn't a problem, I have had figity people that I finally told to just don't move for a few seconds and I will go away.
    The bell of the stethescope needs to be on the thumb side of the arm, check that radial pulse prior to using that arm, could be scar tissue damage.
  4. by   PJMommy
    I would add that the last time I took a manual BP was...well, I think I did one a couple of months ago to be sure I could still do it. Most places have the automated BP cuffs. As for breath sounds, sometimes it takes listening to abnormal sounds a bit before you know what you are listening for. Have you done a critical care rotation where many vented patients have a whole symphony of lung sounds? I've always felt that, once you have a good feeling for what you are listening for, the "background" sounds aren't distracting - you start to tune those out. This, like many things, comes with practice.

    As for feeling pulses, try using your another hand. I struggled and struggled with pedals until I started using my LEFT (non-dominant) hand. Don't know why this works but what feels like a 1+ to my right hand feels like a 2+ to my left. Maybe it's because of all the dailiy use we put our dominant hand and fingers through???
  5. by   nicolel1182
    i have trouble with pedal pulses too so i look foward to any advice given on here
  6. by   hcmanp
    I had a doctor as a patient in one of my early clinicals, and was desperately trying to palpate the DP pulse without much luck. To make things worse, he kept wiggling his big toe. I finally told him I needed him to stop moving his foot, at which point he said, rather crisply, I am doing that to remind you that this pulse is easily palpable once you locate the tendon that moves the big toe up. I have never had difficulty finding the little devil since - unless it's absent!

    Re breath sounds: nothing will help except tincture of time and practice. You might try some of the virtual hospital websites that feature sounds.
  7. by   Jessica Student RN
    Wow. Thanks for all the great advice. I tried using my left hand and, go figure, I can feel the pedal pulse easier. I guess really great assessment skills will just come with time and experience. So I will relax and try not to beat myself up over this.
  8. by   HyperRNRachel
    For breath sounds, I once told an ICU nurse that I was weak in this area and she had me follow her assessments. Since I got to hear what I was suppose to hear it made it easier to recongnize the various sounds when I do my own assessment. In my experience if you let the nurses know up front that you need help in a particular area they will find a way to help you out.
  9. by   tracytoon
    I followed the RT around for a day when I was in clinicals and she identified different lung sounds for me. It was a great learning experience.
  10. by   tridil2000
    Quote from nicolel1182
    i have trouble with pedal pulses too so i look foward to any advice given on here

    if the patient's bp is above 160, you can actually SEE the pedal pulse throb, assuming they have decent circulation.

    listen to as many 'sick' lungs as you can. that's the only way to learn breath sounds really.

    imo, you can not beat the littman cardiology 3 steth. mine (is a cardiology 2) has lasted 15 years so far!
  11. by   UM Review RN
    i have trouble with pedal pulses too so i look foward to any advice given on here
    OK, here's a good trick for finding the pedal pulse. Run your forefinger up between the Great Toe and the First toe. You'll come to a dent, then a bone. You should feel the pulse right on or near the dent.

    The trick to feeling for the pedal pulse, especially if it's weak, is this: Don't press so hard that you occlude the flow, or else you won't feel the pulse.
  12. by   maire
    Quote from Angie O'Plasty, RN
    OK, here's a good trick for finding the pedal pulse. Run your forefinger up between the Great Toe and the First toe. You'll come to a dent, then a bone. You should feel the pulse right on or near the dent.

    The trick to feeling for the pedal pulse, especially if it's weak, is this: Don't press so hard that you occlude the flow, or else you won't feel the pulse.
    This right here is what I was taught, and it rarely fails me. Great advice.
  13. by   stidget99
    Whenever using a stethoscope to auscultate any sounds (lung, bowel), it helps me to close my eyes. I can weed out any other noises and hear just what I am looking for.
  14. by   tommycher
    When doing a manual blood pressure, the stethoscope actually should be placed on the little finger side of the antecubital area.

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