Heart and lung sounds in obese patients

nurseprnRN, BSN, RN · Jan 6, 2015

Sometimes rolling the pt to her left will bring the heart a little closer to the ribcage, maybe enough to make a difference for you. You'll have to reach underneath her to hear under the breast area. You can compress fat somewhat, but recognize that doing that will tighten the skin and thus turn your bell (if you use one to pick up low tones like S3 and S4) into another diaphragm head, so the S1 and S2 might be clearer but you'll lose S3 and S4.. You can also remember that sound carries downstream, and perhaps you'll be able to hear over her aortic arch or even carotids (don't lean on carotids unless you like bradycardia a LOT ).

Otherwise, I think it's practice, practice, practice until you have heard so many hearts that you can pick up even smaller more distant tones.

tsm007 · Jan 6, 2015

Sometimes rolling the pt to her left will bring the heart a little closer to the ribcage, maybe enough to make a difference for you. You'll have to reach underneath her to hear under the breast area. You can compress fat somewhat, but recognize that doing that will tighten the skin and thus turn your bell (if you use one to pick up low tones like S3 and S4) into another diaphragm head, so the S1 and S2 might be clearer but you'll lose S3 and S4.. You can also remember that sound carries downstream, and perhaps you'll be able to hear over her aortic arch or even carotids (don't lean on carotids unless you like bradycardia a LOT ).

Otherwise, I think it's practice, practice, practice until you have heard so many hearts that you can pick up even smaller more distant tones.

Thank you. Going to try those tricks and see what happens.

Lev, MSN, RN, NP · Jan 6, 2015

Sometimes you can hear better if you listen to their back. Just try not to get your anatomical points confused.

NurseGirl525, ASN, RN · Jan 6, 2015

Sometimes you can hear better if you listen to their back. Just try not to get your anatomical points confused.

This. On an obese patient I can hear the lung sounds much better on the back. For heart sounds, I have them lay on their back so I can move the breast tissue easier. We had a lady at my facility last semester for rehab and she had MS. She was also obese. I know sometimes it is difficult to manipulate, I am a large breasted person myself but not obese, and it was difficult for my partner to especially get my apical heart rate because my breast was in the way. And I think she was uncomfortable touching me there. I just ended up moving it myself and holding it so she could listen. So I would even try having the patient hold it out of the way for you if you are having difficulties.

tsm007 · Jan 6, 2015

I found a great

showing all the little tricks you shared! You have to forward through it to the female demo, but it really helped me see what you were describing. I think I got it now. I am sure I read all this before, but seeing a visual demo really helped me get the idea. I know someone that I have difficult hearing on so I'm going to ask her if I can try this out and see how much a difference it makes.

vanilla bean · Jan 6, 2015

I had a nursing instructor tell us to try Erb's Point if having trouble hearing an apical heartbeat. I've had luck using that tip when auscultating obese women with large breasts. Of course, that won't help you to hear heart tones that you need the apex for, but it's helpful to get a rate. I also agree about listening to breath sounds from the back - if the pt can't sit up for you, then have them roll or turn to the side. Try to minimize ambient room noise (turn off TV volume, etc) and have them take several deep breaths through an open mouth at each site if you can. Apply a little light pressure to the 'arms' (binaurals) of your stethoscope to make sure the ear tips are snugly in your ears and try to focus your attention on what you're hearing. Happy listening :-)