Heart Sounds anyone?

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Help! I've learned all of the heart assessment auscultating spots ... but sometimes, I just can't hear a darn thing? I'll hit all the marks ... and still nothing... the stethoscope is working ... the patient is breathing, so I know the heart is beating. I mean, I hear nothing ... even if they turn toward the left? It doesn't matter if the pt is obese, though that probably compounds it, or thin. There are times I just can't hear it. Is this a technique thing, a hearing loss issue on my part :) (I do doubt this, but am open to the possiblity), a hardware problem (standard cardiac littman), or is it possible that some patients' heart sounds are so faint that normal breathing silences it... Can I tell you how silly I feel even asking this question? So, Silly. Would appreciate any help, suggestions, or corroboration of this problem... Thanks...

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Hi there.

Don't feel silly for asking for help! I am only in my second semester and I have already learned that we have to ask when in doubt.

How about... are you auscultating over a bone(rib)? or are you in the intercostals?

Are your stethoscope earpieces too tight?

Do you have a rotating diaphragm/bell on your stethoscope? Is it rotated to the diaphragm side?

Those are a few of the things I can think of.

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Another suggestion is to make sure the earpieces are facing forward.

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Specializes in L&D, Antepartum.

I'm still a student but one trick is to have the patient sit up and forward. If they are turned to the side, you still may not be able to hear it. I still have a hard time with some patients but with practice I have been able to get almost all of them. When I can't, I ask for help.

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Specializes in Surgical.

yes, definately make sure the earpeices are facing forward. I am embarrassed to say this but it is the truth: I was out of nursing school roughly six months before I realized I had earpeices turned the wrong way! I was very embarrassed, it wasnt that I didnt hear things before but wow I could sure hear them afterward! I usually tell this story to any new grad I am orienting. It makes them a little less timid about asking me questions. I am sure they think if I spent six months with my stethoscope turned the wrong way I am not going to laugh at them!:bugeyes:

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I agree with the earpieces advice. One time in nursing school, a doctor had me listen to a murmur, and I said I couldn't hear it. He then informed me that maybe if I tried putting my stethoscope on the right way, I could hear better.

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I'm a new nurse, but I've found that heart sounds are hard to find on some "big" people. Some pts have a lot of muscle, bone, and fat and you can not get heart sounds in every spot.

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Take your time. Listen for lung sounds first, since they often obscure heart tones. Then listen "under" the lung sounds, and you'll hear the heart. I used to think patients knew I was incompetent when I did things slowly. I now know that they appreciate my "thoroughness." :lol2:

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all the above posts are correct - your scope must not be properly fitted. when you do start to hear things, this will help you make sense of them: http://tinyurl.com/heartsoundsbook

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Specializes in PICU, NICU, L&D, Public Health, Hospice.
The Auscultation Assistant
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Specializes in ER, progressive care.

Try troubleshooting:

1. Are the earpieces placed the right way? They should be pointing forward, not backward! Some stethoscopes have moveable ear piece parts.

2. Make sure you turn the diaphragm piece so that it is open to the diaphragm, not the bell! I had mine turned to the bell part and I tried auscultating bowel sounds with the diaphragm and heard nothing!! I freaked, then realized I wasn't turned to the diaphragm :lol2:

3. Make sure you are listening on the intercostal spaces, not the ribs.

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