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Help! I Can't Hear Lung Sounds

Posted

Specializes in New Grad.

Hello All,

I have been having trouble hearing lung sounds since day 1. I have a good Littman and an MDF. I can only hear the inhale if someone takes a deep breath with their mouths open, including my own. The exhale is always silent. During clinicals, I had marked whatever my preceptor put in their assessment on the chart, but now that I have graduated, that just can't fly anymore. I have listened to sounds on Youtube thru my stethoscope, but I never hear those sounds in real life.

What am I doing wrong? Someone please help me.

Chickenlady, ADN

Specializes in ER, GI, Occ Health. Has 7 years experience.

I'm not sure how new you are, your 2 years of experience as a new grad is confusing.  But, I had trouble with lung sounds out of nursing school, it just took time and experience to get an ear for it. 

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Have you had your hearing tested?   Inspiratory and Expiratory sounds have a different pitch.; expiratory  are softer, lower pitch. 

Since you've had difficulty since nursing school, an appointment with an audiologist for hearing exam would be beneficial.

http://respiratory.guide/auscultation/lung-sounds-module?courseid=1110

https://www.physio-pedia.com/Lung_Sounds

https://www.RN.com/nursing-news/basic-review-of-pulmonary-auscultation/

 

 

msdecember31st, MSN, RN, EMT-B

Specializes in New Grad.

On 9/27/2020 at 4:46 PM, Chickenlady said:

I'm not sure how new you are, your 2 years of experience as a new grad is confusing.  But, I had trouble with lung sounds out of nursing school, it just took time and experience to get an ear for it. 

IDK how it did that, I just graduated last month

On 9/27/2020 at 7:48 PM, NRSKarenRN said:

Have you had your hearing tested?   Inspiratory and Expiratory sounds have a different pitch.; expiratory  are softer, lower pitch. 

Since you've had difficulty since nursing school, an appointment with an audiologist for hearing exam would be beneficial.

http://respiratory.guide/auscultation/lung-sounds-module?courseid=1110

https://www.physio-pedia.com/Lung_Sounds

https://www.RN.com/nursing-news/basic-review-of-pulmonary-auscultation/

 

 

Had it checked, I was cleared 😕

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Experience will hone your auscultation skills!  

Repeatedly listen to online lung sound websites.  Ask staff to see if any problems with your stethescope..

Get friendly with a Respiratory Therapist and tell them you need advice, can they help you master this skill; can they tag with you for a few patients to practice.

Let your colleagues know you want experience with any patients with unusual breath sounds: crepitus heard in Subcutaneous emphysema/chest tube leaks,  stridor, coarse  rhonchi, pleural friction rub etc.

Best wishes mastering this skill.

 

On 9/27/2020 at 4:40 PM, msdecember31st said:

During clinicals, I had marked whatever my preceptor put in their assessment on the chart

Oh no! 😩 Always just come clean ASAP if you aren't getting something. There's no shame in it.

****

Anyway. Something that comes to mind: I wonder if you just need to "hear" what you're already hearing.

You know, like those magic pictures where you stare at it just right until a 3D image comes into focus?

Even if quiet and even if using good technique (not talking, stetho on the skin, etc.) there is a lot to be distracted by when auscultating. Sounds made by every tiny movement, if your fingers are tense/pressing the stetho, even your finger joints can make little "creaks" which will be magnified. Little hairs on the patient's skin, the sound of the heart which might be capturing your ear while you are trying to hear something else...distant gurgles magnified all the way from the abdomen, etc.

While listening to sounds on YT or a recording is good practice, the sounds aren't going to be that distinct IRL for various reasons (your distraction, the competition of other sounds, etc.)

I think you should at least try this magic picture technique, only do it with your ears/hearing instead of eyes/vision.

I did something like that when learning to listen to/for heart murmurs. At first you hear a lot of stuff, S1, S2, etc., etc, and you kind of have to let that "fade out" so that you can hear something else.

Worth a try, especially since you think your stetho is fine and you've had your hearing checked. Do some exercises to get your brain to understand that you want to hear something else...you know?

It's possible that you need to tune in to something that is going to end up being more "background" than what you think it is right now.

Best of luck! 🙂

 

Edited by JKL33

On 9/27/2020 at 4:40 PM, msdecember31st said:

What am I doing wrong? Someone please help me.

This may be a stupid question but can you hear heart and bowel sounds clearly?

msdecember31st, MSN, RN, EMT-B

Specializes in New Grad.

15 hours ago, NRSKarenRN said:

Experience will hone your auscultation skills!  

Repeatedly listen to online lung sound websites.  Ask staff to see if any problems with your stethescope..

Get friendly with a Respiratory Therapist and tell them you need advice, can they help you master this skill; can they tag with you for a few patients to practice.

Let your colleagues know you want experience with any patients with unusual breath sounds: crepitus heard in Subcutaneous emphysema/chest tube leaks,  stridor, coarse  rhonchi, pleural friction rub etc.

Best wishes mastering this skill.

 

Thank you! 

msdecember31st, MSN, RN, EMT-B

Specializes in New Grad.

12 hours ago, JKL33 said:

Oh no! 😩 Always just come clean ASAP if you aren't getting something. There's no shame in it.

****

Anyway. Something that comes to mind: I wonder if you just need to "hear" what you're already hearing.

You know, like those magic pictures where you stare at it just right until a 3D image comes into focus?

Even if quiet and even if using good technique (not talking, stetho on the skin, etc.) there is a lot to be distracted by when auscultating. Sounds made by every tiny movement, if your fingers are tense/pressing the stetho, even your finger joints can make little "creaks" which will be magnified. Little hairs on the patient's skin, the sound of the heart which might be capturing your ear while you are trying to hear something else...distant gurgles magnified all the way from the abdomen, etc.

While listening to sounds on YT or a recording is good practice, the sounds aren't going to be that distinct IRL for various reasons (your distraction, the competition of other sounds, etc.)

I think you should at least try this magic picture technique, only do it with your ears/hearing instead of eyes/vision.

I did something like that when learning to listen to/for heart murmurs. At first you hear a lot of stuff, S1, S2, etc., etc, and you kind of have to let that "fade out" so that you can hear something else.

Worth a try, especially since you think your stetho is fine and you've had your hearing checked. Do some exercises to get your brain to understand that you want to hear something else...you know?

It's possible that you need to tune in to something that is going to end up being more "background" than what you think it is right now.

Best of luck! 🙂

 

Thanks so much!

2 hours ago, Wuzzie said:

This may be a stupid question but can you hear heart and bowel sounds clearly?

Yes, I hear them perfectly 

I would try an electronic stethoscope. I do not have one, but you can find them in places such Uniform Advantage , etc. Or you can just order one online and return it if it doesn't work for you. 

 

Edited by NewRN'16

Been there,done that, ASN, RN

Has 33 years experience.

Is your palpation technique correct? You won't be able to hear diddly if you're over bone. I was dazed and confused about lung sounds for a long time..  I just didn't know WHAT I was hearing. I eventually became the go to nurse for lung sounds. It takes practice. 

 I'm gonna get reamed for this, but lung sounds are not a significant part of assessment. Respiratory assessment depends on rate, work of breathing , skin color, and pulse ox. Report issues with those to the doc.. they will just order an x-ray anyway. I will bet the rent.. that THEY did not listen to  breath sounds.

PollywogNP, ADN, BSN, MSN, LPN, NP

Specializes in Med-Surg/Tele/ER/Urgent Care. Has 44 years experience.

The patient needs to take deep breaths with their mouth wide open! I have to say it with every assessment if not they breath through their nose, you use the diaphragm of the stethoscope. Curious, you are an EMT-B & have an MSN?

I say you find a friend and ask for help. Tell them you're having trouble hearing, and can they use their stethoscope, put it in the right place so they can hear, then give you the earpiece? I do this pretty frequently with weird heart sounds. I know they're there, but I can't hear them, so when someone else can I ask if they can find it then let me listen while they hold the bell in the same place. Takes away the variable of placement, plus they can tell you exactly how it sounds/what you're listening for on that particular patient. 

Also, have you listened on yourself? One day I did that and it was super helpful. I could experiment with different bell placements and breathing patterns and see how they sound without the pressure of being in a patient's room. 

ALSO, sorry it's small and silly, but make sure your bell is turned the correct way.