Lung sounds and breasts

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Hey people, first time poster here. I'm also a first year student and tomorrow I begin acute care clinicals. This will be my second bunch of clinicals, my first being at an extended care facility with elderly patients.

Overall my first experiences with clinicals was good. I had the opportunity to change briefs, give baths/showers, watch a dressing change, assess stage 2 pressure ulcers, perform baseline assessments, etc. Unfortunately there was one part of my experience that I feel I need to improve: lung sounds. I'm a drummer and my ears are pretty crappy as it is. My patient had dementia so communication was a bit tricky and I could never get her to take deep breaths. My patient was also female so naturally I felt awkward trying work around her breasts--What is the best way to listen to lung sounds in a way that makes the patient as comfortable as possible?

I tried to reach down the front of her gown but then my elbow/arm is right up in her face. I was thinking perhaps I could simply untie the gown from her neck and lower it gradually as I work my way down, but then if she's got an IV that could get in the way...and my patient couldn't really straighten her arms so that would have been tricky too.

Any response would greatly appreciated! (Also--I get the impression that people under 30 are thought of as somewhat burdensome...any general wisdom on how I can fight that stereotype?)

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Specializes in Med/Surg.

If her breasts are even remotely an issue, that leads me to believe you are listening to anterior lung sounds (from the front). My simple solution would be to listen to her lungs from the back. This is easier to hear, anyway. You can listen to the upper lung sounds from the front with no difficulty, usually, but more often than not it is hard to listen to the lowers (due to large breasts, difficulty moving arms, obesity, etc etc etc). If the patient isn't oriented enough to cooperate well, have someone come with you to roll the patient on their side. That will not help them take deep breaths, but it will help what you hear. I have found that demonstrating to patients that won't take deep breaths sometimes helps.

On a side note, when I learned lung auscultation, we were taught that it was proper to listen to the back and not the front. Admittedly, I do listen to the front for "ease of use," if you will, but only if I believe I am hearing things properly. If not, it's the back.

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Specializes in Psych.

I don't generalize

Good luck in your studies!

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Thanks Cherry. And yes, at my college they want us to listen to the anterior, posterior and lateral sides.

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Specializes in Hospice.

right, but you can listen to upper anterior, posterior and sides , no need to be fighting that area when you can get the information you need with the other areas. when im going to assess heart sounds though big breast do become an issue and i either have them lift their breast up of give them warning that im giong to.

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Specializes in Management, Emergency, Psych, Med Surg.

1. Listen to the posterior chest. Have the patient sit up and cross her arms in front of her to place the scapula out of the way. You can then have her lie back and you can listen to the lateral chest. When you have a female with large breasts you have to go high on the anterior part of the chest and usually have to lift the breast to hear lower. I urge you to have a female in the room with you any time you have to touch the female private parts.

2. Get yourself an amplified stethoscope. I have one and they cost about $300 but they are worth it if you have trouble hearing.

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Well the consensus seems to be to listen to the posterior side and not bother with the anterior side unless there's an abnormality or difficulty hearing. I suppose this is just one of the little ways that book-learning differs from real-life experience...

Thanks everyone!

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Specializes in Critical Care, Nsg QA.

If you are only listening on the posterior side, you are only doing half a job. When it comes to assessments, don't skimp. Assessments are what nurses do. You base much of your care on your assessment findings. If the patient has large breasts, using the back of your hand gently push the breast to the side. It may take a few minutes longer to listen to all areas.

You don't want to get stuck in a situation where there are changes in lung sounds that you missed because you couldn't be bothered. You will call the doctor and when (s)he asks for lung sounds, what are you going to say? Ah, geez, I didn't really listen.

As a student, learn to do a proper assessment

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Specializes in Critical Care.

When trying to listen to the anterior bases, I usually just listen just lateral of the breast. You will be hearing the same segment of the lung as if you placed the stethescope under the breast tissue. If you must listen to the bases more medial, then you'll just have to lift the breast or ask them to do it. I was always taught to lift the breast with the back of your hand so that it never seems like you are trying to cup or feel their breast. After a couple years of EMS and doing a billion 12-leads and listening to a million lung sounds, I no longer have any problems lifting what needs to be lifted. If its a younger female, they are usually a little more modest so i'll usually ask them to do it. The older ladies usually don't mind so much so I just let them know what I'm about to do. (Many of them have made the comment that they don't mind because its the most attention they've seen in years, lol.)

Posterior lung sounds are better for your lung bases. And its the best way to listen to your right middle lobe since most of that lobe is actually posterior. Only a very small section of your RML is anterior, and another small wedge is lateral (like right in the axilla).

Anterior is easier, but you should listen from the front and back. You may hear two different things. What you hear may also be changed by the patient's position due to fluid shifts of infiltrates.

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J621d, I certainly DO plan to listen thoroughly--I'm merely getting the opinions of more experienced nurses.

Also, do any of you wear gloves when doing the baseline? I don't mind touching someone's arm when I'm taking BP but touching a breast with my bare hand seems creepy.

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You don't need to go inside the gown to listen to things with a stethoscope. A thick sweatshirt maybe, but not a gown. There's also no need to handle bare breasts because unless there's a reason to do a breast exam, they can stay covered with the gown.

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J621d, I certainly DO plan to listen thoroughly--I'm merely getting the opinions of more experienced nurses.

Also, do any of you wear gloves when doing the baseline? I don't mind touching someone's arm when I'm taking BP but touching a breast with my bare hand seems creepy.

Yup...

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