Lung sounds, Heart Murmurs, BP, & Stethoscope

[tammy_zeidan09]

So I begin an ADN program this August, and I am involving myself in open lab to get to know the lab and prctice hearing sounds [bp, heart, lungs] on the sim manikins. When I did today, I had a tough time distinguishing the different noises. I also work as a CNA and sometimes have a tough time bc of the noise in the tubing. My hand usually fumbles with holding the chestpeice down tight.

I have a Littmann Lightweight.

Any suggestions for holding the scope a certain way to avoid noises from the tubing? Distinguishing the noises?

Of course practice is key, but any other suggestions?

Thanks in advance.

[nurseprnRN, BSN, RN]

practice, practice, practice. really, there's no substitute for it. as soon as you get into clinicals, listen to every chest that comes your way. tell the staff that you really want help in hearing different kinds of lung sounds.

there's probably less chance that you'll get people to share different heart sounds with you unless you're on a cardiac floor, and maybe not even then. this is because, seriously, most nurses don't listen to heart sounds and don't know how. (that does not mean it's ok to ignore that imho, but hey.)

when you see that someone has charted an s3 or s4, or a grade (i - vi) (aortic or mitral) murmur :heartbeat, or you see something like "systolic murmur at the right sternal border," ask someone to help you listen to it so you can identify it too, and figure out what it means. you can ask physicians, too. really. most of them are willing to help you learn. the ones that aren't, well, the heck with 'em, ask someone else.

all of a sudden it will all come together....but do not expect it to all come together your first year in school . you need to listen to more hearts than you'll see in all your clinicals to put it together.

as to the stethoscope, you can get a better one, but in the meantime, think about cutting the tubing shorter so it doesn't drape all over the place and get banged around while you're trying to hear through it. they really don't have to be a centimeter longer than you need to listen. practice on a friend or in lab and figure out the shortest tube you can get away with. then pull the head off, cut the tube shorter, and put the head back on. this will help. of course it may cut down on the "way cool, look at me, i'm a nurse with my steth around my neck just like the big girlz" thing, because it will be shorter, but what's more important to ya?

[tammy_zeidan09]

as to the stethoscope, you can get a better one, but in the meantime, think about cutting the tubing shorter so it doesn't drape all over the place and get banged around while you're trying to hear through it. they really don't have to be a centimeter longer than you need to listen. practice on a friend or in lab and figure out the shortest tube you can get away with. then pull the head off, cut the tube shorter, and put the head back on. this will help. of course it may cut down on the "way cool, look at me, i'm a nurse with my steth around my neck just like the big girlz" thing, because it will be shorter, but what's more important to ya?

oh my! didn't think you can cut the stethoscope! without ruining it??

thanks for the reply though. really helpful!

when i listened to the crackle noises in simman and it was hard. when i asked my instructor she said this is when your nursing instincts come alive. it's the minor difference between crackle and normal we have to pay close attention to. when she said this, i then noticed the ever so "slight" difference. tough stuff.

and the volume was on 4-5. doubt many lung sounds would be as loud as that.

[Esme12, ASN, BSN, RN]

Oh, they can be rather loud. There are times you can hear them rattling and wheezing from the door way. You will get better at blocking out the unnecessary noises. It really is practice, practice, practice. Heart tomes for murmurs come later as they can be difficult to discern. There are several YOutube videos that you can watch and listen.

Take your hair and rub it between your fingers by your ear....crackles. Crepitus sounds like rice krispies. Wheezes are like a prolonged squeaky toy for a dog. Ronchi are gurgling like mucous stuck in your throat.

A better stethoscope will help. You don't have to go crazy but like a Littmann Cardiology II will make a ton of difference.

Rome Wasn't built in a day!!!!:hug:

[tammy_zeidan09]

Thanks so much!! his place is tons helpful!

I'll look into the vids now!

=]

[nurseprnRN, BSN, RN]

yep, you won't ruin it. promise. if when you pull the head off all you see is an open single-lumen tube, snip away.