New Grad RN...Why can't I hear lung sounds!!

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I am a new nurse. Only been on the floor about 3 weeks. However, I am growing concerned over my inability to hear lung sounds. I am under the gown, they are taking deep breaths, I'm listening intently...nothing. I am almost always charting decreased in lower lobes because I just can't hear anything beyond the upper ant/post lobes. I look back at what previous nurses have charted and they have described what they hear on the lower lobes. How am I missing these sounds?? In nursing school I blamed my measly $50 stethoscope. However, I bought a nice stethoscope since and the sounds have not improved. Has anyone else had this problem? What do you suggest?

I'd say have someone check your stethoscope's 'ears'. i had a friend who bought an almost $500.00 stethoscope and couldn't hear anything so she went to the store and have them fix the stethoscope's ears to accommodate her ears' anatomy and now she can hear it perfectly.

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Specializes in Emergency, Telemetry, Transplant.

A couple random thoughts:

1. Be sure you place your stethoscope on an intercostal space...not over a rib.

2. Just because another nurse heard something does not mean it was actually there. I've listened no too long after other nurses and did not hear what they heard (for example, they heard crackles--I hear clear lungs). I think some nurses feel like they have to hear something....there are some nurses that I can think of that never charted clear--there was always something.

3. Try reading a doctor's H&P. I realize it may have changed since they wrote the note, but I find it helpful.

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Are you able to hear your own lung sounds? Or a friend's? How about heart sounds? Are you able to hear them?

If yes, then check your stethoscope placement on the anterior and posterior chest wall. If no, get your hearing checked.

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As many of you suggested I think I need to have my hearing checked out. As a child I had ear issues (multiple ear infections, avoided swimming bc the water would pool in my ears for days, even went to the doc periodically to have the wax drained out). Those kind of issues have not bothered me for a while. However, I am constantly "popping" my ears to clear them. I am going to listen to my own lungs today and schedule an appt to have my ears looked at. I want to get this figured out!

it really may be as benign as having waxy buildup in your ears.

good idea, to get it checked out.:)

leslie

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Specializes in Tele, Med-Surg, MICU.

In a healthy friend or family member, with a good stethoscope you should always hear air going in and out... hopefully after you see your doc it's an easy fix!

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Personally I find hearing crackles extremely hard, but trust me once someone is wheezing you will hear it (music sound). For some reason I have a hard time distinguishing crackles (maybe lack of experience?)

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It took me a while to feel confident that what I heard is what I heard, especially if it differed from what the last person heard.

Agree that you're not necessarily wrong if it's different, even if two trustworthy listeners listen right after the other, I've seen lung sounds change that fast. And it is a bit on the "subjective" side, so one person's rhonchi is another person's coorifice is another person's crackles.

I agree with checking your hearing, but also think about what you expect to hear. Pneumonia on the right? Should be diminished on the right. It's "cheating" but it will get you more comfortable with trusting your assessment. And soon enough, you'll be the one hearing first that it's diminished on the right, convincing the doc to get an x-ray and finding out they have pneumonia on the right. If it's something that doesn't make sense with the diagnosis, have a second person give you an opinion. I have nurses that I trust their assessment skills way more than my own, and they'll ask me to listen or to look at something, to tell them, "Nope, you're not crazy, that's what it is!"

And I think at first, it's not so much your ability to identify what you hear, but to identify when there's a change. Knowing what exactly you heard at 7pm isn't nearly as important as knowing it's different at midnight.

On the bright side, you're trying to fix the problem. I've seen lung sounds charted by people that I've never seen them with a stethoscope.

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Specializes in Home Health.

This may sound nuts, but it is true, I swear. If I clench my teeth when using my stethoscope, often I hear nothing. If I relax my jaw and move the lower jaw slightly forward, I hear great. Trivia: one of the benefits of the motion of the jaw with chewing is it promotes movement of wax in the ear so that it won't build up. I thought this was interesting.

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In my experience, I have noticed that some nurses just chart 'diminished' for everybody. Then, you go in and it's clear. It's kinda ridiculous.

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Specializes in ICU.

Are the earpieces on your stethoscope angled correctly to direct the transmitted sounds towards your eardrums? I find I have to direct mine forward to hear well. (Drives me nuts when I have an isolation pt and I can't get the cheapo isolation stethoscope to do this.)

:paw:

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Specializes in Home Health/Hospice.

hate to say this but are you listening in the correct anatomical positions?

Is your hearing okay, can you hear heart sounds or bowel sounds okay?

Do you have the stethescope turned correctly?

Are you wearing them correctly?

Sorry all simple questions...and I'm sure all have asked.

Also are your prior nurses ACTUALLY hearing clear sounds?

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I can hear heart and bowel sounds fine, just not the lungs!

I have read through all of your suggestions/questions/stories and find them all very helpful. Thank you again for your responses!!

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