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?
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.
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
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.
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.
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?
nursing.mypassion
43 Posts
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.