nurses not using stethoscopes

Nurses General Nursing

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new grad here, noticed ALL the nurses on my unit (med surg) do not use their stethoscopes...and just compare their notes to the previous shift notes..... i just bought a new stethoscope and hung it around my neck and the nurse told me to leave it in my bag. so how am i supposed to do assessments???? patient hasnt pooped in 3 days but do you think any of the nurses would pull out their stethoscopes to listen to bowel sounds??..... im still on orientation and i feel like this hospital is making me crazy... i still do my full assessments regardless!

Specializes in Neurosurgery, Oncology, Level 1 Trauma.

Be your own nurse, do it the rigjt way becausr your patients deserve it. When the time comes that you are precepting new grads teach them to do it right. Wear your stethoscope and realize that you listening matters

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I don't think it's necessary to use a stethoscope for bowel sounds. You primarily want to ask the patient if they are passing gas or having daily bowel movements. This is a better assessment of what's going on with their bowels than listening. A stethoscope is a great tool for assessing wheezing and if bad enough you can pre empt a very bad asthma attack by ordering a treatment. For basic general nursing care there isn't much use for the stethoscope aside from respiratory. It's useful also when intubating a patient during a code and checking for lung sounds in the left side (make sure the tube didn't go in the right mainstream bronchus) and for checking placement of an NG tube. (Blowing air in and listening for a gurgling sound) but for bowel sounds it's ok to not listen if the patient is passing gas or having bowel movements. Thanks for your post it generated some interesting discussion.

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I don't think it's necessary to use a stethoscope for bowel sounds. You primarily want to ask the patient if they are passing gas or having daily bowel movements. This is a better assessment of what's going on with their bowels than listening. A stethoscope is a great tool for assessing wheezing and if bad enough you can pre empt a very bad asthma attack by ordering a treatment. For basic general nursing care there isn't much use for the stethoscope aside from respiratory. It's useful also when intubating a patient during a code and checking for lung sounds in the left side (make sure the tube didn't go in the right mainstream bronchus) and for checking placement of an NG tube. (Blowing air in and listening for a gurgling sound) but for bowel sounds it's ok to not listen if the patient is passing gas or having bowel movements. Thanks for your post it generated some interesting discussion.

Are you a nurse?

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Specializes in Orthopedics, Med-Surg.
Well like I stated in another post, I've been an RN for over 40 years. I've worked every single specialty, except Labor and Delivery. The thing is people that claim it takes too long, must be doing it wrong. It takes MERE MINUTES! I teach my students how to do one and by the end of the semester they get it done like it is second nature. Priorities? Ok, then a rapid is a priority. I like to PREVENT the rapid or codes. But that is just me.

You've been a nurse for 40 years? Wow. And you still take care of eight postop orthopedic patients on day shift? That's impressive how you are able to get it all done. I'm sorry that I am a lesser being.

I've heard the old saw, "work smarter; not harder". It was painfully obvious then, as it is now, that the people who utter empty words like that have no clue how to solve the problem.

But wait! You mentioned "your students". So in other words, you are having others do the work instead of you. I always found it much easier to get my work done when I had little worker bees to do my work for me, as when upper class students were on the floor and they'd do all my charting for me. And they did an excellent job caring for both of my patients. I just concentrated on the other six.

You may be an excellent instructor; I don't really know. What I do know is that I won't be browbeaten by a nurse who hasn't done my job personally in the last ten years. Not all units are the same, as you ought to know. I did use my stethoscope regularly, when I worked in the CVICU or a stepdown unit. But I gave that up long ago... too much stress.

But that is just me.

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Susie 2310, yes I am a nurse. I have been an RN for over 30 years. I have a Masters in Nursing. Most of my experience is direct patient care and all of it with surgical patients. ICU/OR/outpatient surgery office. I have spent some time in administration and teaching. But I see myself as a front line RN. If this comes across as arrogant in anyway it isn't meant to. If I have learned nothing else from my time in Nursing its that just when you think you have it figured out, you will be humbled! And I have been humbled many times, ugh! I feel comfortable commenting on surgical issues but little else. In this post the nurse is clearly trying to do her best to assess the patients GI status. I believe the patients own subjective data is the best way to do this. Better than a stethoscope. Assuming the patient is speaking back to the nurse then its appropriate to simply ask about passing gas or bowel movements.

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Susie 2310, yes I am a nurse. I have been an RN for over 30 years. I have a Masters in Nursing. Most of my experience is direct patient care and all of it with surgical patients. ICU/OR/outpatient surgery office. I have spent some time in administration and teaching. But I see myself as a front line RN. If this comes across as arrogant in anyway it isn't meant to. If I have learned nothing else from my time in Nursing its that just when you think you have it figured out, you will be humbled! And I have been humbled many times, ugh! I feel comfortable commenting on surgical issues but little else. In this post the nurse is clearly trying to do her best to assess the patients GI status. I believe the patients own subjective data is the best way to do this. Better than a stethoscope. Assuming the patient is speaking back to the nurse then its appropriate to simply ask about passing gas or bowel movements.

You wouldn't listen to bowel sounds for a post-operative patient? Post op ileus?A patient with a GI bleed/possible hypovolemic shock? Abdominal pain? Those are all conditions you would see in surgical patients and ICU patients. You are forgoing an important part of the patient's objective assessment by not listening to bowel sounds. Subjective data is important (i.e. asking the post-op patient about passing gas/bowel movements), but objective data is very important too, and both need to be considered together. Relying just on subjective data can lead to an incorrect clinical picture, just as relying only on objective data can lead to an incorrect clinical picture.

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I agree that getting both subjective and objective data is relevant and important. And there is certainly nothing wrong with listening to bowel sounds in any setting. As with any other data point it's important to think about what we will do with the information we obtain and how it will change or impact our care. I will share how I would think about and approach the scenarios you asked about: post op patients and post op ileus: assuming you mean abdominal surgery then I would expect an ileus. Most patients having abdominal surgery have an ileus and it lasts about 3 days. So why would I listen to bowel sounds? What would I do differently based on my finding either way? The patient will have their diet advanced and if they tolerate it and once they are passing gas I will know that their ileus is resolving. Once they have a bowel movement the ileus is officially resolved. The knowledge of bowel sounds in this scenario is irrelevant.

GI Bleed and hypovolemic shock. In true hypovolemic shock, bowel sounds would not be a priority. Other objective (not subjective) data would supersede anything bowel sounds would tell me. hgb/hct count, visible signs of blood in the stool or vomiting blood, blood in the NGT, low blood pressure and elevated heart rate. All of these data points will impact the course of treatment. Its not that it would be wrong to listen to bowel sounds but it wouldn't help you decide what course of action to take. In other words the information you would glean from listening for bowel sounds will not inform your treatment plan.

abdominal pain: again not a problem to listen but its not a reliable way of making a diagnosis. A physical exam by a physician or APN, and most likely a radiologic study of some kind, KUB or CT will be needed to make a diagnosis. The bowel sounds will not contribute to the diagnosis.

I am attaching an abstract below. the conclusion of the study:

"CONCLUSIONS: Bowel sounds are not associated with flatus, bowel movement, or tolerance of oral intake after major abdominal surgery"

Bowel Sounds Are Not Associated With Flatus, Bowel Movement, or Tolerance of Oral Intake in Patients After Major Abdominal Surgery

Read, Thomas E. M.D.1–3; Brozovich, Marc M.D.1,4; Andujar, Jose E. M.D.1,5; Ricciardi, Rocco M.D., M.P.H.2,3; Caushaj, Philip F. M.D.1,6

Author Information

1 Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, Pittsburgh, Pennsylvania

2 Lahey Hospital and Medical Center, Burlington, Massachusetts

3 Tufts University School of Medicine, Boston, Massachusetts

4 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

5 Wellstar Kennesrone Regional Medical Center, Marietta, Georgia

6 Hartford Healthcare Medical Group, University of Connecticut School of Medicine, Hartford, Connecticut

See Tribute Video to Robert D. Madoff, M.D., at http://links.lww.com/DCR/A345

Financial Disclosure: None reported.

Presented in part at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, PA, April 30 to May 5, 2005.

Correspondence: Thomas E. Read, M.D., Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA 01805. E-mail: [email protected]

Abstract Back to Top

BACKGROUND: Auscultation for bowel sounds has been advocated by some clinicians as a method to determine the resolution of postoperative ileus.

OBJECTIVE: Our primary aim was to prospectively evaluate the relationships between bowel sounds and the ability to tolerate oral intake in patients after major abdominal surgery. Secondarily we aimed to evaluate relationships among bowel sounds, flatus and bowel movement, and oral intake.

DESIGN: This was a prospective, blinded observational study.

SETTINGS: The study was conducted at Western Pennsylvania Hospital.

PATIENTS: A total of 124 adult patients undergoing major abdominal surgery were included.

MAIN OUTCOME MEASURES: Data were collected by medical students blinded to the purpose of the study for 10 days postoperatively or until discharge, including the presence of bowel sounds (auscultation for 1 minute), flatus, bowel movement, and tolerance of oral intake (defined as ingestion of >=1000 mL/24 h and each subsequent day without vomiting). Associations between paired variables were determined using [script phi] coefficient testing.

RESULTS: The study population consisted of 51 men and 73 women, with a mean age of 64 years (range, 20–92 y). The majority of patients (78/124 (63%)) underwent colorectal resection. The median length of hospital was 6 days. Bowel sounds were not associated with flatus, bowel movement, or tolerance of oral intake throughout the study period. The positive predictive value of bowel sounds in predicting flatus and bowel movement was low in the early postoperative period and remained

LIMITATIONS: The rate of tolerance of oral intake was relatively modest throughout the study period.

CONCLUSIONS: Bowel sounds are not associated with flatus, bowel movement, or tolerance of oral intake after major abdominal surgery.

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I agree that getting both subjective and objective data is relevant and important. And there is certainly nothing wrong with listening to bowel sounds in any setting. As with any other data point it's important to think about what we will do with the information we obtain and how it will change or impact our care. I will share how I would think about and approach the scenarios you asked about: post op patients and post op ileus: assuming you mean abdominal surgery then I would expect an ileus. Most patients having abdominal surgery have an ileus and it lasts about 3 days. So why would I listen to bowel sounds? What would I do differently based on my finding either way? The patient will have their diet advanced and if they tolerate it and once they are passing gas I will know that their ileus is resolving. Once they have a bowel movement the ileus is officially resolved. The knowledge of bowel sounds in this scenario is irrelevant.

GI Bleed and hypovolemic shock. In true hypovolemic shock, bowel sounds would not be a priority. Other objective (not subjective) data would supersede anything bowel sounds would tell me. hgb/hct count, visible signs of blood in the stool or vomiting blood, blood in the NGT, low blood pressure and elevated heart rate. All of these data points will impact the course of treatment. Its not that it would be wrong to listen to bowel sounds but it wouldn't help you decide what course of action to take. In other words the information you would glean from listening for bowel sounds will not inform your treatment plan.

abdominal pain: again not a problem to listen but its not a reliable way of making a diagnosis. A physical exam by a physician or APN, and most likely a radiologic study of some kind, KUB or CT will be needed to make a diagnosis. The bowel sounds will not contribute to the diagnosis.

(QUOTE)

From Susie2310:

While auscultating for bowel sounds would not be diagnostic by itself; it is incorrect to say that presence or absence of bowel sounds will not contribute to the diagnosis or to the management of the patient's problems. The OP is a bedside nurse; auscultating bowel sounds along with other assessment data may provide the first indication of a patient problem that will be/should be investigated further by a physician with labs, diagnostic tests, etc., and may provide indication of an emergent condition. The absence of bowel sounds can indicate the patient is experiencing serious problems, and hyperactive bowel sounds can be indicative of serious problems also. The documentation of bowel sounds is important for continuity of care. A poster on this forum has mentioned that their family member died after the hospital staff neglected to listen to bowel sounds.

An internist in a primary care office recently took the time to auscultate a family member's abdomen, and in the urgent care setting a family member who presented with GI bleed symptoms and shock symptoms had their abdomen auscultated by the physician, who then ordered labs and prepared to admit my family member to the hospital. Clearly physicians continue to find the auscultation of bowel sounds valuable, as they do listening to heart and lung sounds. Yes, of course the tachycardia and bleeding were indications of my family member's condition, but the quality/presence of bowel sounds was considered important information by the physician too.

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I ran into nurse that didn't even wear a stethoscope. I was completely shocked.

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