Overweight people and lung/heart/bowel sounds

srg4784 · Sep 20, 2006

So... is it harder to find these sounds on a bigger client for anyone else?

Hmmm.....I haven't ran into this problem yet, GOOD QUESTION. I'd like to see others inputs from this. I "think" it would be harder because they have more adipose layers than people within "normal" weight limits thus insulating their bowels so well that you cant hear much. Also remember to listen for 3-5 mins before you determine someone with "no bowel sounds". So that could be it? Even if so, there has to be a way to get the readings.

Marie_LPN, RN, LPN, RN · Sep 20, 2006

Depending on where the weight was, i had difficulty hearing some things. Lungs typically wasn't a proble, nor heart, but the bowel sounds on someone who had more weight on their lower belly was harder. And i hated having to push the steth in more to try to hear (esp. if they were in for ab. pain), but i had to, so i could hear anything.

Also, the longest it took me to hear bowel sounds in a person was 8 minutes. That was a long 8 minutes.

MS Kathy · Sep 20, 2006

I was very surprised the first time I tried listening to my sister's and my mother's

hearts for the first time- I could not hear them!!!!!! And they aren't overweight.

Oh and ask your instructor for hints- that is what they are there for!

(Don't be afraid LOL)

Some tips to help w/ heart sounds- have the patient lean forward a bit. - have the patient pump their arms a few times (my mom knew just what to do from all of her physicals apparently.)

Breath sounds- have them take a deep breath.

I know with my check offs- we didn't have to tell what breath sounds or heart sounds we heard. We just had to know the procedure and place the stethascope correctly.

What they are will come with time- and many off them seem subjective. I went to respiratory therapy one day and followed them around listening to lungs all day- I still didn't get it, but it did help boost my confidence to know when it wasn't "right."

Bowel sounds- Everyone I listened to in the hospital had bowel sounds that could be heard everywhere. Everynow and then I would have to listen for a long time but they were there.

Switch up and practice with another pair. After all the more you hear now the more practice you have.

Good Luck! and I hope some others have good ideas for you.

Kathy

TheCommuter, BSN, RN · Sep 20, 2006

I have never had problems detecting body sounds on overweight people. You might want to mutilate your stethoscope, meaning cut about 4 to 6 inches off the end and then reattaching the bell. Shortening the length of a typical stethoscope often results in more pure, clearer sounds. A stethoscope that is too long can muffle important sounds and make then difficult to detect.

I shortened the cheap stethoscope that was issued to me by my school. I could not hear anything out of it before the 'mutilation', but once I cut 6 inches off and reattached the bell I can now hear clearly out of it.

MIA-RN1, RN · Sep 20, 2006

I really hope this doesn't come across as mean. That is NOT my intention. But my lab partner is a very big girl (and one of my best friends). So, we practice looking for lung, heart, and bowel sounds on each other. And I cannot hear anything. I have tried on other people, thinking maybe it was just me, but I heard the sounds on the other people (all of a "normal" weight).
So... is it harder to find these sounds on a bigger client for anyone else? Any tricks that would help? I know I will always have overweight patients and I want to be able to do my job correctly. Thanks for any advice!

Breath sounds are way easier to hear on the back than on the front. Maybe try that.

Bowel sounds can be tough. I take care of post partum patients and run into trouble w/ larger patients sometimes. Try varying the pressure you use when you place your steth on them. That sometimes helps.

Heart sounds just be sure you are placed right. Move the steth around a bit.

Also, something to share with you is that one of my classmates, in our LAST clinical rotation of the whole program, was complaining that she hardley ever can hear anything from her stethoscope. I showed her how to turn it 'on' (rotate the end til it clicks) She was embarrassed and amazed. So be sure your steth is 'on'.

Marie_LPN, RN, LPN, RN · Sep 20, 2006

One of the hardest things i still run into is listening to heart and lung sounds on someone with large breasts. In order to hear, of course i have to get underneath, but i have naturally ice cold hands (they turn right back to ice after washing them in hot water), and needless to say, not a good thing, because i can't hear anything crackles over "OOOOO YOUR HANDS ARE COOOOOOOOOOOOLD . The only solution i've come up with so far is putting towels in the blanket warmer, putting my hands in one on my way to a room, and use the warm towel to move the breast (better than a cold hand).

Nurse-To-Be-Joy · Sep 20, 2006

Thanks for all of your advice. I'm gonna have to try what you all have mentioned! I will definately speak with my instructors and see what they have to say.