Published Aug 23, 2012
I need some tips for when assessing a patients heart and lungs. I sometimes have trouble hearing lung sounds. I just got a new better stethoscope so maybe that will help ( littman cardio iii) but I have trouble telling between diminished or clear and something's I know sounds are abnormal but can't always pinpoint between crackes or rales or rhonci. Is there an easier way to help determine which or does it come with more experience?
I also want to know when you go to do a heart assessment what do you do. In school we learn about apex, aortic, pulmonic, tricuspid But sometimes I just witness the apical rate taken and that it's.
Also any tips on always finding and counting ribs on any size of patient?
I appreciate any tips or advice.
I think after learning the different abnormals and what they sound like it's just a matter of experience. I'm a new nurse and I still have sometimes have trouble differentiating between really coarse crackles and rhonchi, but I have a lot less trouble than I did in school, so I think its something that comes to you fairly quickly.
nurse2033, MSN, RN
You will get a better idea after a couple of hundred assessments, keep going. The people who listen to apical only are only doing part of the assessment. As I used to tell my trainees, you can choose to be part of the A team or the B team. You will also learn on which patients is the full-on appropriate. I would do the full assessment until you get comfortable on every patient, every time.
Crackles sound like bubbles. That's all I ever witnessed on my floor in the nursing home I used to work at. I never got to experience Rhonci. And honestly, while I was in an accelerated program for my LPN Apex is all the focused on. I felt cheated when I graduated anyway.
With diminished you really cannot hear anything. If it's clear you can at least hear them in haling. Plug your ears and inhale through your mouth, that's clear, it should sound like that. If they are breathing and you cannot hear anything, good changes it's diminished. You should even be able to hear them breathe when the steth is placed in a different area but close to lungs. I have a litman lightweight and wow it's really sensitive.
Its all about practice. The more you do, the better you get. That is really the best way to learn them.
If you know of any patients on the floor with something funky going on, or you overhear a nurse talk about a murmur or click, go in and ask to take a listen. This helps a lot, knowing what you are listening to before you hear it, helps make that distinction.
There is a lot of stuff on youtube you can use, but really the only sure way to know is practice.
Christy1019, ASN, RN
Rhonchi literally sounds like an old man snoring and is usually heard with pulmonary congestion due to mucous/infection, crackles are like bubble wrap popping, wheezing is a whistling sound, more common on expiration but can occur on inspiration/expiration which signifies more severe constriction from asthma, cold, anaphylaxis etc. On obese pts or large chested females you might hear lung sounds better posteriorly.
I suck at heart sounds except irregular beats, usually assoc with a fib.
Heart sounds eh.....
Many of my patients are super obese, or super sick. More often than not I cannot hear any heart sounds...thhey are so faint....
Anyone else haave trbl hearing the heart?
It's not so much that I have trouble hearing it, despite having some hearing loss, I just can't seem to pick up on the subtle abnormalities that more commonly occur. Especially if they are at all tachycardic, its like trying to count to 50 when someone keeps yelling "12, 49, 32, 100!!!" Lol. I personally use and love the littmann master classic II, all black edition, engraved with my name and title after the last one was stolen. It's not super common so if mines missing and I see someone else wearing one, I ninja tackle them and check for my name on it Haha
Another tip for lung sounds, make sure they actually are breathing in and out of their mouth with deep breaths (I can't tell you how often I have to repeatedly tell them that because they do it once then revert to shallow breathing through their nose lol) and discourage them from making extra noises like moans, sighing etc because it can be misinterpreted as adventitious sounds. Have them sit straight up to allow for full lung expansion so you can ensure lower lobes are fully inflating for accuracy, and listen directly over skin if possible, if not, minimize layers of clothing for better assessment.
Thank you all for the tips.
wish_me_luck, BSN, RN
Rales and crackles are the same. Like Christy said, it sounds like bubble wrap popping or a "wet" sound (fluid build up) and is in CHF and pulmonary edema. Rhonchi and grunting--that's what I asked about earlier. It sounds like snoring but apparently, grunting you can hear without a stethoscope. Wheezing, I think everyone has heard someone wheeze, and it's in COPD, asthma, and indicates airway constriction/inflammation.
Agreed with poster that said better heard on bare skin and you may not have as easy of a time if the person is hairy on their chest. Use your land marks for apical pulse or count the intercoastal spaces (that is not feasible on many people), displace breast tissue (or ask the pt to) to listen if the patient is well endowed.
Morainey, BSN, RN
The vast majority of my patients have nice clear lung sounds, so I found that once I got used to hearing "normal", wheezes, crackles, and diminished lung sounds became very obvious. Like another poster mentioned, do about 100 assessments and they will come very easily. I found asking patients to take a "big deep breath with your mouth open!" is the most effective way to hear good lung sounds, as well as putting the stethoscope up against bare skin, turning the TV off, and not being shy about asking people to sit up or roll over.
As far as heart sounds go, I usually listen to aortic and pulmonic valve areas, and then at the apex to get an apical rate. I listen for S1, S2, and any murmurs or clicks. Since I don't work on a cardiac floor, that is my basic assessment - quick and dirty!
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