Tips for Listening to Quiet Respirations?

[lizzayzay]

Hey all, nursing student here!

This is something that's been bugging me for months.

Listening to respirations on a patient whose breaths aren't easily audible is super difficult for me. So many patients I see during clinical are really sick, and look as though taking deep breaths really tires them out. I feel badly asking patients to keep taking deep breaths because I couldn't hear well the first time (not like they know that, but still), and I'm concerned about how knowledgeable I look to them if I take what feels like forever to do their heart/lung assessment; I don't see any of the RNs at clinical listening for nearly as long as I take sometimes. I also don't want to increase their oxygen demand too much or anything.

Sometimes in clinical, my patients' nurses seem to zoom through auscultating heart/lung/bowel sounds--and I wonder if they're just very skilled and efficient, or if they may benefit patients by doing longer assessments. I feel super slow in comparison and feel awkward about it. Because of this, I end up skimping on many of my patients' respiratory exams because it feels like I'm taking too long and feel awkward/badly about that.

I also know I'm going to need more practice before I'm really good at these assessments. I'm hoping it'll get easier with time, but for now, I need to figure out how to stop skimping over parts.

So, here are my questions:

When you have difficulty hearing respirations, what do you find helps?

Especially, when the patient is super sick or SOB/easily fatigued/has diminished breath sounds, how do you approach auscultating their lungs?

Do you hold off and try to complete a respiratory exam later when they start to look exhausted, or do you continue the exam right then regardless of how they're feeling?

Any other thoughts/suggestions?

Thanks so much in advance!

[traumaRUs, MSN, APRN]

Moved to Nursing Student Assistance

[vanilla bean]

First, minimize any ambient noise in the area that you have control over (turn the TV volume off, etc). Try to listen to posterior breath sounds rather than anterior. Ask the patient to sit up/forward for you or have them roll from side to side if they are too weak or unable to sit up for you. Asking your patient to take a deep breath is important, so if they are truly that sick and tire before you are able to complete your assessment, then just allow them time to rest. Ask them to breathe through an open mouth and apply a little light pressure to the 'arms' of your stethoscope to make sure the ear buds are snugly in your ears (also, make sure they're in your ears the right way - facing forward into your ear canals). Focus your attention on what you're hearing.

Don't worry about comparing your speed to that of the nurses at your clinical sites. You are learning and honing a new skill. Speed will come with practice and proficiency. Don't "skimp" on your respiratory exams - take the time you need now while you're still a student and in a position to be able to take as much time as you need. Ask your fellow students if they heard any interesting breath sounds on their patients and go take a listen! Listen to as many people as possible - it's how you become an expert at your assessments.

[Nurse Leigh]

^^ All this, and is you have RT on your floor, take a listen when they do - even if you have already done your assessment. The RT will listen before and after a breathing treatment and they are the BOMB with pulmonary stuff...a great resource.

And since I mentioned it, don't hesitate to learn from every resource you can, as a student and practicing nurse. Good luck!

[lizzayzay]

Thank you all so much!! This is really wonderful advice.

(Sorry for the delayed response, by the way! I am just now catching up in life post-nursing school graduation, yayyy! This is still absolutely helpful for me, though.)

[smf0903]

I second everything already said. One thing I will add, and as weird as it sounds, close your eyes while listening. I don't know if just removing visual stimuli helps me concentrate more or what, but it truly does help.

[CardiacDork, MSN, RN]

You need to tell your patients to take deep breaths! Do NOT feel bad! Do you know what happens when patients don't take deep breaths, your patients should be doing IS X 10 Q hour.

Please research incentive spirometer and please research consequences of NOT using IS and NOT deep breathing.

Do not tire them out but do encourage IS use and deep breaths as tolerated.

[akulahawkRN, ADN, RN, EMT-P]

In addition to the above, I would also suggest listening to EVERYONE that you assess. I'm an ER Nurse and even though many of my patients do not have respiratory complaints, I listen to everyone's lungs, hearts and bellies. This is a skill that you can develop and it only takes me a few moments to do the listening but I've found occasionally diminished lung sounds and that led to asking about respiratory symptoms which led to improving their breathing.

Why do I do all that listening? Simple, really. It keeps my ears tuned to the stethoscope. If my ears are stuffy or haven't been equalized lately, sometimes my hearing is a little diminished so I can compensate for the loss as well. We also have quite a few frequent fliers where I work and I've seen the same patients a few times so I develop a sense of what's normal for each individual patient as well. More than once I have noticed that a patient isn't breathing as well as they usually do just because I have that baseline.

Lastly, learn to trust your ears. Yes, you should check your equipment (I do it every time I put my steth in my ears), but you should also very much learn to trust your ears. If you're hearing a very quiet chest, be very worried. Sometimes you're hearing the beginnings of respiratory failure...