Trouble hearing BP sounds, help

mybrowneyedgirl, BSN, RN · Aug 29, 2009

Did you tap your scope while it was in your ears to test it? Some scopes turn off by twisting 180 degrees by the bell.

keithjones · Aug 29, 2009

find a training scope with two sets of earpieces and listen in with someone who knows what they are doing... or buy a better scope!

xcitednsgstudent87 · Aug 29, 2009

Yes, I agree u may have a cheap stethoscope. I have an ADC Cherokee (INEXPENSIVE) and the sounds are very clear to me. Our instructors say that Prestige is a pretty good brand. Its a generic of Littmann. Good Luck!

Do-over, ASN, RN · Aug 29, 2009

I can hear great with my cheapie... Can you hear anything else with it? Try turning the chestpiece until you hear a click...

nikkisn · Aug 29, 2009

i had the same problem two days ago...my bell was turned the wrong way and i couldn't hear anything out of the side i was listening to, very frusterating. my teacher didn't teach us the basics of a stethoscope and i had no idea the bell even turned. if your ever confused just look in your book or google it, that's how i figured it out.

MattiesMama · Aug 30, 2009

First, make sure that you are wearing your stethescope properly-the earpeices should be pointing outwards, towards the tip of your nose and should fit in your ears with a bit of a seal (but not so much of a seal that you can't hear anything!) Tap on the bell to make sure that it's working properly.

Second, make sure you have your bell in the right anatomical place...I always feel around first to find the point where the brachial pulse is strongest, and mark it lightly with a pen or dig my fingernail in slightly to make an impression and put the bell so that the center is over that marking (an added benefit to this is you can kind of guess whether their pressure will be high or low...a really strong brachial usually means they will have an elevated BP)

Third, make sure that the bell is secure under the B/P cuff when you inflate it and doesn't move from where it needs to be.

Make sure the room is as quiet as possible. Turn off the TV, tell your patient not to talk (they love doing this during B/P and any other auscultation for some reason, lol!) Deflate the cuff sloooooowly-for me finding the point where the sounds STOP (the diastolic) is the hardest part, esp. when you have a pt. who has an auscultory gap or a weak B/P to begin with.

That should do it...I also strongly suggest getting a Littman Classic SE. It has self-sealing ear peices and the bell is specially designed to fit under a B/P cuff.

Taking an accurate blood pressure was by far the hardest thing for me to get used to in the beginning of nursing school so you are not alone! Get your own B/P cuff and practice practice practice, on yourself, on your freinds and family, whoever you can find- It just takes some getting used to.

Daytonite, BSN, RN · Aug 30, 2009

it is a matter of training your ear of what to listen for. there is an online virtual b/p cuff you can play around with for practice:

the virtual blood pressure cuff:

http://medicine.osu.edu/exam/

- from ohio state university college of medicine, an interactive guide to physical examination for 8 body systems that includes sounds. has an interactive blood pressure cuff. scroll down the page and click on the "take a blood pressure" link near the bottom of the page. you will be able to hear and watch a blood pressure manometer and tell the program what the final blood pressure is. it re-cycles to give you lots of practice!

Do-over, ASN, RN · Aug 30, 2009

I always feel around first to find the point where the brachial pulse is strongest, and mark it lightly with a pen or dig my fingernail in slightly to make an impression and put the bell so that the center is over that marking (an added benefit to this is you can kind of guess whether their pressure will be high or low...a really strong brachial usually means they will have an elevated BP)

Palpating the brachial pulse is very helpful. However, I would like to suggest that marking a patient's skin with ink or a fingernail is not a good idea. Just my :twocents: .

XYcsccSN · Aug 30, 2009

Another thing to do if you are having trouble hearing the sounds... Palpate the brachial artery and place the diaphragm or bell exactly over it. If you are using the bell, make sure you are not pressing down to hard. Try it with the diaphragm, see if you can hear it that way. The bell is for lower pitched sounds, but it makes no difference if you use the bell or diaphragm.

Adams_Mama_07 · Aug 30, 2009

My trouble when I practice on people with mine is keeping it steady, I hear scratching sounds all over the place so that prevents me from hearing clearly. If that's not your problem, the above posters have really good advice that I will definitely be sure to implement.

MattiesMama · Aug 30, 2009

Palpating the brachial pulse is very helpful. However, I would like to suggest that marking a patient's skin with ink or a fingernail is not a good idea. Just my .

I'm not suggesting you claw at them or mark them up with a sharpie...lol. It's just a hint my CI gave me when I was having a hard time-a tiny dot or a light impression with your fingernail makes a good landmark. I wouldn't make it regular habit but it's helpful when you are trying to learn like the OP.