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Focus: The Nurse and the Stethoscope

Do you have a question only another nurse can handle? This is the place to post it.
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Kunle Emmanuel
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Focus: The Nurse and the Stethoscope

Unread post by Kunle Emmanuel » Wed Sep 07, 2016 11:59 am

Many junior Nurses including some senior ones believe that the stethoscope belongs to the doctor.Most of us think the only thing a Nurse can do with a stethoscope is to check BP. Most of us are not familiar with different sound in the body and so we limit ourselves to BP.
Some time you see nurses resuscitating a patient without a stethoscope hung around their neck to check heart sounds, apex beat etc
  • Facts revealed that a Nurse can use a stethoscope to perform the following:
    Heart Sounds
    Respiratory Sounds
    Bowel Sounds
    Apex Beat
    Blood Pressure
But how many nurses have the skill to do these examinations on a patient.
If you have a post op patient, you are suppose to monitor his bowel sound to determine when to commence graded oral sip.
If you have a patient with heart failure, you are suppose to monitor his heart rate (apex pulse) more especially if he is on Digoxin
Yes, someone just reminded me that you can also use stethoscope during NG tube insertion* to ascertain that the tube is in situ. But sometime nurses pass NG tube without stethoscope.

If your patient is on chest tube, you are suppose to monitor his respiratory sound using your stethoscope and report when there is abnormal sound: When you have a patient with STEMI or MI, you are suppose to watch out for abnormal heart sounds such as S3 or S4 to ascertain when patient is going into cardiac arrest or arrhythmia.
Some time nurses do rectal washout examining the bowel movement especially in constipation that arise after surgery. Abnormal bowel sound could signal post op complications such as paralytic illus.
Some time nurses do rectal washout without examining the bowel movement especially in constipation that arise after surgery. Abnormal bowel sound could signal post op complications such as paralytic illus.

Our stethoscopes are not only for taking BP at the brachial artery.
Some nurses supervises patient resuscitation to mortality without using the stethoscope on any part of the body beside the brachial artery for taking BP.
Some nurses even fold their arms watching the Doctor messing up without doing anything and the patient relatives are also watching.
The relatives sees you as a mere technician who doesn't know what to do when somebody is dying...
That is why some relations who have such experience don't always want to waste their time calling the nurse when patient's condition change. They always shout on top of their voice "Doctor! Doctor! Doctor!" Even on films it happens.

Let me share my experience about a nurse and the stethoscope. Some time ago...
I use to hang a stethoscope around my neck when ever I am on the ward. I don't hang stethoscopes on trolleys, I hang them even when we are on ward rounds, on medication rounds. Even when doing procedures like rectal washout etc
Unfortunately a very senior nurse who was supervising me on afternoon duty came around to do the routine. She asked why I was hanging stethoscope and I answered that I am using it not only for BP.
And she said: "You want to pose as a doctor"
I was speechless,
And I was wondering if she knew the function of the stethoscope to a Nurse apart from taking BP. Nurses should appear like this on the ward.

You should learn other skills of patient examination apart from taking PB.
You should know the normal and the abnormal sounds of the heart, bowel, respiration etc so that when a house officer of placing a stethoscope at the wrong point you should know.
Always make yourself a valuable team member who can offer something not just receiving orders as you may call it.

Some of us are even ashamed of using the stethoscope on other parts of the patient because of lack of confidence. Don't be ashamed, when you do that and discusses your findings with the doctor, you earn respect from the doctor and the patient.
Hang your stethoscope around your neck when on ward ward round with doctors, Don't hang it on the trolleys they are not made for trolley.
You have a lot to do with stethoscope than a doctor.
Some people think when we are saying these things, we are envying doctor but I say to them that They are wrong we are only trying to be professionals.

We will talk about Nurses dressing code and where you shouldn't go with your uniforms as a nurse next time we meet.

  • Thank you!
    Be a professional Nurse
    Be a confident Nurse
    Be a smart Nurse
    Be an intelligent Nurse

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Written by Iroko Ajimoh


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Kunle Emmanuel
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Re: Focus: The Nurse and the Stethoscope

Unread post by Kunle Emmanuel » Thu Sep 08, 2016 1:26 pm

The stethoscope was invented by French physician R.T.H. La[ep6]nnec in 1819 (McFerran, 1998). A simple stethoscope consists of a diaphragm or an open bell-shaped structure, which is applied to the body, connected by rubber or plastic tubes to shaped earpieces for the examiner (McFerran, 1998). Stethoscopes, the workhorse of practice, have stood the test of time and have been proven to be robust and reliable (Tytan Medical, 2003).

Modern stethoscopes are extremely sensitive and highly advanced instruments, which will continue to improve even more (Tytan Medical, 2003). Electronic stethoscopes are available and, in this hospital, are mainly used by cardiologists. In A&E ordinary ones are used, from personal preference.

The stethoscope allows the practitioner to assess a patient’s cardiac, respiratory and intestinal state and is an integral tool in professional nursing practice. It is used to listen (auscultation) to the body’s sounds during a physical examination and assessment. Health-care professionals routinely auscultate a patient’s lungs, heart, and intestines to evaluate the frequency, intensity, duration, number, and quality of sounds (Kummar and Clark, 1999).

In A&E nurses mainly use stethoscopes for chest auscultation. In the community they are generally used when monitoring blood pressure.

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Re: Focus: The Nurse and the Stethoscope

Unread post by Kunle Emmanuel » Thu Sep 08, 2016 1:28 pm

Using the stethoscope

Before using a stethoscope, the practitioner must tell the patient what he or she wants to assess and seek permission (NMC, 2002). The patient should be placed in a comfortable position: either sitting upright leaning forward for cardiorespiratory assessment or lying supine or lateral for abdominal auscultation.

The practitioner should address any anxieties, so the patient is relaxed. Being tense can increase heart rate muscle tone (Welsby, 1996). Once the patient has given consent, is relaxed and in the correct position, the practitioner can begin.

The practitioner must ensure the earpieces of the stethoscope are placed comfortably into the ears. If they are too tight this will this not only cause discomfort, but reduce sound quality; a snug fit is required to ensure good passage of sound down the auditory canal (Kummar and Clark, 1999).

The tubing should be as short as possible, preferably around 48cm. Conducting sound through a shorter distance of tubing reduces further background noise (3M Health Care, 2003).

The practitioner should firmly apply the chest piece to the area of the body about to be auscultated. The diaphragm is normally used for high-frequency sounds and murmurs, and the bell for low and medium frequency sounds (3M Health Care, 2003).

The chest piece should always be placed against the patient’s skin and not over clothing, as the latter reduces the validity and accuracy of sounds and picks up the rubbing of clothing fibres (3M Health Care, 2003).

The diaphragm should be applied with reasonable pressure, ensuring that the patient is not hurt, and the bell piece should be applied lightly. Stretching the tubing can decrease quality of sound.

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Re: Focus: The Nurse and the Stethoscope

Unread post by Kunle Emmanuel » Thu Sep 08, 2016 1:29 pm

Lung assessment

Normal lung sounds occur in all parts of the chest area, including above the clavicle and as low as the bottom of the rib cage. When listening to the lungs, the categories of findings include:

- Normal breath sounds

- Decreased or absent breath sounds

- Abnormal breath sounds.

Absent or decreased sounds are inaudible (absent) or reduced in volume (decreased) compared with other areas of the lung when the lungs are examined with a stethoscope. They reflect reduced airflow to a portion (segment) of the lungs; overinflation of a portion of the lungs, such as with emphysema; air or fluid around the lungs; or sometimes increased thickness of the chest wall, namely pneumothorax or haemothorax (Marieb, 1998).

There are several types of abnormal breath sounds: rales, rhonchi, and wheezes are the most common (Marieb, 1998).

Rales: Rales - crackles or crepitations - are small clicking, bubbling, or rattling sounds in a portion of the lung. They are believed to occur when air opens closed alveoli (air spaces). Typical ways to describe rales include moist, dry, fine, coarse.

Rhonchi: Rhonchi are sounds that resemble snoring. They are produced when air movement through the large airways is obstructed or turbulent.

Wheezes: Wheezes are high-pitched, musical sounds produced by narrowed airways, often occurring during expiration (Welsby, 1996).

Where to auscultate Figure 2 shows where to auscultate when examining the lungs. The process has seven steps, as follows:

- 1. Systematic examination

- 2. From apex to base

- 3. Side to side

- 4. Symmetrical comparison

- 5. Anterior aspect

- 6. Posterior aspect

- 7. Lateral aspect.
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Re: Focus: The Nurse and the Stethoscope

Unread post by Kunle Emmanuel » Thu Sep 08, 2016 1:31 pm

The stethoscope is an invaluable tool in the assessment of heart, lung and abdominal sounds. It is easy to use, portable, relatively inexpensive, relative safe to use in practice and when used correctly is invaluable for detecting pathological disease in patients.

Practitioners need knowledge of how the stethoscope works, an understanding of the pathophysiology of the human body and of infection risks to ensure the tool is safely and correctly used for the benefit of the patient.

Combined nursing and medical training in assessment, anatomy and physiology would ultimately ensure that appropriate standards were achieved.

The evidence-based approach to clinical practice aims to deliver appropriate care in an efficient manner to each patient. The lack of research comparing stethoscope types and comparing the way different health professionals use stethoscopes is a gap that needs addressing in order to ensure the best possible care for patients. Such information would help practitioners to perfect their skills.

An increased evidence base would enable nurses to be selective about which items of clinical information to attend to, to generate a broader range of initial hypotheses and to link these together in an efficient and meaningful way (Carnevali, 1993).

Only by questioning practice, conducting and reviewing research periodically, can nurses deliver informed, high-quality care to their patients.


Source: https://www.nursingtimes.net/clinical-a ... 32.article
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Re: Focus: The Nurse and the Stethoscope

Unread post by Royston » Tue Sep 13, 2016 8:44 pm

I can remember when I was in nursing school and I first held the stethoscope and put it in my ears. Then, I listened to heart sounds and did blood pressure readings. It was a glorious sound in my ears. Nurses are expected to do heart sounds, breath sounds in the lungs, bowel sounds, aortic sounds in the neck for rumbling sounds, and blood pressure readings. These types of skills are mostly learned in the registered nursing program (BSN) program. I was thankful that I learned all of those skills because they came in handy when I used them in clinical practice for my patients in clinical.

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Re: Focus: The Nurse and the Stethoscope

Unread post by Royston » Tue Sep 13, 2016 8:47 pm

This is a good web link to read about the anatomy and physiology of the heart and why and how nurses can hear with the stethoscope:

http://www.pacificmedicalacls.com/acls- ... heart.html

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Re: Focus: The Nurse and the Stethoscope

Unread post by Desy75 » Wed Oct 25, 2017 10:30 am

Very well written information. Keep up the good work. Thanks.
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