Show Rationale and key points This article aims to improve nurses’ knowledge and understanding of the procedure for auscultating heart sounds in adults, as part of a cardiovascular examination. It focuses on auscultating normal heart sounds; it is beyond the scope of this article to discuss the pathophysiology of abnormal findings. »A stethoscope is used to auscultate for heart sounds. The diaphragm of the stethoscope is used to identify high-pitched sounds, while the bell is used to identify low-pitched sounds. »There are two normal heart sounds that should be elicited in auscultation: S1 (lub) and S2 (dub). »The practitioner should listen over each of the four main heart valve areas: the aortic, pulmonary, tricuspid and mitral valve areas. They should also listen for any additional sounds such as clicks, and heart murmurs. Reflective activity ‘How to’ articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: »How you think you could use this article to improve your practice in undertaking cardiac examinations. »How you could use this resource to educate your colleagues about auscultating for heart sounds. Nursing Standard. 32, 5, 41-43. doi: 10.7748/ns.2017.e10965 Correspondence
Conflict of interest None declared Peer review This article has been subject to external double-blind peer review and checked for plagiarism using automated software Received: 21 July 2017 Accepted: 08 August 2017 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
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Buy now Or Health Assessment- Examination Equipment Sherpath LessonQuestion 1 of 24During auscultation of the patient’s chest, how should the nurse position the stethoscope to minimizeextraneous noises?1.Position and hold the diaphragm lightly against the patient’s skinoThe diaphragm of the stethoscope should be held firmly against the skin.2.Position and hold the bell firmly on the patient’s skinoThe bell of the stethoscope should be held lightly against the skin.3.Position the head of the stethoscope on the patient’s skin and hold the tubing so it does nottouch the bedoPlacing the head of the stethoscope on the patient’s skin prevents extraneous noises; however,holding the stethoscope tubing can cause extraneous noises.4.Position the head of the stethoscope between the second and third fingers and position it on thepatient’s skinoHolding the head of the stethoscope between the second and third fingers stabilizes the headand prevents extraneous noises. Placing the head of the stethoscope on the patient’s skinprevents extraneous noises. Question 2 of 24When using a stethoscope during the physical exam, how should the stethoscope be positioned in thenurse’s ears to optimize hearing and comfort? Get answer to your question and much more Question 3 of 24When auscultating the patient’s lungs, how should the head of the stethoscope be held? Get answer to your question and much more  While the technology required to listen in on our internal noises is very simple, learning how to perform effective auscultation takes a while. The sooner you learn to use a stethoscope effectively, the sooner you’ll be on your way to understanding the sounds made by the human body. Different types of stethoscope While they all perform the same function, a variety of different stethoscopes have been developed for various specialties. Some are designed specifically for cardiology or paediatricians. General purpose stethoscopes are ideal for students and nurses, while electronic stethoscopes can enhance traditional auscultation through the use of digital technology. The right stethoscope for you is the model that gives you the best insight into the patient’s condition. Along with the type of stethoscope you use, your budget will also make a difference, with the quality of sound generally reflected in the price you pay. This article covers traditional or acoustic stethoscopes, as these are much more common than electronic or digital devices. Using your stethoscope Starting from the top of the stethoscope, the ear pieces should be inserted so that they point towards the bridge of your nose. A good stethoscope is designed with binaurals (the two tubes that end with the ear pieces) that point slightly forwards. This is because your ear canals are angled slightly forwards. You’ll know that you have a good fit because all the noise around you becomes very faint when the ear pieces are inserted, allowing you to concentrate on the sounds coming through the stethoscope. If you’re not sure whether you’ve got the stethoscope the right way round, put the two ear pieces together and you’ll see that they form the point of a shallow ‘V’. If the V is directed towards you, it’s the wrong way around. Another useful guide is to hold the stethoscope headset in front of your face and see whether you can see the holes in the earpieces. If you can, again it’s the wrong way around. Because the earpieces should face slightly away from you, the holes will be out of sight. Choose ear pieces that fit snugly and comfortably, based on their size, design and material. Getting the fit right is important for both acoustic performance of the stethoscope and your comfort. Discomfort could be a distraction that prevents you from using your stethoscope effectively. Ear pieces are replaceable. The diaphragm and the bell On some models these are on opposite sides, requiring the chest piece to be rotated to switch between the two. This is done by twisting the tube just before the point where it enters the chest piece. If you’re not sure which side is currently active, or you want to be sure that you’ve switched between modes, tap the diaphragm lightly with your fingertip. In diaphragm mode you’ll hear the tapping very loudly through the earpieces. It’s a good idea to learn the difference and practice changing mode before working with patients, because using the wrong side of the stethoscope with a patient, and having to switch it round while admitting you made a mistake, could undermine their confidence in you as a medical professional. Littmann stethoscopes, which are extremely popular, have a tuneable diaphragm, meaning that a change in pressure is all that’s required to switch from diaphragm to bell. Holding the stethoscope lightly against the skin puts it in bell mode, while pressing it against the skin switches to diaphragm mode. Depending on what you are listening for, the stethoscope should be placed against different points on the body. Ideally it should always be against the skin because even a thin layer of clothing will impede performance. Knowing how to use a stethoscope is, of course, only the beginning of your education in how to assess a patient’s condition. You’ll need to learn how to recognise different sounds and understand their significance in the light of the patient’s medical history. Cleaning your stethoscope From time to time, take a moment to check that your ear pieces are free of obstructions. Depending on how you use and store your stethoscope, it’s possible for dirt and fluff to accumulate, which will impair auditory performance. The entire stethoscope can be cleaned with disinfectant or alcohol wipes. Application of liquid is to be avoided, particularly solvents, as these can cause permanent damage. When cleaning, it’s also worth checking for cracks or other damage, because these can also impair performance. Replacement parts are usually available. When using a stethoscope should the slope of the earpiece point?Make sure that the slope of the stethoscope earpieces point forward or toward your nose. Use a stethoscope that has both bell and diaphragm capacity. See Figure 5.4 for bell and diaphragm.
When performing a physical assessment the first technique the nurse will always use is?When performing a physical assessment, the technique the nurse will always use first is: ANS: inspection. The skills requisite for the physical examination are inspection, palpation, percussion, and auscultation.
Which techniques help correctly identify auscultation sounds?[Angling the stethoscope earpieces in the ear correctly can help identify sounds when auscultating, because it allows the nurse to hear sounds more accurately.] [Placing the stethoscope directly on the patient's skin ensures accurate auscultation findings.]
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When using the stethoscope for auscultation How should the nurse position the earpieces?
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