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How-to Use a Stethoscope Well

By Edited Nov 26, 2013 0 3

Accompanying the epidemiological transition, has come an ever present need for healthcare professionals to hone in their assessment skills. More and more healthcare providers have become cognizant of this clear shift from more acute illnesses to chronic disease processes, and have fully integrated the functionality of the stethoscope into their clinical practice.

In the healthcare setting, the stethescope has clearly played a tremendous role, as a frequently used assessment instrument and tool, in successfully obtaining vital information and data about a particular patient's condition.

As a Nurse, I take pride in providing the best possible care I can to my patients. Not only does this begin with a fundamental understanding of the way the body works, and the many disease processes that textbook upon textbook have been written about, but it also means that I continually strive to fine-tune these assessment skills in order to ultimately benefit my patients.

I have read upwards of 50 to 100 articles, on the internet, about the proper use of a stethoscope. While I am confident that this article is one of the best, I highly encourage you to share, in my Comment section, anything I have missed, could have stated better, or general things you have learned from using the stethoscope in your own practice.

Firstly, whether invasive or not, prior to conducting any type of skill, or treatment, it is essential that a healthcare professional wash their hands. In the event that you can't fully lather your hands with soap, and rinse under water for at least 30 seconds, you should, at the very least, use a non-oil based product like hand sanitizer. Any further precautions you take, in general, will be based on the patient's illness, the route of transmission, as well as their illness progression. Remember, the CDC (Center for Disease Control) maintains that good hand hygiene is the simplest, most effective measure for preventing nosocomial infections.

Secondly, while you should always ensure to clear your stethoscope with an alcohol prep pad, before and after usage, it is human nature to forget this step, especially when responding to an emergency situation. Knowing this inherent tendency, you should at least wipe off the plastic ear pieces, as well as, a stethoscope's diaphragm and bell. Many healthcare providers have made it routine to carry at least a small handful of alcohol prep pads, in their breast pocket, in the event that they need them while caring for their patients throughout the day.

Your patient may not notice the cleanliness of your stethoscope, however, taking these actions is consistent with the professionalism that a healthcare provider is expected to display at all times. Many nurses, and doctors, have also opted to get covers for their bells, and diaphragms, which can certainly help to ensure cleanliness, and minimize bacteria formation of their stethoscopes.

Depending on the make, brand, and/or company that manufacturers your stethoscope, you will find that their general functionality and configuration may be slightly different. Some, like my trusty Littmann Cardiology III stethescope, may actually require slight pivoting of the diaphragm and bell, rather than simply applying more pressure indenting the chest further, in order to hear the subtle difference between low and high pitched sounds.

Fourthly, just prior to listening, or "auscultating" a patient's heart, bowl, lungs, or neck (for, what is called a 'bruit'), you should communicate to your patient what exactly it is that you intend to do. While not necessarily a requirement, doing this does display good general common courtesy and respect for the autonomy of your patient. Prior to conducting any type of skill, or treatment, that intentionally invades a patient's close private space, you should take a moment to do this.

Taking the time to address any patient concerns, while actively listening, can also be conducted in this step.

While each human body system has a plethora of considerations with regards to how a healthcare professional actually assesses it, the respiratory system has it's own unique set of considerations that are absolutely critical and must be paid attention to.

Prior to listening to a patient's lungs, you should always ensure that they are made aware that they may begin to feel dizzy. Because of the amount of deep breathes required to auscultate all the lung lobes, or fields, this dizziness may certainly occur, and should be expected. Dependent on your patient's illness, or condition, however, you may choose to focus your assessment to a particular lobe, rather than listen to all the lung fields.

Sixthly, it is important to remember that your stethoscope is meant to be used as a tool, for data collection, in conjunction with a variety of other instruments that a healthcare provider has at their disposal.

Seventhly, when assessing a patient, you should proceed in sequence from observation (sight, sound, smell, etc.), to auscultation (listening with your Stethoscope), to palpation (feeling/touching). The reason why you do this is to ensure that as little trauma is done to the internal workings of the body.

3M Littmann Cardiology III Stethoscope, Black Tube, 27 inch, 3128
Amazon Price: $206.33 $144.30 Buy Now
(price as of Nov 26, 2013)
While I no longer work as a nurse because of the different course my U.S. military obligations have taken me down, this is the exact stethoscope that I used throughout nursing school and beyond. I cannot recommend it enough.
Finding Joy in Healing: my journal, my journey (Volume 1)
Amazon Price: $17.95 $13.35 Buy Now
(price as of Nov 26, 2013)
This book was written by my neighbor, Janet. While you can certainly find scientific information, regarding the management of pain, within a standard book (like a Nursing textbook), few books manage to capture the intimate and highly personal nature of the chronic pain experience in the same way that Janet's book does. Having graduated from nursing school in 2009, it is my honest opinion that this book should be mandatory reading for any college nursing program/curriculum. I would highly recommend this book.
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Comments

Nov 5, 2009 1:46am
Atabeygi
This is a well thought out and well written article with very accurate information.

I must say though that the sequence for a physical examination is inspection, palpation, auscultation, and percussion. The order written at the end of the article where auscultation comes right after inspection is used only in an examination of the abdomen, where you listen to the bowl sounds before palpating.
Mar 19, 2010 12:27pm
x3xsolxdierx3x
oh my....

Thank you for bringing that to my attention Atabeygi! That was such an elementary mistake....

my apologies.
Jul 13, 2010 4:32pm
jcmayer777
Didn't you buy a new stethescope from your IB contest winnings?
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