Single tubed stethoscopes are better than double tubed ones. The tubes in double tubed stethoscopes can rub together. This noise can make it hard to hear heart sounds. [2] X Research source Thick, short, and relatively stiff tubing is best, unless you plan to wear the stethoscope around your neck. In that case, a longer tube is best. Make sure that tubing is free of leaks by tapping on the diaphragm (the flat side of the chest piece). As you tap, use the earpieces to listen for sounds. If you don’t hear anything, there may be a leak.
Make sure that the earpieces are facing forward. If you put them in backwards, you won’t be able to hear anything. [4] X Research source Make sure that the earpieces fit snugly and have a good seal to keep out ambient noise. If the ear pieces don’t fit well, most stethoscopes have removable earpieces. Visit a medical supply store to purchase different earpieces. [5] X Research source With some stethoscopes, you can also tilt the earpieces forward stethoscopes to ensure a better fit. [6] X Research source
If the earpieces are too loose, you may not be able to hear anything. To tighten the tension, squeeze the headset near the earpieces. [8] X Research source If the earpieces are too tight, they might hurt your ears and you might have a hard time using your stethoscope. To reduce the tension, pull the headset apart gently. [9] X Research source
If you want a stethoscope with really high sound quality, you might want to consider an electronic stethoscope. An electronic stethoscope provides amplification so that it is easier to hear heart and lung sounds. Using an electronic stethoscope may make it easier to hear your patient’s heart and lungs, but keep in mind that they are expensive. [13] X Research source
To make your patient more comfortable, warm up the stethoscope by rubbing it on your sleeve, or consider buying a stethoscope warmer.
The “lub,” or systolic, sound happens when the mitral and tricuspid valves of the heart close. The “dub,” or diastolic, sound happens when the aortic and pulmonic valves close.
There are several different ranges of resting heart rates to consider for patients under 10 years old. Those ranges include:[19] X Research source Newborns up to one month old: 70-190 beats per minute Infants 1 - 11 months old: 80 - 160 beats per minute Children 1 - 2 years old: 80 - 130 beats per minute Children 3 - 4 years old: 80 - 120 beats per minute Children 5 - 6 years old: 75 - 115 beats per minute Children 7 - 9 years old: 70 - 110 beats per minute
If you hear a whooshing sound or a sound that is more like “lub. . . shhh. . . dub,” your patient might have a heart murmur. A heart murmur is blood rushing quickly through the valves. Many people have what are called “innocent” heart murmurs. [21] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source But some heart murmurs do point to issues with heart valves, so you should advise your patient to see a doctor if you detect a heart murmur. [22] X Research source If you hear a third heart sound that is like a low-frequency vibration, your patient might have a ventricular defect. This third heart sound is referred to as S3 or a ventricular gallop. Advise the patient to see a doctor if you hear a third heart sound. [23] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source Try listening to samples of normal and abnormal heart sounds to help you determine if what you are hearing is normal.
As you listen place the stethoscope on the upper part of the chest, then the midclavicular line of the chest, and then the bottom part of the chest. Make sure to listen to the front and back of all of these regions. Make sure to compare both sides of your patient’s lungs and note if anything is abnormal. By covering all of these positions you will be able to listen to all of the lobes of your patient’s lungs. [24] X Research source
There are two types of normal breath sounds:[25] X Research source Bronchial breath sounds are those heard within the tracheobronchial tree. Vesicular breath sounds are those heard over the lung tissue.
There are four types of abnormal breath sounds: Wheezing sounds like a high pitched sound when the person exhales, and sometimes when they inhale as well. Many patients who have asthma also have wheezes, and sometimes you can even hear the wheezing without a stethoscope. [27] X Research source Stridor sounds like high-pitched musical breathing, similar to wheezing, heard most often when the patient inhales. Stridor is caused by a blockage in the back of the throat. This sound can also often be heard without a stethoscope. [28] X Research source www. onhealth. com/content/1/normal_healthy_heart_rate_charts_health_heart Rhonchi sounds like snoring. Rhonchi cannot be heard without a stethoscope and happens because the air is following a “rough” path through the lungs or because it is blocked. [29] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source Rales sounds like popping bubble wrap or rattling in the lungs. Rales can be heard when a person inhales. [30] X Research source
You should hear “growling” in all four sections. Sometimes after surgery, bowel sounds will take a while to return. [34] X Research source
If you do not hear any bowel sounds, that may mean that something is blocked in the patient’s stomach. It can also indicate constipation and bowel sounds may return on their own. But if they do not return, then there may be a blockage. In this case, the patient would need further evaluation by a doctor. [36] X Research source If the patient has hyperactive bowel sounds followed by a lack of bowel sounds, that could indicate that there has been a rupture or necrosis of the bowel tissue. [37] X Research source If the patient has very high-pitched bowel sounds, this may indicate that there is an obstruction in the patient’s bowels. [38] X Research source Slow bowel sounds may be caused by prescription drugs, spinal anesthesia, infection, trauma, abdominal surgery, or overexpansion of the bowel. [39] X Research source Fast or hyperactive bowel sounds can be caused by Crohn’s disease, a gastrointestinal bleed, food allergies, diarrhea, infection, and ulcerative colitis. [40] X Research source
Be careful not to press too hard on the artery or you may cut off circulation and cause your patient to faint. Never press on both carotid arteries at the same time.
You may also want to listen for bruits over the abdominal aorta, renal arteries, iliac arteries, and femoral arteries.
Find your pulse in your inner arm to help you determine where your brachial artery is located. [45] X Trustworthy Source Cleveland Clinic Educational website from one of the world’s leading hospitals Go to source
A systolic blood pressure above 120 or a diastolic blood pressure above 80 indicates that your patient may have high blood pressure. In that case, your patient should seek further evaluation by a doctor.
