1. How to Use a Stethoscope ?

Stethoscope is a medical instrument used to hear sounds

made by the heart, lungs, and intestines. Using a stethoscope to
hear sounds is called auscultation . Medical professionals are trained
to use stethoscopes, but you can learn how to use one too. Keep
reading to learn how to use a stethoscope.

Get a high quality stethoscope. A high quality stethoscope is

important. The better the quality of your stethoscope, the easier it
will be for you to listen to your patients body.

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.
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 dont hear anything, there may
be a leak.

Adjust your stethoscopes earpieces. It is important to make

sure that the earpieces are facing forward and that they fit well.
Otherwise, you might not be able to hear anything with your
stethoscope.
o Make sure that the earpieces are facing forward. If you
put them in backwards, you wont be able to hear anything.
o Make sure that the earpieces fit snugly and have a good
seal to keep out ambient noise. If the ear pieces dont fit well, most
stethoscopes have removable earpieces. Visit a medical supply
store to purchase different earpieces.
o With some stethoscopes, you can also tilt the earpieces
forward stethoscopes to ensure a better fit.
 Check the earpiece tension on your stethoscope. In other
words, make sure that the earpieces are close to your head but not
too close. If your earpieces are too tight or too loose, readjust them.
o If the earpieces are too loose, you may not be able to
hear anything. To tighten the tension, squeeze the headset near the
earpieces.
o 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.

Choose an appropriate chest piece for your

stethoscope. There are many different types of chest pieces
available for stethoscopes. Choose one that is appropriate for your
needs. Chest pieces come in different sizes for adults and children.

Preparing to Use a Stethoscope

Select a quiet place to use your stethoscope. Use your

stethoscope in a quiet place. Find a quiet area to ensure that the
body sounds you want to hear will not be overpowered by
background noises.

Position your patient. To listen to the heart and abdomen, you

will want to have your patient get into a supine position. To listen to
the lungs, you will want your patient to sit up. In other words, ask
your patient to lay down.j Heart, lung, and bowel sounds may sound
different depending on the patient's position: i.e., sitting, standing,
lying on one's side, etc..

Decide whether to use the diaphragm or bell. The diaphragm,

or flat side of the drum, is better for hearing medium- or high-
 pitched sounds. The bell, or round side of the drum, is better for
hearing low-pitched sounds.

o 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 patients heart and lungs, but keep in mind that
they are expensive.

Have your patient put on a hospital gown or lift up clothing

to expose skin. Use the stethoscope on bare skin to avoid picking
up the sound of rustling fabric. If your patient is a man with chest
hair, keep the stethoscope still to avoid any rustling sounds.

o To make your patient more comfortable, warm up the

stethoscope by rubbing it on your sleeve, or consider buying a
stethoscope warmer.
Listening to the Heart
Hold the diaphragm over the patients heart. Position the
diaphragm on the left upper part of the chest where the 4th to 6th
ribs meet, almost directly under the breast. Hold the stethoscope
between your pointer and middle fingers and apply enough gentle
pressure so that you dont hear your fingers rubbing together.

Listen to the heart for a full minute. Ask the patient to relax
and breathe normally. You should hear the normal sounds of the
human heart, which sound like lub-dub. These sounds are also
called systolic and diastolic. Systolic is the lub sound and diastolic
is the dub sound.

o The lub, or systolic, sound happens when the mitral

and tricuspid valves of the heart close.
o The dub, or diastolic, sound happens when the aortic
and pulmonic valves close.

Count the number of heartbeats you hear in a minute. The

normal resting heart rate for adults and children over 10 years old is
between 60-100 beats per minute. For well-trained athletes, the
normal resting heart rate may only be between 40-60 beats per
minute.

o There are several different ranges of resting heart rates

to consider for patients under 10 years old. Those ranges include:
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

Listen for abnormal heart sounds. As you count the heartbeats,

you should also listen for any abnormal sounds. Anything that does
not sound like lub-dub may be considered abnormal. If you hear
anything abnormal, your patient may need further evaluation by a
doctor.

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. 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.
 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.
Try listening to samples of normal and abnormal
heart sounds to help you determine if what you are hearing is
normal.

Listening to the Lungs

Ask your patient to sit straight up and breathe normally. As
you listen, you can ask the patient to take a deep breath if you
cannot hear breath sounds or if they are too quiet to determine if
there are any abnormalities.

Use the diaphragm of your stethoscope to listen to your

patients lungs. Listen to the patients lungs in the upper and
lower lobes, and on the front and back of the patient.

o 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.
o Make sure to compare both sides of your patients lungs
and note if anything is abnormal.
o By covering all of these positions you will be able to
listen to all of the lobes of your patients lungs.

Listen for normal breath sounds. Normal breath sounds are

clear, like listening to someone blowing air into a cup. Listen to a
sample of healthy lungs and then compare the sounds to what you
hear in your patients lungs.

o There are two types of normal breath sounds:

 Bronchial breath sounds are those heard within
the tracheobronchial tree.
Vesicular breath sounds are those heard over the
lung tissue.

Listen for abnormal breath sounds. Abnormal breath sounds

include wheezing, stridor, rhonchi, and rales. If you do not hear any
breath sounds, the patient may have air or fluid around the lungs,
thickness around the chest wall, or airflow that is slowed down or
over inflation to the lungs.

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.
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.
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.
Rales sounds like popping bubble wrap or rattling
in the lungs. Rales can be heard when a person inhales.

Listening to Abdominal Sounds

Place the diaphragm on your patients bare stomach. Use
your patients belly button as the center and divide your listening
around the belly button into four sections. Listen to the upper left,
upper right, lower left and right.
 Listen for normal bowel sounds. Normal bowel sounds sound
like when your stomach growls or grumbles. Anything else may
suggest that something is wrong and that the patient requires
further evaluation.

o You should hear growling in all four sections.

Sometimes after surgery, bowel sounds will take a while to return.

Listen for abnormal bowel sounds. Most of the sounds that you
hear when listening to your patients bowels are just the sounds of
digestion. Although most bowel sounds are normal, there are some
abnormalities that could point to a problem. If you are unsure if the
bowel sounds you hear are normal and/or the patient has other
symptoms, then the patient should see a doctor for further
evaluation.

o If you do not hear any bowel sounds, that may mean

that something is blocked in the patients 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.
o 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.
o If the patient has very high-pitched bowel sounds, this
may indicate that there is an obstruction in the patients bowels.
o Slow bowel sounds may be caused by prescription
drugs, spinal anesthesia, infection, trauma, abdominal surgery, or
overexpansion of the bowel.
o Fast, or hyperactive bowel sounds can be caused by
Crohns disease, a gastrointestinal bleed, food allergies, diarrhea,
infection, and ulcerative colitis.
 Listening For a Bruit

Determine if you need to check for a bruit. If you have

detected a sound that seems like a heart murmur, you should also
check for a bruit. Since heart murmurs and bruits sound similar, it is
important to check for both if one is suspected.

Place the diaphragm of your stethoscope over one of the

carotid arteries. The carotid arteries are located in the front of
your patients neck, on either side of the Adams apple. If you take
your index and middle finger and run them down the front of your
throat, you will trace over the locations of your two carotid arteries.
[44]

o 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.[45]

Listen for bruits. A bruit makes a whooshing sound that indicates

that an artery is narrowed. Sometimes a bruit may be confused with
a murmur because they sound similar, but if the patient has a bruit
then the whooshing sound will be louder when you listen to the
carotid artery than when you listen to the heart.[46][47]

o You may also want to listen for bruits over the

abdominal aorta, renal arteries, iliac arteries and femoral arteries.

Checking Blood Pressure

Wrap the blood pressure cuff around your patients arm,

right above the elbow. Roll up your patients sleeve if it is in the
way.[48] Make sure that you use a blood pressure cuff that fits your
patients arm. You should be able to wrap the cuff around your
 patients arm so that it is snug, but not too tight. If the blood
pressure cuff is too small or too large, get a different size.

Press the diaphragm of the stethoscope over the brachial

artery just below the cuff's edge. You can also use the
diaphragm if you have trouble hearing with the bell. You will be
listening for Korotkoff sounds, which are low tone knocking sounds
that indicate the patients systolic blood pressure.

o Find your pulse in your inner arm to help you determine

where your brachial artery is located.

Inflate the cuff to 180mmHg or 30mm above your expected

systolic blood pressure. You can find the reading by looking at
the sphygmomanometer, which is the gauge on the blood pressure
cuff. Then, release air from the cuff at a moderate rate (3mm/sec).
As yyou release the air, listen with the stethoscope and keep your
eyes on the sphygmomanometer (gauge on the blood pressure
cuff).

Listen for Korotkoff sounds. The first knocking sound that you
hear is your patients systolic blood pressure. Note that number, but
keep watching the sphygmomanometer. After the first sound stops,
note the number that it stops on. That number is the diastolic
pressure.

Release and remove the cuff. Deflate and take the blood
pressure cuff off of your patient right after you have gotten the
second number. When you are done, you should have two numbers
that make up your patients blood pressure. Record these numbers
side by side, separated by a slash. For example, 110/70.
 Wait a few minutes if you want to check the patients blood
pressure again. You may want to re-measure if the patients blood
pressure is high.

o 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.

Why become nurse ?

Nurses are an integral component of a medical team, and for
many patients, their primary care providers. A career in nursing
opens doors to many opportunities, including healthcare education,
research and specialization in areas of practice. Nurses enter the
profession for many reasons, the most significant being its practical
and personal advantages.
Nurses provide direct, one-on-one care to patients. Most
individuals in a hospital or care home setting spend more time with
nurses than with doctors. Nurses often choose the profession out of
a desire to tend to the needs of patients, including in situations of
short-term treatment of illness and long-term counseling of chronic
conditions. This human side of the medical profession, rather than
the analytical or research-related aspects, is appealing to many who
choose to pursue a nursing career.
Nurses have widely applicable skills and can choose from a
variety of working environments, including home care facilities,
doctor's offices, medical clinics, community centers and hospitals.
According to Discover Nursing.com, nurses can advance into 104
specialties. These include addictions, critical care, neonatology and
genetics. While many nurses provide direct patient care, others
choose to be nurse educators, policy advisers and pharmaceutical
representatives.
Patients in medical facilities or care centers require 24-hour
care. As a result, nursing shifts are available around-the-clock, and
nurses can often choose shifts that are convenient for them and
their families. For nurses with their own caregiver responsibilities,
this flexibility may afford them a work-life balance. Some may have
a shift rotation; others, in particular in offices and schools where 24-
hour care is not provided, may work regular business hours.
According to the Bureau of Labor Statistics, 20 percent of nurses
worked part-time in 2010.