Daniel O'Neill, BSc (Hons), RN, GIBiol, PGDip, ALS, ATNC.
Staff Nurse and Student Extended Nurse Practitioner, Accident and Emergency Department, Frimley Park Hospital, SurreyThis paper examines the use of the stethoscope in relation to clinical assessment within the acute sector, in particular in accident and emergency departments (A&E).
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.
Cardiovascular assessment Assessment of the cardiovascular system using a stethoscope is common. The heart has four chambers. The two upper chambers are called the atria; and the two lower chambers are called the ventricles. Valves that temporarily close to permit blood flow in only one direction are located between the atria and ventricles, and between the ventricles and the major arteries from the heart and to the lungs (Marieb, 1998).
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:
Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push food through. Since the intestines are hollow, bowel sounds can echo throughout the abdomen, much like the sounds heard from water-pipes. Most bowel sounds are benign and simply indicate that the gastrointestinal tract is working (Welsby, 1996). However, in some instances abnormal bowel sounds provide valuable information about the health of the body.
The stethoscope should be able to detect both faint, high-pitched sounds and low-pitched sounds; it should have short tubing, snug earpieces, and a chest piece consisting of both a diaphragm and bell (3M Health Care, 2003).
Auscultation is very subjective and depends on the ability and preferences of the individual performing it. Research shows cardiologists are more proficient at using auscultation to diagnose heart conditions compared with other health professionals (Perloff, 1990).
The potential for passing on ear infections is an increased risk when communal stethoscopes hung up in the department are used by a lot of people.
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.
Carnevali, D. (1993) Diagnostic Reasoning and Treatment Decision-making in Nursing. Philadelphia, Pa: Lippincott.
Kummar, P., Clark, M. (1999)Clinical Medicine (4th edn). London: Saunders.
Lukin, A., Polic, S., Rumboldt, Z. et al. (1996) Comparison of auscultation findings using a classic stethoscope (Littmann 2120) and electronically amplified stethoscope (Medmax2). Lijec Vjesn (Serbo-Croatian journal) 118: 5-6, 127-128.
Marieb, E. (1998) Human Anatomy and Physiology (3rd edn). New York, NY: Benjamin/Cummings.
McFerran, T. (ed.). (1998) Dictionary of Nursing (3rd edn). Oxford: Oxford University Press.
Nursing and Midwifery Council. (2002) Code of Professional Conduct. London: NMC.
Perloff, J. (1990) Physical Examination of the Heart and Circulation (2nd edn). Philadelphia, Pa: W.B. Saunders.
Robinson, D. (1993) Nurse practitioner or mini doctor? Accident and Emergency Nursing 1: 53-55.
3M Health Care. (1996) 3M Littmann Stethoscope: 20 examples of cardiac and pulmonary auscultation (CD and booklet). Loughborough: 3M Health Care.
3M Health Care. (2003) Website: www.3m.com/uk/littmann (accessed 31 January 2003).
Tytan Medical. (2003) Website: www.tytan.com.tw (accessed 31 January, 2003).
Welsby, P. (1996) Clinical History Taking and Examination. London: Churchill Livingstone.