How to use a Stethoscope: Understanding the Stethoscope Basics

placement stethoscope heart sounds

The stethoscope is a very important instrument or tool that is used in the health care industry by health care professionals to auscultate or listen to the bodily sounds of patient.

In this article, the discussion is going to be focused around how to use a stethoscope and clarifying a few stethoscope terminologies.

Stethoscope Terminologies

  • Auscultation
    • This word that dates to the Latin word auscultare which simply means to listen. It a technique that involves listening to the sounds from the heart, lungs, blood vessels, stomach and intestine.
  • Parts Terminology
    • The parts of the stethoscope are very easy to understand. Here are some of the parts of the stethoscope that you need to familiarize yourself with to better understand how the stethoscope works
      • Diaphragm
      • Bell
      • Chest-piece
      • Tubing
      • Headset
      • Ear tube or Aural tube
      • Ear-tips

To learn more about the stethoscope parts please refer to my previous article Parts of a stethoscope

Wearing the Headsetproper way to wear stethoscope

The first thing to ensure before using a stethoscope is that you put on the head piece correctly. And the stethoscope headpiece is worn accurately by putting the head stead on with the ear tips facing away from your nose. 

This is the accurate way of wearing the head set because of the anatomy of your ears. Once you have the headset worn the correctly, you are all set in listening to bodily sounds.

The diaphragm is a sealed membrane that vibrates, much like your own eardrum. When it does, it moves the column of air inside the stethoscope tube up and down, which in turn moves air in and out of your ear canal, and voila, you hear sound. 

Since the surface area of the diaphragm is much greater than that of the column of air that it moves in the tube, the air in the tube must travel more than the diaphragm, causing a magnification of the pressure waves that leave the ear tip. In your ear, larger pressure waves make louder sounds. This is how stethoscopes amplify sounds.

 

Holding the Stethoscope Properly

proper way to use stethoscope

The important tip here is that in most cases you’ll want to hold the chest piece between the distal part of your index and middle finger on you dominant hand. This grip is better than using your fingertips around the edge of the diaphragm/bell because it allows you to press against the patient without your fingers rubbing it and creating extra noise. A gentle touch is best.

Placing your stethoscope correctly

Place the chest piece (diaphragm or bell) directly against skin for the best sound transmission. If you’re in a hurry you can hold it over one thing layer of clothing, such as a T-shirt, but this isn’t recommended, as doing so risks missing nuances that might be crucial.

Using the Stethoscope

1. Measuring blood pressure

correct way to use stethoscope

This is one of the most common use of a stethoscope, but has to be done properly for accurate readings.

The placement of the Blood Pressure cuff (BP cuff) is critical. The BP cuff has to be place on the upper arm and the patient’s arm has to be positioned at the heart level.


Steps to measure the blood pressure

  • Wrap the BP cuff on the patient’s upper arm, ensure that the cuff is not too tight or too loose. But tight enough so that you can still slide one finger into the BP cuff when wrapped on the patient.
  • Locate the brachial pulse using two fingers, the index and the middle finger
  • Put on your stethoscope and place the diaphragm on the brachial pulse
  • Ensure that the valve on the Bp cuff is closed
  • Pump the BP cuff quickly to 60 mmHg while still placing your diaphragm on the brachial pulse
  • Keep your eyes on the manometer and continue pumping the cuff in an increment of 10mmHg until the brachial pulse completely disappears and you can no hear the pulse on your stethoscope
  • Slowly open up the dial of the valve of the cuff at 2 mmHg per second
  • Keep listening with your stethoscope while you do this until you hear the first beep sound of a pulse
  • Note the point on the manometer when you start hearing the pulse again as that is your systolic blood pressure
  • Continue deflating the cuff slowly at 2 mmHg until you hear no longer hear the thump of the pulse
  • Note the point where you no last heard the thump as that is the diastolic blood pressure
  • Record the systolic and diastolic pressure as fractions with the systolic blood pressure on the numerator and the diastolic blood pressure on the denominator of the fraction. For instane: if I got a systolic pressure of 110 and a diastolic of 78, I will record the blood pressure as 110/78 .

Assessing lung sounds

lung assessment nursing

This allows you to identify the rate, rhythm and quality of breathing, any obstructions of the airways, as well as rubs that indicate inflammation of the pleura.

You start the lung assessment from above the clavicles and work your way down to the the bottom of the lungs.

Also, when you listen to the back, ask the patient lean forward slightly to easier auscultation. In addition, you listen to 7 pairs of areas at the back and 6 pairs of area at the front. Be sure to listen to left and right sides at the same level before moving down to the next level so that you can compare the sound you hear in the left lungs to the right lung at the same level and any differences will be heard clearly.

Assessing heart sounds

landmarks of the heart

During heart assessment with a stethoscope, you listen for rate, type, and rhythm of heart sound, as well as any sounds adventitious sounds or abnormal heart sounds such as murmurs or clicks.

When listening to heart sounds, there are 5 primary areas: Aortic, Pulmonic, Erb’s point, Tricuspid and Mitral. Please refer to my article Head to toe assessment, where I explain in detail where to find and how to assess these heart landmarks.

Assessing Bowel Sounds

This is easy to do, and important if there may be a bowel obstruction or paralytic ileus. The gurgling, hyperactive noises are called borborygmi.

Detecting Bruits

A bruit (pronounced “brew – ee,” the t is silent)can be detected with the bell of the stethoscope. It is an abnormal blowing or whooshing sound of blood through an artery that usually indicates that the artery has been narrowed, causing a turbulent flow, as seen in arterioscleroisis that occurs due to fatty plaque build up.

Bruits are abnormal usually absent in a normal healthy patient. Bruits can be detected in the neck (carotid artery bruits), kidneys (renal bruits), temporal arteries, femoral, iliac and umbilicus (abdominal aortic bruits).

Measuring the Span of the Liver

proper use of a stethoscope

Besides measuring the liver span by percussion, another cool way of measuring the liver span is by using the stethoscope.

You do this by placing the stethoscope below the right nipple, the other index finger just above the belt line in line with the nipple, and gently scratch the skin up toward the chest piece of the stethoscope.

When you place your stethoscope over the liver, area the sound will become dull. To measure the liver span, mark the location where the dullness begins, and ends provides a decent measurement of the liver size in that location.

For more detailed information about assessing the lung, heart and other body system please check out my article Head to toe assessment

If you have any comments, feedback or questions. I would like to hear from you.

kindly share them in the comment section below.

Thank you for reading!

About Pam 9 Articles
Pam is the founder and author of InfoWatchNurse and ThinkStethoscopes. Pam is an award-winning leader. In 2017, She pioneered the first ever peer tutoring program for nursing students at York University. She was also a Peer Tutor and Mentor for nursing students. Today, Pam creates posts and articles on health topics to give back to the nursing community.  She blogs about nursing, health, nursing skills and other health-related topics on her websites. You can connect with Pam on Linkedin and Instagram.

2 Comments

  1. Hey Pam.

    I’m currently studying to become a nurse and these tips will help me out… like a lot! Also love how clean your site looks.

    Good job! 🙂

    • Hi Michael

      I am glad to hear that you find the information useful. Thank you so much for your kind compliment friend. You might find my other site infowatchnurse useful. I post nursing related stuff on there. I hope you have a great day!
      Regards

      Pam

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