What is one of the most common, yet important pieces of equipment you will need as a NURSE?



A STETHOSCOPE !!!


One of the most important factors about a Stethoscope is how to use it and use it correctly.


One of the most used pieces of clinical equipment you will use whether you are in Nursing school, Medical Assisting school, CNA school, Medical school…and any other health related area of study, will be a stethoscope. You will not only use it in school and clinical training, but also when you are working as a Nurse, or in your chosen profession.


First of all, you don’t need an expensive stethoscope, a less expensive stethoscope works just as well as the expensive ones, especially with constant practice and use.

However, if it is in your budget at some point, the more expensive ones do let you hear better due to quieter tubing, noise reducing earpieces, a better chest-piece and overall construction.


So why is a Stethoscope so important?


A stethoscope is a tool, a piece of equipment that is used to listen to heart sounds, lung sounds, abdominal or stomach sounds, blood pressure sounds, and even sounds in the carotid arteries.

By looking at a stethoscope, it seems simple enough, and if a person has watched a medical, nursing, fire or police drama on TV, you have watched the character put one end of the stethoscope into their ears, and the other end onto the patient.


Taking a closer look a stethoscope…


If you look at the stethoscope straight on, the construction seems to be straightforward. You put the small pieces into the ears, and the other part on to the patient.

It is that simple, but with a couple of small

adjustments, to make it do what a stethoscope is supposed to do.


First the EAR-TUBES.


If you look at the ear tubes of a stethoscope from the side, you will notice that the tubes are not exactly straight. They are actually angled, and they are angled for a reason.

The reason being is so that the eat tips, can go into the ears at the same angle of the ear canal. It may seem that the ear canal goes completely sideways or lateral, which it does to a degree, but the ear canal actually angles slightly towards the back of the head.

That is why the Ear-Tubes of the Stethoscope are angled forward. So that they go into the ear canal at the same angle, allowing sound to travel with ease in the right direction.

When you put the ear pieces into your ears, first take a look at the tubes, making sure they are angling forward, towards your eyes, and nose, then insert the ear pieces into your ears, then listen to whatever you are listening to!

If you put them backwards, they may not allow you to hear the sound as best as you could, which defeats the purpose of the stethoscope, and they may cause some discomfort.




Stethoscope Tubing


The tubing of the stethoscope transfers the sound, or frequencies of sound to the ear-tubes, and ultimately to the Ear tips, then to the ear canal. On the other end of the tubing connects to the stem. The Stem connects the chest piece to the tubing. The Chest piece is what the Stethoscope is designed around, and primarily made to listen to…the chest.


If you were not aware, “STETHOS” actually mean CHEST, so it is properly called a stethoscope. The chestpiece is what all these other pieces are designed around, and work for, to be able transmit what is being listened to from the chest. A stethoscope not only transmits chest sounds, but also blood pressure, and abdominal sounds (as mentioned earlier.)


Some stethoscopes have a two-sided chestpiece, which consists of a diaphragm on one side and a bell on the other. These types can be rotated, which uses a ball bearing to allow the chest piece to be clicked into place, to whichever side is needing to be used.

So why does it matter which side is used…it matters because of the type of sounds that are being listened to.


The larger side, which is known as the diaphragm is used to listen to larger areas that generate higher frequencies. Like lung or breath sounds, and bowel or abdominal sounds.

If you are listening to lungs sounds for example, and you cannot hear anything, you may have to rotate the chestpiece at the stem to “open” and allow sound to travel to “that side” of the chest piece. To amplify the sound and hear these sounds best, the diaphragm should be held firmly against the skin.


The smaller side of the chest piece is known as the Bell. This is the cone shaped side and is used to listen to lower frequency sounds, such as heart sounds and murmurs.

To amplify these low frequency sounds and hear them best, the bell should be held lightly against the skin.


To test which side the chest piece is open to (at the stem), whether the bell or diaphragm; once you have the ear pieces in your ears, you can gently tap the side you will be using. If when you tap that particular side, there is no sound, simply turn the chest piece to open that side.

Some stethoscopes may only have one side, which act as both the bell and the diaphragm. The type of sound to be listened to and heard, is determined by the amount of pressure being applied. These are known as tunable or pressure-sensitive diaphragms that can act as both a bell and a diaphragm.

A Master Cardiology is an example of this type of stethoscope that has this type of chest piece.

One important aspect in caring for your patients and your stethoscope, it the cleaning of your stethoscope, whichneeds to be done between each patient.


Stethoscopes these days are made to be able to be cleaned easily.


The Littman company recommends cleaning your with a 70% alcohol solution, not to use hand sanitizer as a cleaning agent due to additives that may damage parts of the stethoscope; not to immerse your stethoscope in any liquid, do not subject it to any sterilization process; not to subject your stethoscope to extreme heat, extreme cold, solvents and oils; remove eartip from the eartubes for thorough cleaning, for safety, snap eartips firmly back onto the ribbed ends of the eartubes.


Proper care of your stethoscope can help your stethoscope last a long time.


To review:

Ear tubes angled forward

Ensure sure you are using the correct side of the stethoscope.

Remember the diaphragm is the larger side and is used to listen to lung or breath sounds, and bowel or abdominal sounds.

The BELL is used listen to heart sounds and murmurs.

Remember to Apply the correct pressure:

The larger diaphragm is used to listen higher frequencies, and to best amplify the sound, the diaphragm should be held firmly against the skin.

The bell, or smaller side, is used to listen to lower frequency sounds, and to best amplify these sounds, the bell should be held lightly against the skin.

Remember to clean your stethoscope between each patient, and wash your hands between each patient.



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