{"id":36,"date":"2020-04-02T11:29:24","date_gmt":"2020-04-02T15:29:24","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/ippa\/?post_type=chapter&#038;p=36"},"modified":"2024-01-14T12:05:24","modified_gmt":"2024-01-14T17:05:24","slug":"auscultation","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/chapter\/auscultation\/","title":{"raw":"Auscultation","rendered":"Auscultation"},"content":{"raw":"The assessment technique of <strong>auscultation<\/strong> involves <strong>listening<\/strong> to the body. Although this is typically performed with a <strong>stethoscope<\/strong>, you can sometimes hear sounds from the body using just your ear. For example, you have probably heard your own or another person\u2019s stomach growling; another example is heavy breathing after exercise.\r\n\r\nYou can perform auscultation on the body to hear several sounds including:\r\n<ul>\r\n \t<li><strong>[pb_glossary id=\"106\"]High-pitched sounds[\/pb_glossary]<\/strong> like lung sounds, bowel sounds, and some heart sounds.<\/li>\r\n \t<li><strong>[pb_glossary id=\"107\"]Low-pitched sounds[\/pb_glossary]<\/strong> like some heart sounds, as well as sounds associated with abnormal vascular sounds of the carotid arteries and the aorta.<\/li>\r\n<\/ul>\r\nTo perform auscultation, you need a high-quality stethoscope. See <strong>Figure 1.10<\/strong> for an <strong>acoustic stethoscope<\/strong> with a separate diaphragm on one side and a bell on the other side. The <strong>diaphragm<\/strong> is used for auscultating high-pitched sounds, while the <strong>bell<\/strong> is used for auscultating low-pitched sounds. Another option is an acoustic stethoscope in which the diaphragm and bell are manufactured as one piece: using this type of stethoscope, you can alternate pressure to auscultate for high- or low-pitched sounds, using light pressure to accentuate low-pitched sounds and firmer pressure to accentuate high-pitched sounds. There are also electronic stethoscopes to help amplify sounds for people with hearing loss. Some advanced stethoscopes facilitate better ambient noise reduction, sound amplification, and capability to record sounds (Leng et al., 2015). Unlike electronic stethoscopes, an acoustic stethoscope does not amplify the body\u2019s sounds; it simply reduces interference from extraneous noises around you.\r\n\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-768x1024.jpg\" alt=\"\" class=\"alignnone size-large wp-image-233\" width=\"768\" height=\"1024\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure<\/strong><strong> 1.10<\/strong>: Stethoscope with a separate diaphragm and bell<\/span>\r\n<h2><strong>Use of the stethoscope<\/strong><\/h2>\r\nProper use of a stethoscope involves several steps.\r\n<ol>\r\n \t<li>Begin by <strong>explaining the procedure<\/strong> and asking <strong>permission to touch<\/strong>.<\/li>\r\n \t<li>Next, create a <strong>quiet environment<\/strong>. Turn off or mute the sound on cell phones, radios, or televisions. Ask the client to not speak or move while you are listening. Also, many clinical environments have ambient noise that you cannot control, particularly in hospitals, when beds are close together, or in an open concept unit such as an emergency room. You will need to focus your hearing; it may help to close your eyes when listening.<\/li>\r\n \t<li>Third, <strong>cleanse the stethoscope<\/strong>. The stethoscope is a potential vector of transmission that can carry pathogenic bacteria (Horiuchi et al., 2018; Tschopp et al., 2016). Clean the entire stethoscope using an alcohol pad on the earpieces and the end piece <strong>immediately prior to use<\/strong>. Always clean the stethoscope from cleanest to dirtiest areas, therefore earpieces first and bell\/diaphragm last.<\/li>\r\n \t<li>Next, place the <strong>earpieces<\/strong> in your ears so that they are <strong>pointing toward your nose<\/strong> as per <strong>Figure 1.11<\/strong>. This positioning aligns with the angle of your ear canal and enhances your capacity to hear. You may need to wiggle them into place so that they are comfortable and angling down your ear canal.<\/li>\r\n \t<li>Last, <strong>open or close the diaphragm or bell<\/strong> depending on which end piece you want to use. It is important to tap on the diaphragm to ensure sounds are heard if using the diaphragm or not heard if using the bell. See <strong>Film Clip 1.2<\/strong>\u00a0on how to open and close the diaphragm and bell.<\/li>\r\n<\/ol>\r\n&nbsp;\r\n\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1.jpg\" alt=\"\" class=\"alignnone size-full wp-image-48\" width=\"1024\" height=\"740\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure<\/strong> <strong>1.11<\/strong>: Positioning in the ears<\/span>\r\n\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n[video width=\"1280\" height=\"720\" mp4=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/Stethoscope-Bell-.mp4\"][\/video]\r\n\r\n<strong>Film clip 1.2<\/strong>: Opening and closing the stethoscope\r\n\r\n&nbsp;\r\n\r\nMake note of your findings when performing auscultation. For example, findings may include \u201cclear air entry bilaterally in all lobes\u201d or \u201chigh-pitched gurgling bowel sounds present in all four quadrants.\u201d\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\" style=\"text-align: center\"><strong>Clinical Tip<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>How best to listen<\/strong>\r\n\r\nThe best practice, supported by evidence, is to conduct assessments on bare skin. Always place the end piece of the stethoscope on bare skin, and never listen over the client\u2019s gown or clothing as this can modify the sounds that you are hearing. In the clinical setting, you will witness many healthcare providers listening over clothing, but this is not the correct way to auscultate sounds. <span style=\"text-align: initial;font-size: 1em\">Substantial amounts of hair (e.g., on the chest, back or abdomen) can also create extraneous noise, making it difficult to hear the expected sounds. <\/span>\r\n\r\n<span style=\"text-align: initial;font-size: 1em\">For infants, the best time to auscultate is while the infant is sleeping or quiet; if they start crying, encourage the care partner to console the infant by repositioning, breastfeeding\/bottle, or soother (if permitted). If you are trying to auscultate the lungs of a young child, you could ask the child to take a big breath and pretend they are blowing bubbles or blowing out candles on a birthday cake.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\" style=\"text-align: center\"><strong>Voices of Experience<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nIt is important to know the expected normal sounds and the abnormal sounds. You should trust what you are hearing. If you are struggling to identify the sounds you are hearing, try closing your eyes and focusing. If a sound is not normal, act on this and\/or ask for a second opinion from your clinical instructor or preceptor. It is always good practice to listen to body sounds in partnership with an expert nurse.\r\n\r\n<\/div>\r\n<\/div>\r\n<h2>Activity: Check Your Understanding<\/h2>\r\n<div class=\"postbox h5p-sidebar\">\r\n<div class=\"h5p-action-bar-settings h5p-panel\">[h5p id=\"11\"]<\/div>\r\n<\/div>","rendered":"<p>The assessment technique of <strong>auscultation<\/strong> involves <strong>listening<\/strong> to the body. Although this is typically performed with a <strong>stethoscope<\/strong>, you can sometimes hear sounds from the body using just your ear. For example, you have probably heard your own or another person\u2019s stomach growling; another example is heavy breathing after exercise.<\/p>\n<p>You can perform auscultation on the body to hear several sounds including:<\/p>\n<ul>\n<li><strong><button class=\"glossary-term\" aria-describedby=\"36-106\">High-pitched sounds<\/button><\/strong> like lung sounds, bowel sounds, and some heart sounds.<\/li>\n<li><strong><button class=\"glossary-term\" aria-describedby=\"36-107\">Low-pitched sounds<\/button><\/strong> like some heart sounds, as well as sounds associated with abnormal vascular sounds of the carotid arteries and the aorta.<\/li>\n<\/ul>\n<p>To perform auscultation, you need a high-quality stethoscope. See <strong>Figure 1.10<\/strong> for an <strong>acoustic stethoscope<\/strong> with a separate diaphragm on one side and a bell on the other side. The <strong>diaphragm<\/strong> is used for auscultating high-pitched sounds, while the <strong>bell<\/strong> is used for auscultating low-pitched sounds. Another option is an acoustic stethoscope in which the diaphragm and bell are manufactured as one piece: using this type of stethoscope, you can alternate pressure to auscultate for high- or low-pitched sounds, using light pressure to accentuate low-pitched sounds and firmer pressure to accentuate high-pitched sounds. There are also electronic stethoscopes to help amplify sounds for people with hearing loss. Some advanced stethoscopes facilitate better ambient noise reduction, sound amplification, and capability to record sounds (Leng et al., 2015). Unlike electronic stethoscopes, an acoustic stethoscope does not amplify the body\u2019s sounds; it simply reduces interference from extraneous noises around you.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-768x1024.jpg\" alt=\"\" class=\"alignnone size-large wp-image-233\" width=\"768\" height=\"1024\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-768x1024.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-225x300.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-1152x1536.jpg 1152w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-1536x2048.jpg 1536w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-65x87.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-350x467.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/09\/IMG_8265-scaled.jpg 1920w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure<\/strong><strong> 1.10<\/strong>: Stethoscope with a separate diaphragm and bell<\/span><\/p>\n<h2><strong>Use of the stethoscope<\/strong><\/h2>\n<p>Proper use of a stethoscope involves several steps.<\/p>\n<ol>\n<li>Begin by <strong>explaining the procedure<\/strong> and asking <strong>permission to touch<\/strong>.<\/li>\n<li>Next, create a <strong>quiet environment<\/strong>. Turn off or mute the sound on cell phones, radios, or televisions. Ask the client to not speak or move while you are listening. Also, many clinical environments have ambient noise that you cannot control, particularly in hospitals, when beds are close together, or in an open concept unit such as an emergency room. You will need to focus your hearing; it may help to close your eyes when listening.<\/li>\n<li>Third, <strong>cleanse the stethoscope<\/strong>. The stethoscope is a potential vector of transmission that can carry pathogenic bacteria (Horiuchi et al., 2018; Tschopp et al., 2016). Clean the entire stethoscope using an alcohol pad on the earpieces and the end piece <strong>immediately prior to use<\/strong>. Always clean the stethoscope from cleanest to dirtiest areas, therefore earpieces first and bell\/diaphragm last.<\/li>\n<li>Next, place the <strong>earpieces<\/strong> in your ears so that they are <strong>pointing toward your nose<\/strong> as per <strong>Figure 1.11<\/strong>. This positioning aligns with the angle of your ear canal and enhances your capacity to hear. You may need to wiggle them into place so that they are comfortable and angling down your ear canal.<\/li>\n<li>Last, <strong>open or close the diaphragm or bell<\/strong> depending on which end piece you want to use. It is important to tap on the diaphragm to ensure sounds are heard if using the diaphragm or not heard if using the bell. See <strong>Film Clip 1.2<\/strong>\u00a0on how to open and close the diaphragm and bell.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1.jpg\" alt=\"\" class=\"alignnone size-full wp-image-48\" width=\"1024\" height=\"740\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1-300x217.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1-768x555.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1-65x47.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1-225x163.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/06\/Stethoscope-Correct-1024x740-1-350x253.jpg 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure<\/strong> <strong>1.11<\/strong>: Positioning in the ears<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<div style=\"width: 1280px;\" class=\"wp-video\"><!--[if lt IE 9]><script>document.createElement('video');<\/script><![endif]--><br \/>\n<video class=\"wp-video-shortcode\" id=\"video-36-1\" width=\"1280\" height=\"720\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/Stethoscope-Bell-.mp4?_=1\" \/><a href=\"http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/Stethoscope-Bell-.mp4\">http:\/\/pressbooks.library.ryerson.ca\/ippa\/wp-content\/uploads\/sites\/114\/2020\/08\/Stethoscope-Bell-.mp4<\/a><\/video><\/div>\n<p><strong>Film clip 1.2<\/strong>: Opening and closing the stethoscope<\/p>\n<p>&nbsp;<\/p>\n<p>Make note of your findings when performing auscultation. For example, findings may include \u201cclear air entry bilaterally in all lobes\u201d or \u201chigh-pitched gurgling bowel sounds present in all four quadrants.\u201d<\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\" style=\"text-align: center\"><strong>Clinical Tip<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>How best to listen<\/strong><\/p>\n<p>The best practice, supported by evidence, is to conduct assessments on bare skin. Always place the end piece of the stethoscope on bare skin, and never listen over the client\u2019s gown or clothing as this can modify the sounds that you are hearing. In the clinical setting, you will witness many healthcare providers listening over clothing, but this is not the correct way to auscultate sounds. <span style=\"text-align: initial;font-size: 1em\">Substantial amounts of hair (e.g., on the chest, back or abdomen) can also create extraneous noise, making it difficult to hear the expected sounds. <\/span><\/p>\n<p><span style=\"text-align: initial;font-size: 1em\">For infants, the best time to auscultate is while the infant is sleeping or quiet; if they start crying, encourage the care partner to console the infant by repositioning, breastfeeding\/bottle, or soother (if permitted). If you are trying to auscultate the lungs of a young child, you could ask the child to take a big breath and pretend they are blowing bubbles or blowing out candles on a birthday cake.<\/span><\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\" style=\"text-align: center\"><strong>Voices of Experience<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>It is important to know the expected normal sounds and the abnormal sounds. You should trust what you are hearing. If you are struggling to identify the sounds you are hearing, try closing your eyes and focusing. If a sound is not normal, act on this and\/or ask for a second opinion from your clinical instructor or preceptor. It is always good practice to listen to body sounds in partnership with an expert nurse.<\/p>\n<\/div>\n<\/div>\n<h2>Activity: Check Your Understanding<\/h2>\n<div class=\"postbox h5p-sidebar\">\n<div class=\"h5p-action-bar-settings h5p-panel\">\n<div id=\"h5p-11\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-11\" class=\"h5p-iframe\" data-content-id=\"11\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"IPPA - Auscultation\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"36-106\" hidden><p>High-pitched sounds are sounds with a high frequency that resemble a shrill or a piercing, sharp scream.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"36-107\" hidden><p>Low-pitched sounds are sounds with a low frequency that resemble a booming drum or a person with a deep, low voice.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":9,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-36","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/36","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":24,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/36\/revisions"}],"predecessor-version":[{"id":341,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/36\/revisions\/341"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapters\/36\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/media?parent=36"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/pressbooks\/v2\/chapter-type?post=36"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/contributor?post=36"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/ippa\/wp-json\/wp\/v2\/license?post=36"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}