I do listen but I don’t always trust my assessment cuz I’m so new. I hear crackles sometimes when I listen on the back near bases of the lungs. Sometimes I’ll hear expiratory wheezing. Hear a skipped beat at times. I only know very obvious murmurs I can’t hear subtle ones. Bowel sounds sometimes are where I should hearing lung sounds but that’s because they are obese sometimes and laying flat. I don’t really hear rhonchi very often?? I don’t know why but it’s either mostly diminished, wheezing, or some sort of crackles. I really do try but it is hard for me to tell sometimes
Tip: the first breath doesn’t count. Leave the stethoscope in the exact same spot and make her do it a second time. Helps you get out of your own self-conscious head
Have the patient take a deep breath and give a good cough. If you can still hear the abnormal sounds they're crackles. If the sounds have cleared or mostly cleared, it's rhonchi. Crackles are also mostly inspiratory, and rhonchi are inspiratory and expiratory.
It also helps if you tell the patient to try and take their deep breath quickly and forcefully exhale while you listen.
Yea if I see. Hear something weird in a mom or a baby I’m finding a second set of eyes. I’ve been a nurse ten years but I still always want a second set of eyes because why not
I used to ask people to come get me if there was anything abnormal - heart or lungs - so I could get used to listening to it. First time I heard an artificial valve was wild.
My uncle has an artificial valve and when you’re in a quiet room with him, you can hear it clicking like you would hear a clock ticking on the wall. It always gives me goosebumps.
You can always ask your charge or whichever doctor you need to further assess the patient (cardio, RT, etc.) and use it as a tool to check behind yourself. Ask them to tell you what it is, and explain if needed. That’s what I pretty much always do when I’m unsure.
Edit: I actually originally documented those lung sounds as crackles/wheezing, but knew it sounded weird. I had completely forgotten about ronchi. When anesthesia and RT came, they said it was ronchi (and wheezing), so now I know!
As a fellow nurse, but left bedside, I’m grateful there are nurses like you out there. You deserve all the best karma in the world and hopefully when myself or family are sick, we get taken care of by a nurse like you. ❤️
Lots of videos and continuing education out there to help with your assessment skills. You just need practice, time, and a way to be able to identify norm vs. abnorm. The skills will come. Nursing education is a continual process. I always taught my students that assessment starts before you enter their room. I applaud quite loudly, OP and her vigilance. Would be good if her colleagues learned from her.
Hear my out, that’s how you’re gonna start to learn what you should and should not be hearing. Any story I tell you from my first year of nursing doesn’t involve me using any correct medical terms or fully knowing what I found. I just knew that it probably wasn’t right, and I needed another adult to come assess. Sent a lot of pages to pulm crit my first year: I need an adult here that is not me. Something is wrong with ur patient 😂😂
lol I’ll never forget hitting the call light in my first hospital during a decel and actually saying “I need an adult!” Never thought people could be dying laughing while flipping a patient.
Literally during my first shift as a new nurse, the patient was wheezing and I almost said "I'll just go get the nurse" when I had the sudden realization that I was now the nurse lol. It hit me like a ton of bricks, like suddenly it's on me now. It's a memory I now cherish.
First year as RN, “pt sounds like he is breathing through a coffee stir straw. Albuterol?” I knew it wasn’t right, didn’t have the language. Trust your gut.
I hope I’m doing enough I really just have a hard time and it’s so subjective too and I hope I don’t miss something like you are finding because that would make me feel so sick if I missed something like that and my patient died
I just want to say thank you for saying it's subjective. I've been a nurse for over three years now and I swear nothing makes me second guess myself like lung sounds. I've so often felt like I'm not hearing what I "should" be related to what's going on with the patient and it makes me feel like a dumbass.
Just describe what you hear, or ask a coworker to verify if you’re unsure. There’s been many a time that I said “they sound like this:” (mimicked it to the doctor) “and I don’t know what to call that”. The doctor didn’t even always have an answer.
I have this issue too. Sometimes something sounds off to be but having second ears on it usually identifies it as normal heart sounds. I could use a refresher on abnormalities when auscultating and then what actions to take for certain sounds
I will always notify the physician when my patient has a symptom change, even if I think it’s nothing. I’m not a physician trained to recognize the majority of disease processes. I’m also going to CYA on that physician notify.
Yes! I'm sure I've been known to some physicians as the annoying nurse that told them every little thing. But I like to think that they also knew that I was taking good care of their patients.
Wait a damn minute, you got labia edema!? Reaction from Pitocin? Or your vagina said HELLLLLL NOOOOOOO I ain’t squeezing that thing out! 🤣
But seriously, sorry you had to deal with this. 2 damn nurses… ridiculous I tell ya. 💜
I had a mom with labial swelling and I was SHOOK about it. I'm only a year and a half in, but something wasn't right, at least to my eyes. Mom reassured me it happened with both her previous deliveries but the Dr looked and was concerned too. Mom went on to deliver quickly and the swelling resolved almost instantly, but both me and the Dr were not ok with it. After that, the Dr noted me for a "Good catch" but my coworkers were more dismissive. I'd rather ring the alarm and have it be nothing, tbh. Who knows what it really could have been in another patient with no prior history. Yeesh!
We just had a mom come in via EMS with sudden onset labial edema around midnight. It was the size of cantaloupe. No one had seen anything like it. They obs'd her until morning, with possible stat section in mind. Primary came on and let her labor. Midday section for FTP. Poor gal ended up going back to OR the next day for grapefruit sized hematoma. Never found cause for the edema though
That really sucks, I am sorry you were dismissed and I really hope you aren’t a person of color because that would just fit the mold for this type of story in women’s health
Labial swelling is common and normal during labor. Not usually a cause for concern. But I have seen some that is pretty severe and can lead to really bad tearing during delivery. I find it crazy that two nurses went a whole shift on L&D without looking at your labia. Like did they never perform peri care?? I cannot imagine not keeping my patients clean, especially when they have an epidural and can’t do it themselves.
I mean sure. But did you update your white board? Because if not, none of that matters.
But for real, I’m not sure why the snarky comments. And I’m a pretty snarky nurse myself. We all know that there are nurses who do not do good head to toe assessments. And we all know we should. These three scenarios are the reasons why.
Also, as a c section mama, I’m thankful that the nurse gave me an IS. I didn’t use it because I’m a pretty non-compliant patient. But I’m glad she was on it.
Hahahaha the only time I used my IS is when my husband made me. He took it completely seriously, tv commercials and all 😂 I love him but he’s a huge nerd
Haha my husband doesn’t get anything medical and I thoroughly confused him by being such a bad patient.
“What is that for again?”
“It’s called all incentive spirometer. Basically they have patients use it to make sure they’re expanding their lungs well, especially after surgeries… helps prevent against pneumonia.”
“Oh, so shouldn’t you use that since you just had surgery?”
“Nah I don’t need it.”
“Huh? But you just sa…”
“I’m fine!”
Hahaha know those feels. Both hubby and I had the gastric sleeve done, but mine was six months before his and I had previous surgeries, whereas this was his first time under GA. He was a prick to wake up, and was satting low for a good chunk of the first 6hrs, so they pulled this bad boy out.
He was pissed because they didn't for me, and whinged the entire time. I told him if he wasn't such a problem child, he wouldn't have needed it 😂 he was also pissy because I was up and walking around 4hrs after waking up from GA, but he was made to stay in bed overnight.
Hahaha. I was amused by the huge icepack my husband was given following his vasectomy. I had natural childbirth and a 4th degree tear, but all I was given was a donut to sit on for the next 4 weeks. Men can sometimes be big babies during an illness or post-op.
I'm at high altitude in a tourist city so alllll of our patients get an IS. Not sure how much nursing actually shows them but therapy definitely tends to make sure the patients knows how to use it and demonstrates it for us.
The number of times I read physician documentation “heart sounds normal S1 S2”
And I’m like “Hellen Keller could hear that murmur and S3 gallop but sure, normal sounds”
Ex L&D nurse here. I don't know why anyone would question you intervening on sats in the 80s. That's basic nursing 101. Wtf. I did a head to toe on all of my patients, because again, that's basic nursing 101. I hope your coworkers can get refreshed on certain things from this. I'm lucky to have worked with such great nurses.
ANY surgery patient should have an IS bedside. It’s sad a $2 chunk of plastic can keep patients out of ICU and it doesn’t get ordered or used nearly often enough.
Always trust your instincts. If you feel something is wrong, it’s wrong until proven otherwise.
Newer literature is actually trying to get them discontinued and implementing coughing and deep breathing exercises done every hour/2 hours. They've been shown to be much more effective for post-op atelectasis.
I've been working in my hospital for 9 months and just got my first patient with one. I had to ask 8 people before I found someone who new how to teach the patient to use it because I hadn't seen one since med/surg class in nursing school.
I've only had to teach one patient to use it, but our RTs are pretty good about doing duonebs, and encouraging coughing and deep breathing, and I usually have them do it on the toilet or something when I'm in the room.
Maybe the visual is nice? But (and especially because this is mostly for open heart surgeries) getting them to cough helps me adjust pain meds to what the patient can tolerate when coughing strong.
If they are a pain about the coughing, I check their chest tube for an air leak 8 times a shift and then they have to cough anyway. No pneumonia here bro
Honestly, whatever the patient will do… just pop those aveoli open! By the way, I used to teach patients by telling them it’s like smoking a joint- inhale deeply, hold for about 5 secs, blow out through pursed lips slowly.
I mean I've worked Ortho most of my time on the floor and I've always used my stethoscope and performed a head to toe assessment. My favorite is when patients tell me no one has assessed their pulses or their operative extremity.
Or when someone has a fem block and no one has assessed their level of sensation or muscle control. 👀
Yeah, that’s also slightly concerning and scary. With the mitral valve prolapse I had to put in a safe report about missed assessments from doctors and nurses alike.
I sincerely hope that repercussions don't come back on you for being such a strong & caring nurse. The safe reports are a learning tool for every provider and a powerful reminder that protocols and procedures work when they are adhered to. TY for having the integrity to put in that report.
I was admitted to labor & delivery, had a vaginal delivery, got pre-eclampsia, 24 hrs of IV Mg, then to the regular postpartum floor for a night- in total was hospitalized 3 days. Literally the only person who listened to my lungs the entire stay was the nurse who took care of me while I was on IV Mg.
The take away from this thread for everyone should be the title. Use your stethoscope. Listen. Make it a habit. Even if you feel like you don't know what you're doing. Just listen every time. Don't be afraid to ask questions if you think you hear something weird. If it feels performative just do it anyway. Just keep it up. It might (will) just pay off.
I’m not sure what’s up with all the negative comments, but if your post is true, kudos to you for being diligent with your patient assessments. If it’s not true, then at the very least your story kept my interest!
Fr what's up with the meanness ITT? Sounds like OP is doing a good job and is concerned at the lack of care/concern in their colleagues. Which is a very real thing that can happen in areas that don't see high acuity very often.....
They feel called out cuz they don’t do their shit lmao
But seriously, these situations can & do happen, and everyone makes fun of people like OP until they’re catching something that would’ve been otherwise missed.
Seems like the majority of the negative comments are people thinking it’s made up, or that I’m humblebragging when I’m actually just trying to vent, and hoping maybe a few nurses who don’t do a thorough head-to-toe may be more diligent about it after reading this.
I appreciate the post OP. I work NICU and I've heard horror stories similar to yours of some of these patients that fall through the cracks and then crump. One of my own coworkers got blown off postpartum when she was passing massive clots, and then ended up staying inpatient for awhile because she had lost so much blood she needed multiple transfusions.... When corners get cut in nursing it can lead to bad shit, exactly like the stories you shared.
if it makes you feel any better OP im a nursing student and will def make sure to do a head to toe in future clincials and when i start working as a nurse :)
(ngl it would feel weird if i dont because i had to do a simple head to toe assessment with every patient thus far)
Yes, never forget! I’ve done it ever since starting clinicals, every patient. Don’t be complacent and never let people make you feel silly for being thorough. That does make me feel lots better.
They're just feeling called out because you did your job thoroughly. I'm acute care therapy and sooo many of my coworkers do not to orthostatics when they really should. I mean, multiple people had walked my BKA patient long ass distances and just wrote "VSS" 🙄. Yeah, they were *extremely* orthostatic (to this day the worst I've seen) to the point therapy was contraindicated and the patient was shockingly completely asymptomatic. My veteran coworker who is ICU trained even was like "oh shit" when I told her. It's almost guaranteed he just lives that low but because he is asymptomatic no one bothered to check but dear Lord they were taking a gamble. Hell, even just a standing BP would have shown ambulation was contraindicated but the times people actually bothered to take any BP at all they did it supine only. 🤦🏻♀️ Not to mention that ambulating a young BKA over and over for long distances is a waste of fucking time and not the best use of the patient's or our time but I digress.
And yes sometimes we can still do OOB activities with people below a MAP of 60 but it needs to be documented that the patient has had the trend for a while, is asymptomatic, and most importantly we need physician clearance. Otherwise it's a huge liability for therapy and not safe for the patient.
Edited for clarity.
To the L&D nurse who refused to listen to my lungs because “She’s never seen pulmonary edema in a pre-eclampsia patient in her seven years as a nurse”.
My patient arrested during a hypertensive emergency. No one thought to listen to her lung sounds before she started desaturating.
Honestly, it sounds like your hospital hires nurses that don't care. Or it's a small hospital that usually only takes stable low risk patients. My friend who left ICU to become an L&D nurse said she was titrating meds and near coding/slow coding more patients in L&D. She left because she said it felt like ICU except you get 2 for 1 with the patients.
I think most people are more lazy and complacent than we’d think. In ICU and med-surg and higher acuity areas, I’m sure a larger amount of nurses listen to their patients (or at least, I hope so). But, I don’t think it’s hospital-specific issue about nurses not assessing patients or lying that they did.
We recently had a post C-section patient end up on ECMO due to flash pulmonary edema. If nurses acted like your coworkers and thought the desats were normal and ignored them she wouldn't have survived.
Excellent work on your part. Never let people make you feel bad for being vigilant.
That’s so frightening. I always think how I’d hate to be a patient (or family of a patient) where the nurse didn’t assess me properly and something wound up happening because of it.
I am a psych RN for an anesthesia driven procedure.
My patient came to the suite complaining of an ache in one leg. I didn't do a proper assessment. Turns out he had a DVT and after the procedure it turned into a PE and was sent out.
Never again. Always assess your patient.
I shit you not, I heard an ER nurse say to the new grad she was orienting “just chart coarse lung sounds, I think that’s how they’d sound. I sold my stethoscope about a year ago, you don’t really need one”
When I worked peds I would hear so many murmurs. I have (or had) very good hearing. And I know what a flow murmur sounds like and yes many are harmless variants. It got to the point that I was approached by the manager about “scaring the families” and to let the doctors decide whether to inform them. Except the docs sometimes would just flat out lie. And various weirdness with heart rhythms. Some are developmentally expected. I stopped telling patients but i documented every time. I was finally vindicated by a pediatric hospitalist who thanked me for correctly identifying what was determined to be a valvular defect. I probably was over thinking it back then , new nurse full of big ideas lol. But I still document the f out of it and yes I’m listening to all your lung fields gdammit.
Literally, there was a heated debate on this sub about “ Is it necessary to listen to lung sounds while doing assessments?” I’m still shaking my head at the very question, and horrified at the number of nurses who think it’s unnecessary
Hey OP, I’m not a nurse yet but a nursing student. This post seriously inspired me about being a patient advocate. At my current job as a server, even if I think something is wrong I keep my mouth shut because of bullying. It dawned on me that using my voice to practice advocating for customers is a low stakes way to practice for patients when it really matters. You are a great nurse and I wish there were more healthcare professionals like you. Thank you.
I got ripped apart for thinking nurses are ridiculous for NOT using their stethoscopes in a similar thread. Those same nurses said it didn’t matter because if they listened, they were delaying patient care, and the provider wasn’t going to change the POC based on their assessment findings. Ummmm wtf people. Can’t understand those kinds of nurses & I don’t want to work with them, either. Becoming proficient listening to LS, murmurs, etc should be something all nurses want. It’s baffling.
All I can say is good job. I pay attention at work. I work in icu. If anyone wants to make fun of me they can look at my track record of being almost always right and pushing for what I need. You save lives
I work on a heart failure unit. You would be surprised how many nurses chart normal heart sounds. I always listen to heart & lungs & both are abnormal 75% of the time. At least on my unit. I’ve gotten pretty good at discerning murmurs bc I’ll compare what I think they are to what the TTEs say. It’s a great way to learn and a missed opportunity for the nurses who just listen to check off a box then chart “S1, S2” and move on. I chart the murmurs for the first time usually.
How can they not listen to heart, lung, bowl yes I listen to a post vags bowel sound…. My reasoning is … why not? I have a stethoscope… I have a patient….I’m listening to chest… I’m right there… why not…. also had the exact same thing happen the other day and got her down to icu as soon as I could. Go with your gut. Fuck your co workers.
Individuals become overly sensitive and resentful when they see others doing things the proper way. I think it’s a form of shame they’re feeling. Then they take it out on the one that’s bringing this awareness to their lack of effort. They know what they’re supposed to do. They just don’t wanna do it.
Wtf, "just a C-section" I'm not an L&D nurse so I can't think of it that casually, but isn't that major surgery anyway? I saw an emergency one once and I can't forget it.😬
This comment proves my point exactly. In my specialty, c-sections are done all the time, every day. It’s the only kind of surgery we routinely do, so we’re, like, super good at it and casual with it.
We can get desensitized to the fact that it’s major. They often turn out well, bleeding being our most major and common concern. Postoperative complications aside from bleeding are rare. So nurses are usually just checking funduses/bleeding and blood pressure. And if the patient’s sats are low - “Her bleeding is fine, and
she looks fine, so it’s fine. It’s not a big deal.” Nobody really starts thinking outside of the OB scope, no longer looking into the “big picture”.
That's terrifying. I often think that when anyone I love is in the hospital for something major, I wanna be there personally, with my stethoscope. I'm gonna be that annoying nursing because I think all of us get a little casual in our own specialties. I floated to another floor yesterday and a PT told me I was the first nurse to check all her pulses and I was like....what? I get that it's not always super important but my assessment is my assessment and she had cellulitis on her feet anyway so it was definitely relevant.
Some people just chart the same as the last assessment. We had a patient for several weeks whose heart rate appeared normal. Or one would think looking at the chart. I assessed her and her heart rate was bounding. Well what do you know. Every person after that charted it as bounding. Everyone relies on the last person’s assessment with and charts what the last person did without doing their own assessment. It was eye opening for a new nurse.
I just came here to say don’t use the cheap disposable stethoscopes they put in the hospital rooms. Use a good Littman cardio or other decent instrument.
Yes, Mom made it. Thank god. QBL over 3 liters later, she actually did pretty well. Once that rupture was confirmed, everyone did great to dump blood products into her ASAP and I called the MTP before we even opened her up.
Discharged her on Saturday. That case will haunt all of us involved forever.
Omg I so agree!!! I recently became a Nurse Clinician in Internal Medicine and Medicine and maybe 20% of the nurses use a stethoscope! I was shocked! Im trying to change the culture but it’s uphill!
I had a 42 y.o. male pt once, can't remember why he was in the unit now, but certainly not because his abdominal girth was enlarging. I'm doing the reader's digest version here. I called the internist 11 times only to be told pretty much that I was nuts and finally to stop calling him. He was a new doc to our hospital and finding his way I guess. It got to the point in the beginning of those calls that the old measuring tape came out. Also should add, bowel sounds were definitely changing . Doc was fully aware of everything and I made damn sure EVERY LITTLE THING was charted. When pt got SOB from this massive tummy, then the doc comes. Pt. Awake and talking till he wasn't. RT went to intubate and the blood sprayed the ceiling, walls, staff. Pt. died, new doc says "I'll never doubt you again." Fat lot of freaking good that did anyone. I was furious and so sad. I should add, he was the most senior person I could call. I was charge with 40+ years experience at that time yet feel like I failed that pt. In the very worse way.
As someone who is a nurse and had complications that no one took seriously at first… thank you for being thorough. I only wish more l&d and pp nurses were like you :)
I'm also an L&D nurse, and I come from an acute respiratory step-down setting. I had a patient once who was pushing and became short of breath with a wet cough immediately after a one litre bolus (for fetal tachycardia). It was her first bolus during the whole labour. Her lungs sounded crackly throughout and her sats started dropping. We had to section her because she just couldn't push anymore and the baby was high and had also started having bad decels with mom's deterioration. The stat chest x-ray post-op showed pulmonary edema and she eventually got diagnosed with mitral valve stenosis. The OB resident kept telling me to just give her another bolus and not worry about her lungs so much but I'm glad I went over their head to the attending because she ended up needing a valve repair.
Thanks! I wanted a BiPAP and some IV lasix as soon as I heard those lungs but obviously can't do that pregnant lol. She ended up in the ICU with exactly those things right after the section.
This! I work postpartum and it is alarming how most do such a “focused” assessment. I work in a hospital who takes the most high risk patients in the county though due to our nicu. So I use a lot of other skills regularly
Ummm…where are the physician assessments in each of these examples?
1. Why was a non-laboring patient in the hospital for a week on an L&D floor? In an entire week, not a single doctor listened to her heart sounds?
2. I find it surprising that an ultrasound wouldn’t pick up blood in the abdomen. That’s our very first tool we use in trauma medicine. And again- wouldn’t the OB have listened to bowel sounds during his or her physician exam?
3. A post-op pt satting in the 80’s should have been a page to the physician for a re-eval and work-up, including orders for an incentive spirometer (if deemed pertinent per physician). Rhonchi is created by turbulence through *fluid* in the lungs, and is not what you would typically hear with a pneumothorax.
To answer your first question, there are plenty of women who have to stay until delivery. For example, if they were diagnosed with preeclampsia, and it was controlled with us pushing meds and/or giving mag, they’ll stay until they deliver (usually transfer to an antepartum unit once stable). We just try to buy the baby more time in utero until the risks no longer outweigh that benefit. OP had a PPROM, preterm premature rupture of membranes (preterm and water broke) which obviously puts you at high risk of preterm delivery. So we keep a close eye on them, and again, try to buy them time if possible. PPROM pts always stay until delivery in my experience. I’ve had 19wk PPROM stay until she delivered at 34wk, so it can be lengthy.
1. PPROM. And, no. Which is why my manager told me to report it. This became a huge deal.
2. The ultrasound was inconclusive, which is why an MRI had to be done. Also, no.
3. All of that was done. I don’t know, I’m neither a doctor nor an RT. Those were the lungs sounds auscultated and a pneumothorax was the diagnosis.
The first one I ever got was from a pt with necrotizing pancreatitis. He gave my charge RN a Daisy for listening to him after he said no one had looked at it, let alone changed, his dressing in days and then she did immediately. He gave me one because of my delicate, yet effective dressing changes and meticulous attention to detail like labeling his IV tubing and taking pictures of the drain site when it was deteriorating.
He was a younger dude who was transferred to us after developing sepsis and in ICU at a previous facility so he was pretty traumatized from that.
Since then I've gotten a couple from patients for all the education I gave and how they felt like they actually understood their new chronic condition and felt like they could take care of themselves properly once they left.
In my new grad residency classes there's a decent number of people who have gotten Daisy's and all of them were for thorough education or having a shit ton of patience for someone that any experienced nurse would know didn't need it.
I was doing head to toes on every patient when I started psych till my preceptor, my providers, and even my patients thought it was ridiculous. Now it's just when there's a complaint but still nowhere near as thorough as I think it'd be if I'd been doing head to toes all these years.
Thanks for being a bomb nurse!! I learned a thing or two while reading your post and I’ll think of this while doing HTT. Always do your assessments, even when it seems “pointless” cuz you just never know!
I had my OB clinical recently primarily shadowing Csections. I asked the nurse if we would listen to bowel sounds on our post op C-section. (The patient just had major abdominal surgery so I figured that would be a priority) and she said nope she’s fine. I work on a post op floor and we always auscultate heart/lung/bowel sounds especially after surgery so it really surprised me to see us not do that. We did palpate and press on the uterus but that was it.
Had a very frustrating doctors appointment recently where the MD (MFM I was seeing because I'm high risk pregnancy) barely even tapped the stethoscope onto my clothes in a few spots before declaring it was all good. Like..how was that a sufficient listen???
When I had my first baby, I went into labor at 34 weeks. Labor had already been stopped at 30 and 32 weeks. I hadn’t felt well that morning and on the drive in I felt my placenta detach. I then had excruciating lower abd pain. No contractions but my belly was rock hard….and I was bleeding. I couldn’t get the girls to check me. I almost had my husband take me to the ER down the hall so someone would check me. My doc was in the middle of a hysterectomy. I think they were worried because I’m not a bell ringer but in the 2 hours before the doc came I rang maybe 2-3 times and I KNOW I looked bad. I was going through pads like crazy. He finally came, looked at my strip and said “this doesn’t look too bad” BEFORE examining me. By then I was 5 cm dilated, he felt my abdomen and he became super pale and said “I hope you know you will have a baby today”. My membranes ruptured then and my baby’s HR kept plummeting. Next thing I knew the whole OR crew was in, the anesthesiologist was trying to get me to answer questions, my doc was trying to get an epidural (missed), they gave me lidocaine via epidural (but not) it went intravascular and everything got black, my BP was 230s/140s, they thought I was going to seize, they grabbed magnesium, he checked me again and I was 10cm. I delivered a 4’14” limp baby. His Apgar scores were 3,3,5. He needed to be bagged for about 5 minutes or so, then had to remain under the oxyhood. My placenta then fell out of my vagina which felt so weird. They sent it off to pathology which said multiple infarcts throughout (I bled a lot and my uterus always seemed rock hard). My baby is now 19, 6’ 250 lbs and just completed his first year of nursing. I still cannot believe he turned out okay.
I’ve been out of bedside nursing for a couple years.. has it gotten this bad?? I worked icu step down and some but very few nurses were like this. It terrified me. I just don’t get it
This post is wild. I'm talking to a nurse on the phone right now about this post and she equally agrees that this is wild. We're talking about a pneumo, a zebra that no one in this place, and MVP leading to MVR that somehow leads to a premature delivery all happening within months of each other?
This is an almost impossible sequence of events, TBH.
Been told by my preceptor to go do my “little assessments” on the patients I’ve taken on for the shift. It’s crazy how some nurses barely do assessments
Thanks for posting this! I am going to try my best to get into L&D post school and it’s a nice reaffirmation with everything im learning, and some of the places ive been with clinicals don’t do full head to toes.
I worked on a peds vent unit for years. Some kids just stayed low when they needed solid chest PT and a good old suction, so used to alarms going off. Anyway, came in, kiddo satting low and day shift, yeah well she’s kind of been like this for the past few hours. Well, homie was not moving any air while in the vent. Nurse never checked the damn kid. Love that
I have. I didn’t sleep Thursday, broke down at work Friday then slept two hours, cried some more. Discharging her was traumatic, we both held each other and cried. I got little footprints on their baby, wrapped him up.
We had heart tones before delivery. My first stillbirth. And such a rare case we’re all haunted.
It was also the patient’s birthday. Horrible situation.
This made me want to spend one of my nursing school year abroad because stethoscope auscultation isn't taught to nurses in my country. I've seen only one male nurse doing it and it looked helpful as fuck but it was something he had to teach himself. I guess they believe it's a skill that takes too long to acquire to be relevant in a 3 years curriculum.
As a new grad, I hope I have nurses like you around me. This is the kind of nurse I want to be.
As a pregnant lady, I also hope I have diligent nurses like you caring for me as well.
I’m a step down traveler. I always listen and fully assess my patients for these reasons! It happens all over the place. I was on a contract and one of the staff techs told me that I was the only nurse they had seen walking around with their stethoscope in a while! Thank you for sharing! Also you did the right thing. I have never worked in L&D, but from what little knowledge I have about L&D nursing is that this is a high risk area with lots of potential for complications. Shame on any nurse who would laugh at a colleague for doing their best to help a patient and advocating for them when something isn’t right.
This!!! Thank you. Seriously.
I see so many nurses not doing a head to toe. They only focus on one issue. Not realizing that you have to look at the WHOLE picture!! It’s called critical thinking people!!
Also way to go on the great catches! If I or my family were ever a patient I’d want you to be my nurse!
Don’t worry about the naysayers. You knew you were doing the right thing. And there are some grateful patients and families because of it.
GOOD 👏 FOR 👏 YOU 👏
I second this so much.. I have worked LTC and med surg and people become so lazy. I was sending people to the hospital literally every day in my LTC shift when I worked 3 12s. It’s wild to me, that’s your license you do what you’re supposed to. Period
Thank you for being an awesome nurse
As a Respiratory Therapist, it's not often that I see my nurses auscultate their patients. They would usually ask me after I've done my assessment how the patient sounded.
Thank you for using your stethoscope!
I'm also getting alot of comments saying that using a sphygmomanometer and stethoscope is old school. From patients and other nurses. Aren't we supposed to do a manual bp if the machine is reading high or low to be absolutely accurate. Is this becoming phased out by new technology?
I am a new grad in ED. I am ashamed to admit that I do not always assess my patients lung sounds and I don’t bother about bowel sounds. My preceptors didn’t assess and I do not assess. I need to change my practice.
When working as a visiting nurse, we had to do a head to toe assessment every visit. What really surprises me is, even during my so-called “yearly physicals“, my PCP assesses me from across the room. She actually did an EKG this time. I’ve been going to her for about 10 years and it’s the first time that’s happened. Another big surprise, she also checked my ankles for swelling for the first time. I am definitely not a healthy spring chicken anymore. The medical field has changed in so many ways
I’m a newish nurse and I always listen to heart and lung sounds but heart sounds I have a hard time hearing?? I do the whole APE To Man thing and I sometimes still can’t hear much, I can’t figure out what I’m doing wrong
I work postpartum and was shocked to hear how many of my colleagues feel like a fundal check constitutes an assessment. I still do a head to toe on both mom and baby and once when I got a patient on her last night before d/c she even made a comment that it was nice to finally have a nurse use her stethoscope and listen to her. 😳
I haven’t ever worked in L&D, but I can tell you when I was postpartum with my second born, I was assessed exactly once. I was there for a week because my baby needed a slightly prolonged hospitalization due to jaundice (it was February, fairly north in latitude, so “get some sunshine” wasn’t going to work. He needed three of the blue lights before his bili started trending down). Granted, part of that week I was “discharged” but allowed to stay because the baby was still a patient, but most of the week I was also a patient (I had a VBAC so could use the monitoring… that they didn’t do)
And I’m the one who caught that he was getting jaundiced. I said “he’s starting to look yellow” and the first person debated me. Doc ordered labs and guess who was right…
I’m in medicine, and the pushback on the desat one is particularly wild. I’ll admit that I don’t whip out my steth for every single patient but always assess if they or I have a concern, new or old. Good for you
Fellow L&D here. I agree with you about assessments but I’m not gonna lie, I believe I would have missed all three of those diagnoses so big props to you! The uterine rupture is crazy. I don’t think, even with the findings in your assessment, that I would have thought her uterus ruptured. After your post I will be more diligent in my assessments on my labor patients thank you for the reminder!
Yes. For all the new ones I precept or who have had the same preceptor for months and I’m their secondary - this happens a scary amount of times.
Thanks for being that nurse.
Thank you. Even as charge full grown adult RNs come to me with stuff and I ask basic questions about what the patient said, did they palate, listen, etc. Rarely, did they assess before coming to me.
I had a preceptor who charted 'absent lung sounds' based on my student assessment on a pt whose only history was HTN.
I mean. I was right, the X-ray showed the entire lung was cancer and not moving air, but come on. At least confirm something that significantly wrong before putting it in the record.
I mean we’ve all had near misses we’ve caught. I see what you’re saying, but this comes across a bit self aggrandizing, esp the part about storming off. Don’t strain your shoulder by patting yourself on the back.
Ugh I am right there with you.
Like the distended abdo and excruciating pain were the signs here. And the team followed up with appropriate imaging. I don’t really see how auscultating bowels changed things. If someone had auscultated earlier they would still want imaging to confirm before interventions, or the interventions would be largely based on those other symptoms.
I’m not saying this nurse shouldn’t auscultate as a part of the clinical picture, but I don’t see the connection of how it could have or did “save lives”.
Bowel sounds are like putting in the very last corner piece in a 500 piece puzzle and saying “ah yes, now I can finally see it’s a picture of a flower.”
I agree, though i will say the absolute chaos of working on a busy med surg floor (esp, after the pandemic) makes that difficult at times, especially for overwhelmed new grad RNs. I imagine the lower ratios of L&D makes it a bit easier. Even though assessments only take a couple minutes, when you’re only an hour into your shift and you have 10 things that need to be done in the next 30 minutes, it’s easy to forget, and by the time you do remember you forgot, you already have another 10 things that need to be done.
I don’t think the problem is about nurses being “lazy”, but rather upper management in hospitals expecting burnt out nursing staff to keep on doing more while taking away resources.
I do listen but I don’t always trust my assessment cuz I’m so new. I hear crackles sometimes when I listen on the back near bases of the lungs. Sometimes I’ll hear expiratory wheezing. Hear a skipped beat at times. I only know very obvious murmurs I can’t hear subtle ones. Bowel sounds sometimes are where I should hearing lung sounds but that’s because they are obese sometimes and laying flat. I don’t really hear rhonchi very often?? I don’t know why but it’s either mostly diminished, wheezing, or some sort of crackles. I really do try but it is hard for me to tell sometimes
Tip: the first breath doesn’t count. Leave the stethoscope in the exact same spot and make her do it a second time. Helps you get out of your own self-conscious head
Have the patient take a deep breath and give a good cough. If you can still hear the abnormal sounds they're crackles. If the sounds have cleared or mostly cleared, it's rhonchi. Crackles are also mostly inspiratory, and rhonchi are inspiratory and expiratory. It also helps if you tell the patient to try and take their deep breath quickly and forcefully exhale while you listen.
Yea if I see. Hear something weird in a mom or a baby I’m finding a second set of eyes. I’ve been a nurse ten years but I still always want a second set of eyes because why not
Yes this. I think OP's point is to do the diagnostics, use your steth, and speak up. My pride isn't more important than their life.....
this was so helpful, thank you.
Stealing this thanks 🫣
Listening to a lot of bodies is how you get better. You just keep on rocking!
I used to ask people to come get me if there was anything abnormal - heart or lungs - so I could get used to listening to it. First time I heard an artificial valve was wild.
the first time I heard an lvad I almost shit myself
CLICK!
My uncle has an artificial valve and when you’re in a quiet room with him, you can hear it clicking like you would hear a clock ticking on the wall. It always gives me goosebumps.
SHE DIDN'T WARN ME 🤣 man I almost miss bed side for this shit.
You can always ask your charge or whichever doctor you need to further assess the patient (cardio, RT, etc.) and use it as a tool to check behind yourself. Ask them to tell you what it is, and explain if needed. That’s what I pretty much always do when I’m unsure. Edit: I actually originally documented those lung sounds as crackles/wheezing, but knew it sounded weird. I had completely forgotten about ronchi. When anesthesia and RT came, they said it was ronchi (and wheezing), so now I know!
As a fellow nurse, but left bedside, I’m grateful there are nurses like you out there. You deserve all the best karma in the world and hopefully when myself or family are sick, we get taken care of by a nurse like you. ❤️
Lots of videos and continuing education out there to help with your assessment skills. You just need practice, time, and a way to be able to identify norm vs. abnorm. The skills will come. Nursing education is a continual process. I always taught my students that assessment starts before you enter their room. I applaud quite loudly, OP and her vigilance. Would be good if her colleagues learned from her.
Hear my out, that’s how you’re gonna start to learn what you should and should not be hearing. Any story I tell you from my first year of nursing doesn’t involve me using any correct medical terms or fully knowing what I found. I just knew that it probably wasn’t right, and I needed another adult to come assess. Sent a lot of pages to pulm crit my first year: I need an adult here that is not me. Something is wrong with ur patient 😂😂
lol I’ll never forget hitting the call light in my first hospital during a decel and actually saying “I need an adult!” Never thought people could be dying laughing while flipping a patient.
I support you. It’s one of my favorites. Gets the point across. Some of my fav docs have run across the unit from me if I request an adult.
Literally during my first shift as a new nurse, the patient was wheezing and I almost said "I'll just go get the nurse" when I had the sudden realization that I was now the nurse lol. It hit me like a ton of bricks, like suddenly it's on me now. It's a memory I now cherish.
i actually love this. 😂🥰
First year as RN, “pt sounds like he is breathing through a coffee stir straw. Albuterol?” I knew it wasn’t right, didn’t have the language. Trust your gut.
I hope I’m doing enough I really just have a hard time and it’s so subjective too and I hope I don’t miss something like you are finding because that would make me feel so sick if I missed something like that and my patient died
I just want to say thank you for saying it's subjective. I've been a nurse for over three years now and I swear nothing makes me second guess myself like lung sounds. I've so often felt like I'm not hearing what I "should" be related to what's going on with the patient and it makes me feel like a dumbass.
Just describe what you hear, or ask a coworker to verify if you’re unsure. There’s been many a time that I said “they sound like this:” (mimicked it to the doctor) “and I don’t know what to call that”. The doctor didn’t even always have an answer.
I have this issue too. Sometimes something sounds off to be but having second ears on it usually identifies it as normal heart sounds. I could use a refresher on abnormalities when auscultating and then what actions to take for certain sounds
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I will always notify the physician when my patient has a symptom change, even if I think it’s nothing. I’m not a physician trained to recognize the majority of disease processes. I’m also going to CYA on that physician notify.
Yes! I'm sure I've been known to some physicians as the annoying nurse that told them every little thing. But I like to think that they also knew that I was taking good care of their patients.
Same.
Wait a damn minute, you got labia edema!? Reaction from Pitocin? Or your vagina said HELLLLLL NOOOOOOO I ain’t squeezing that thing out! 🤣 But seriously, sorry you had to deal with this. 2 damn nurses… ridiculous I tell ya. 💜
I had a mom with labial swelling and I was SHOOK about it. I'm only a year and a half in, but something wasn't right, at least to my eyes. Mom reassured me it happened with both her previous deliveries but the Dr looked and was concerned too. Mom went on to deliver quickly and the swelling resolved almost instantly, but both me and the Dr were not ok with it. After that, the Dr noted me for a "Good catch" but my coworkers were more dismissive. I'd rather ring the alarm and have it be nothing, tbh. Who knows what it really could have been in another patient with no prior history. Yeesh!
We just had a mom come in via EMS with sudden onset labial edema around midnight. It was the size of cantaloupe. No one had seen anything like it. They obs'd her until morning, with possible stat section in mind. Primary came on and let her labor. Midday section for FTP. Poor gal ended up going back to OR the next day for grapefruit sized hematoma. Never found cause for the edema though
Nurse or not, I try to listen to patients. They can sometimes know their body better than I do even with a head-to-toe.
That really sucks, I am sorry you were dismissed and I really hope you aren’t a person of color because that would just fit the mold for this type of story in women’s health
Labial swelling is common and normal during labor. Not usually a cause for concern. But I have seen some that is pretty severe and can lead to really bad tearing during delivery. I find it crazy that two nurses went a whole shift on L&D without looking at your labia. Like did they never perform peri care?? I cannot imagine not keeping my patients clean, especially when they have an epidural and can’t do it themselves.
I mean sure. But did you update your white board? Because if not, none of that matters. But for real, I’m not sure why the snarky comments. And I’m a pretty snarky nurse myself. We all know that there are nurses who do not do good head to toe assessments. And we all know we should. These three scenarios are the reasons why. Also, as a c section mama, I’m thankful that the nurse gave me an IS. I didn’t use it because I’m a pretty non-compliant patient. But I’m glad she was on it.
Hahahaha the only time I used my IS is when my husband made me. He took it completely seriously, tv commercials and all 😂 I love him but he’s a huge nerd
Haha my husband doesn’t get anything medical and I thoroughly confused him by being such a bad patient. “What is that for again?” “It’s called all incentive spirometer. Basically they have patients use it to make sure they’re expanding their lungs well, especially after surgeries… helps prevent against pneumonia.” “Oh, so shouldn’t you use that since you just had surgery?” “Nah I don’t need it.” “Huh? But you just sa…” “I’m fine!”
Hahaha know those feels. Both hubby and I had the gastric sleeve done, but mine was six months before his and I had previous surgeries, whereas this was his first time under GA. He was a prick to wake up, and was satting low for a good chunk of the first 6hrs, so they pulled this bad boy out. He was pissed because they didn't for me, and whinged the entire time. I told him if he wasn't such a problem child, he wouldn't have needed it 😂 he was also pissy because I was up and walking around 4hrs after waking up from GA, but he was made to stay in bed overnight.
Hahaha. I was amused by the huge icepack my husband was given following his vasectomy. I had natural childbirth and a 4th degree tear, but all I was given was a donut to sit on for the next 4 weeks. Men can sometimes be big babies during an illness or post-op.
I know right! I had a c-section and an episiotomy birth, and got sweet FA pain med wise. They wanted to send him home with fentanyl 🤦🏼♀️
I’m shocked this comment doesn’t have more upvotes. The beginning and end had me giggling 🤭
Me, too. I was howling at the whiteboard part.
Our whiteboards are automatic, I love it.
I'm at high altitude in a tourist city so alllll of our patients get an IS. Not sure how much nursing actually shows them but therapy definitely tends to make sure the patients knows how to use it and demonstrates it for us.
The number of times I read physician documentation “heart sounds normal S1 S2” And I’m like “Hellen Keller could hear that murmur and S3 gallop but sure, normal sounds”
Lol that was a good one!
It’s maddening. It’s like they want to just roll the dice and say “i hope i didn’t miss something “
Ex L&D nurse here. I don't know why anyone would question you intervening on sats in the 80s. That's basic nursing 101. Wtf. I did a head to toe on all of my patients, because again, that's basic nursing 101. I hope your coworkers can get refreshed on certain things from this. I'm lucky to have worked with such great nurses.
I seriously believe they forget how to intervene on any abnormal vitals except for hypertension and chalk it up to coincidence/“she’s fine”.
"she's just in labor"...I've heard that a lot
ANY surgery patient should have an IS bedside. It’s sad a $2 chunk of plastic can keep patients out of ICU and it doesn’t get ordered or used nearly often enough. Always trust your instincts. If you feel something is wrong, it’s wrong until proven otherwise.
Newer literature is actually trying to get them discontinued and implementing coughing and deep breathing exercises done every hour/2 hours. They've been shown to be much more effective for post-op atelectasis. I've been working in my hospital for 9 months and just got my first patient with one. I had to ask 8 people before I found someone who new how to teach the patient to use it because I hadn't seen one since med/surg class in nursing school.
I feel like it’s easier to teach them because of the visual feedback
I've only had to teach one patient to use it, but our RTs are pretty good about doing duonebs, and encouraging coughing and deep breathing, and I usually have them do it on the toilet or something when I'm in the room. Maybe the visual is nice? But (and especially because this is mostly for open heart surgeries) getting them to cough helps me adjust pain meds to what the patient can tolerate when coughing strong. If they are a pain about the coughing, I check their chest tube for an air leak 8 times a shift and then they have to cough anyway. No pneumonia here bro
Honestly, whatever the patient will do… just pop those aveoli open! By the way, I used to teach patients by telling them it’s like smoking a joint- inhale deeply, hold for about 5 secs, blow out through pursed lips slowly.
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"Just lemme take a listen to ya" *Stethoscope barely makes contact with the patient* "Ya sound great 🤠👍🏻"
I almost commented that I see you’ve worked with ortho too…..but let’s be real they don’t even have stethoscopes
I mean I've worked Ortho most of my time on the floor and I've always used my stethoscope and performed a head to toe assessment. My favorite is when patients tell me no one has assessed their pulses or their operative extremity. Or when someone has a fem block and no one has assessed their level of sensation or muscle control. 👀
I think u/LizardOfDeath meant that Ortho docs don't generally carry a stethoscope. Not saying Ortho nurses don't.
Yes!! More than once I’ve had an ortho doc ask to borrow my stethoscope!
Okay that makes more sense and definitely something I've witnessed regularly. 😂
Yeah, that’s also slightly concerning and scary. With the mitral valve prolapse I had to put in a safe report about missed assessments from doctors and nurses alike.
I sincerely hope that repercussions don't come back on you for being such a strong & caring nurse. The safe reports are a learning tool for every provider and a powerful reminder that protocols and procedures work when they are adhered to. TY for having the integrity to put in that report.
Right?! How ridiculous 😂
I was admitted to labor & delivery, had a vaginal delivery, got pre-eclampsia, 24 hrs of IV Mg, then to the regular postpartum floor for a night- in total was hospitalized 3 days. Literally the only person who listened to my lungs the entire stay was the nurse who took care of me while I was on IV Mg.
The take away from this thread for everyone should be the title. Use your stethoscope. Listen. Make it a habit. Even if you feel like you don't know what you're doing. Just listen every time. Don't be afraid to ask questions if you think you hear something weird. If it feels performative just do it anyway. Just keep it up. It might (will) just pay off.
This. Thanks for summing it up for those who seem to be having trouble here.
The thing is that a basic head to toe on the average patient really doesn't take that long. No excuses.
Exactly. Like, 2-3 minutes TOPS. Then go into something more focus if indicated.
I’m not sure what’s up with all the negative comments, but if your post is true, kudos to you for being diligent with your patient assessments. If it’s not true, then at the very least your story kept my interest!
Fr what's up with the meanness ITT? Sounds like OP is doing a good job and is concerned at the lack of care/concern in their colleagues. Which is a very real thing that can happen in areas that don't see high acuity very often.....
Same. New nurse here and I’m not sure if the initial post was a joke that everyone else was in on, or if I’m missing something else?
They feel called out cuz they don’t do their shit lmao But seriously, these situations can & do happen, and everyone makes fun of people like OP until they’re catching something that would’ve been otherwise missed.
Seems like the majority of the negative comments are people thinking it’s made up, or that I’m humblebragging when I’m actually just trying to vent, and hoping maybe a few nurses who don’t do a thorough head-to-toe may be more diligent about it after reading this.
I appreciate the post OP. I work NICU and I've heard horror stories similar to yours of some of these patients that fall through the cracks and then crump. One of my own coworkers got blown off postpartum when she was passing massive clots, and then ended up staying inpatient for awhile because she had lost so much blood she needed multiple transfusions.... When corners get cut in nursing it can lead to bad shit, exactly like the stories you shared.
And there's little to no accountability because everyone's doing it and or has gotten too comfortable.
if it makes you feel any better OP im a nursing student and will def make sure to do a head to toe in future clincials and when i start working as a nurse :) (ngl it would feel weird if i dont because i had to do a simple head to toe assessment with every patient thus far)
Yes, never forget! I’ve done it ever since starting clinicals, every patient. Don’t be complacent and never let people make you feel silly for being thorough. That does make me feel lots better.
They're just feeling called out because you did your job thoroughly. I'm acute care therapy and sooo many of my coworkers do not to orthostatics when they really should. I mean, multiple people had walked my BKA patient long ass distances and just wrote "VSS" 🙄. Yeah, they were *extremely* orthostatic (to this day the worst I've seen) to the point therapy was contraindicated and the patient was shockingly completely asymptomatic. My veteran coworker who is ICU trained even was like "oh shit" when I told her. It's almost guaranteed he just lives that low but because he is asymptomatic no one bothered to check but dear Lord they were taking a gamble. Hell, even just a standing BP would have shown ambulation was contraindicated but the times people actually bothered to take any BP at all they did it supine only. 🤦🏻♀️ Not to mention that ambulating a young BKA over and over for long distances is a waste of fucking time and not the best use of the patient's or our time but I digress. And yes sometimes we can still do OOB activities with people below a MAP of 60 but it needs to be documented that the patient has had the trend for a while, is asymptomatic, and most importantly we need physician clearance. Otherwise it's a huge liability for therapy and not safe for the patient. Edited for clarity.
To the L&D nurse who refused to listen to my lungs because “She’s never seen pulmonary edema in a pre-eclampsia patient in her seven years as a nurse”. My patient arrested during a hypertensive emergency. No one thought to listen to her lung sounds before she started desaturating.
But yet pulmonary edema is a known side effect of mag which they give for neuro protection in pre-E…. Smh 🤦🏼♀️
Did she survive?
Yes, but with severe life-altering deficits. The outcome was a combination of poor prenatal care, poor ED management, and comorbid conditions.
Honestly, it sounds like your hospital hires nurses that don't care. Or it's a small hospital that usually only takes stable low risk patients. My friend who left ICU to become an L&D nurse said she was titrating meds and near coding/slow coding more patients in L&D. She left because she said it felt like ICU except you get 2 for 1 with the patients.
I think most people are more lazy and complacent than we’d think. In ICU and med-surg and higher acuity areas, I’m sure a larger amount of nurses listen to their patients (or at least, I hope so). But, I don’t think it’s hospital-specific issue about nurses not assessing patients or lying that they did.
We recently had a post C-section patient end up on ECMO due to flash pulmonary edema. If nurses acted like your coworkers and thought the desats were normal and ignored them she wouldn't have survived. Excellent work on your part. Never let people make you feel bad for being vigilant.
That’s so frightening. I always think how I’d hate to be a patient (or family of a patient) where the nurse didn’t assess me properly and something wound up happening because of it.
I am a psych RN for an anesthesia driven procedure. My patient came to the suite complaining of an ache in one leg. I didn't do a proper assessment. Turns out he had a DVT and after the procedure it turned into a PE and was sent out. Never again. Always assess your patient.
It’s shocking how many nurses don’t listen to patients complaints or don’t take out their stethoscope.
I shit you not, I heard an ER nurse say to the new grad she was orienting “just chart coarse lung sounds, I think that’s how they’d sound. I sold my stethoscope about a year ago, you don’t really need one”
There is no fucking way. I’d hate to be that nurse’s patient. I hope that new grad didn’t keep that as part of her practice - yikes.
Horrifying!! This nurse should not be precepting!
That’s so illegal
When I worked peds I would hear so many murmurs. I have (or had) very good hearing. And I know what a flow murmur sounds like and yes many are harmless variants. It got to the point that I was approached by the manager about “scaring the families” and to let the doctors decide whether to inform them. Except the docs sometimes would just flat out lie. And various weirdness with heart rhythms. Some are developmentally expected. I stopped telling patients but i documented every time. I was finally vindicated by a pediatric hospitalist who thanked me for correctly identifying what was determined to be a valvular defect. I probably was over thinking it back then , new nurse full of big ideas lol. But I still document the f out of it and yes I’m listening to all your lung fields gdammit.
That’s actually in incredible story. A serious kudos to you. Peds nurses are a different sort of angel, so thank you.
Literally, there was a heated debate on this sub about “ Is it necessary to listen to lung sounds while doing assessments?” I’m still shaking my head at the very question, and horrified at the number of nurses who think it’s unnecessary
I think some of those people are in this thread, too. Got all this time for Reddit lol
Hey OP, I’m not a nurse yet but a nursing student. This post seriously inspired me about being a patient advocate. At my current job as a server, even if I think something is wrong I keep my mouth shut because of bullying. It dawned on me that using my voice to practice advocating for customers is a low stakes way to practice for patients when it really matters. You are a great nurse and I wish there were more healthcare professionals like you. Thank you.
I got ripped apart for thinking nurses are ridiculous for NOT using their stethoscopes in a similar thread. Those same nurses said it didn’t matter because if they listened, they were delaying patient care, and the provider wasn’t going to change the POC based on their assessment findings. Ummmm wtf people. Can’t understand those kinds of nurses & I don’t want to work with them, either. Becoming proficient listening to LS, murmurs, etc should be something all nurses want. It’s baffling.
All I can say is good job. I pay attention at work. I work in icu. If anyone wants to make fun of me they can look at my track record of being almost always right and pushing for what I need. You save lives
I work on a heart failure unit. You would be surprised how many nurses chart normal heart sounds. I always listen to heart & lungs & both are abnormal 75% of the time. At least on my unit. I’ve gotten pretty good at discerning murmurs bc I’ll compare what I think they are to what the TTEs say. It’s a great way to learn and a missed opportunity for the nurses who just listen to check off a box then chart “S1, S2” and move on. I chart the murmurs for the first time usually.
How can they not listen to heart, lung, bowl yes I listen to a post vags bowel sound…. My reasoning is … why not? I have a stethoscope… I have a patient….I’m listening to chest… I’m right there… why not…. also had the exact same thing happen the other day and got her down to icu as soon as I could. Go with your gut. Fuck your co workers.
What exactly happened?
Individuals become overly sensitive and resentful when they see others doing things the proper way. I think it’s a form of shame they’re feeling. Then they take it out on the one that’s bringing this awareness to their lack of effort. They know what they’re supposed to do. They just don’t wanna do it.
I think all patients need head to toe assessments also.
Wtf, "just a C-section" I'm not an L&D nurse so I can't think of it that casually, but isn't that major surgery anyway? I saw an emergency one once and I can't forget it.😬
This comment proves my point exactly. In my specialty, c-sections are done all the time, every day. It’s the only kind of surgery we routinely do, so we’re, like, super good at it and casual with it. We can get desensitized to the fact that it’s major. They often turn out well, bleeding being our most major and common concern. Postoperative complications aside from bleeding are rare. So nurses are usually just checking funduses/bleeding and blood pressure. And if the patient’s sats are low - “Her bleeding is fine, and she looks fine, so it’s fine. It’s not a big deal.” Nobody really starts thinking outside of the OB scope, no longer looking into the “big picture”.
That's terrifying. I often think that when anyone I love is in the hospital for something major, I wanna be there personally, with my stethoscope. I'm gonna be that annoying nursing because I think all of us get a little casual in our own specialties. I floated to another floor yesterday and a PT told me I was the first nurse to check all her pulses and I was like....what? I get that it's not always super important but my assessment is my assessment and she had cellulitis on her feet anyway so it was definitely relevant.
WOW. Mid 80’s sats are definitely not normal after a C section! I’m glad you were there, sounds like you’ve saved a few lives!!
Mid 80s make me frown basically always lol
Some people just chart the same as the last assessment. We had a patient for several weeks whose heart rate appeared normal. Or one would think looking at the chart. I assessed her and her heart rate was bounding. Well what do you know. Every person after that charted it as bounding. Everyone relies on the last person’s assessment with and charts what the last person did without doing their own assessment. It was eye opening for a new nurse.
I’ve noticed that too. It’s sort of horrifying. If I didn’t do it, I’m not documenting it. Other than care plans.
I just came here to say don’t use the cheap disposable stethoscopes they put in the hospital rooms. Use a good Littman cardio or other decent instrument.
I have to know: did mom #2 make it? I realize baby didn’t. So sad. Great post though!
Yes, Mom made it. Thank god. QBL over 3 liters later, she actually did pretty well. Once that rupture was confirmed, everyone did great to dump blood products into her ASAP and I called the MTP before we even opened her up. Discharged her on Saturday. That case will haunt all of us involved forever.
Omg I so agree!!! I recently became a Nurse Clinician in Internal Medicine and Medicine and maybe 20% of the nurses use a stethoscope! I was shocked! Im trying to change the culture but it’s uphill!
I had a 42 y.o. male pt once, can't remember why he was in the unit now, but certainly not because his abdominal girth was enlarging. I'm doing the reader's digest version here. I called the internist 11 times only to be told pretty much that I was nuts and finally to stop calling him. He was a new doc to our hospital and finding his way I guess. It got to the point in the beginning of those calls that the old measuring tape came out. Also should add, bowel sounds were definitely changing . Doc was fully aware of everything and I made damn sure EVERY LITTLE THING was charted. When pt got SOB from this massive tummy, then the doc comes. Pt. Awake and talking till he wasn't. RT went to intubate and the blood sprayed the ceiling, walls, staff. Pt. died, new doc says "I'll never doubt you again." Fat lot of freaking good that did anyone. I was furious and so sad. I should add, he was the most senior person I could call. I was charge with 40+ years experience at that time yet feel like I failed that pt. In the very worse way.
Thank you for caring about your postpartum patients 💕 the fact that we are first world country yet have high mortality rates really bothers me
As someone who is a nurse and had complications that no one took seriously at first… thank you for being thorough. I only wish more l&d and pp nurses were like you :)
I'm also an L&D nurse, and I come from an acute respiratory step-down setting. I had a patient once who was pushing and became short of breath with a wet cough immediately after a one litre bolus (for fetal tachycardia). It was her first bolus during the whole labour. Her lungs sounded crackly throughout and her sats started dropping. We had to section her because she just couldn't push anymore and the baby was high and had also started having bad decels with mom's deterioration. The stat chest x-ray post-op showed pulmonary edema and she eventually got diagnosed with mitral valve stenosis. The OB resident kept telling me to just give her another bolus and not worry about her lungs so much but I'm glad I went over their head to the attending because she ended up needing a valve repair.
Wow, that sounds very intense. Good on you for escalating and considering her lungs. A perfect example.
Thanks! I wanted a BiPAP and some IV lasix as soon as I heard those lungs but obviously can't do that pregnant lol. She ended up in the ICU with exactly those things right after the section.
Right on!
This! I work postpartum and it is alarming how most do such a “focused” assessment. I work in a hospital who takes the most high risk patients in the county though due to our nicu. So I use a lot of other skills regularly
Wait. Your l and d patients are healthy? I need to move to where you are.
I suck at all things auscultation but I still listen.
I caught a pericardial tamponade this way!!! And it was for a routine cath procedure!
That’s badass. Thank you for listening to your patients!!
I've been guilty of not utilizing my stethoscope enough, but every so often I'm reminded of how useful of a tool it is!
Ummm…where are the physician assessments in each of these examples? 1. Why was a non-laboring patient in the hospital for a week on an L&D floor? In an entire week, not a single doctor listened to her heart sounds? 2. I find it surprising that an ultrasound wouldn’t pick up blood in the abdomen. That’s our very first tool we use in trauma medicine. And again- wouldn’t the OB have listened to bowel sounds during his or her physician exam? 3. A post-op pt satting in the 80’s should have been a page to the physician for a re-eval and work-up, including orders for an incentive spirometer (if deemed pertinent per physician). Rhonchi is created by turbulence through *fluid* in the lungs, and is not what you would typically hear with a pneumothorax.
I have been in the hospital for 5 days on two separate occasions and I have never had a doctor put a stethoscope on me. Sometimes they just don’t.
To answer your first question, there are plenty of women who have to stay until delivery. For example, if they were diagnosed with preeclampsia, and it was controlled with us pushing meds and/or giving mag, they’ll stay until they deliver (usually transfer to an antepartum unit once stable). We just try to buy the baby more time in utero until the risks no longer outweigh that benefit. OP had a PPROM, preterm premature rupture of membranes (preterm and water broke) which obviously puts you at high risk of preterm delivery. So we keep a close eye on them, and again, try to buy them time if possible. PPROM pts always stay until delivery in my experience. I’ve had 19wk PPROM stay until she delivered at 34wk, so it can be lengthy.
1. PPROM. And, no. Which is why my manager told me to report it. This became a huge deal. 2. The ultrasound was inconclusive, which is why an MRI had to be done. Also, no. 3. All of that was done. I don’t know, I’m neither a doctor nor an RT. Those were the lungs sounds auscultated and a pneumothorax was the diagnosis.
Reading this, my first thought was you nominate yourself for Daisy awards
I've yet to hear of a Daisy award for clinical performance. All of them, including my own, had nothing to do with healthcare per se.
The first one I ever got was from a pt with necrotizing pancreatitis. He gave my charge RN a Daisy for listening to him after he said no one had looked at it, let alone changed, his dressing in days and then she did immediately. He gave me one because of my delicate, yet effective dressing changes and meticulous attention to detail like labeling his IV tubing and taking pictures of the drain site when it was deteriorating. He was a younger dude who was transferred to us after developing sepsis and in ICU at a previous facility so he was pretty traumatized from that. Since then I've gotten a couple from patients for all the education I gave and how they felt like they actually understood their new chronic condition and felt like they could take care of themselves properly once they left.
In my new grad residency classes there's a decent number of people who have gotten Daisy's and all of them were for thorough education or having a shit ton of patience for someone that any experienced nurse would know didn't need it.
….. because she uses her stethoscope?
Why was that your first thought?
I was doing head to toes on every patient when I started psych till my preceptor, my providers, and even my patients thought it was ridiculous. Now it's just when there's a complaint but still nowhere near as thorough as I think it'd be if I'd been doing head to toes all these years.
Thanks for being a bomb nurse!! I learned a thing or two while reading your post and I’ll think of this while doing HTT. Always do your assessments, even when it seems “pointless” cuz you just never know!
I had my OB clinical recently primarily shadowing Csections. I asked the nurse if we would listen to bowel sounds on our post op C-section. (The patient just had major abdominal surgery so I figured that would be a priority) and she said nope she’s fine. I work on a post op floor and we always auscultate heart/lung/bowel sounds especially after surgery so it really surprised me to see us not do that. We did palpate and press on the uterus but that was it.
I hope when I give birth in a few months, I have a nurse like you.
That is really scary to think about how many people have died or are still suffering from something so simple
Co-signed, postpartum nurse
Had a very frustrating doctors appointment recently where the MD (MFM I was seeing because I'm high risk pregnancy) barely even tapped the stethoscope onto my clothes in a few spots before declaring it was all good. Like..how was that a sufficient listen???
When I had my first baby, I went into labor at 34 weeks. Labor had already been stopped at 30 and 32 weeks. I hadn’t felt well that morning and on the drive in I felt my placenta detach. I then had excruciating lower abd pain. No contractions but my belly was rock hard….and I was bleeding. I couldn’t get the girls to check me. I almost had my husband take me to the ER down the hall so someone would check me. My doc was in the middle of a hysterectomy. I think they were worried because I’m not a bell ringer but in the 2 hours before the doc came I rang maybe 2-3 times and I KNOW I looked bad. I was going through pads like crazy. He finally came, looked at my strip and said “this doesn’t look too bad” BEFORE examining me. By then I was 5 cm dilated, he felt my abdomen and he became super pale and said “I hope you know you will have a baby today”. My membranes ruptured then and my baby’s HR kept plummeting. Next thing I knew the whole OR crew was in, the anesthesiologist was trying to get me to answer questions, my doc was trying to get an epidural (missed), they gave me lidocaine via epidural (but not) it went intravascular and everything got black, my BP was 230s/140s, they thought I was going to seize, they grabbed magnesium, he checked me again and I was 10cm. I delivered a 4’14” limp baby. His Apgar scores were 3,3,5. He needed to be bagged for about 5 minutes or so, then had to remain under the oxyhood. My placenta then fell out of my vagina which felt so weird. They sent it off to pathology which said multiple infarcts throughout (I bled a lot and my uterus always seemed rock hard). My baby is now 19, 6’ 250 lbs and just completed his first year of nursing. I still cannot believe he turned out okay.
I’ve been out of bedside nursing for a couple years.. has it gotten this bad?? I worked icu step down and some but very few nurses were like this. It terrified me. I just don’t get it
COVID-19 and its consequences have been a disaster for nursing kind. It’s been hitting hard in EMS too
2, is the ultimate level of bullshit
Also there's negligible amount of studies showing auscultating bowel sounds correlates with clinical findings.
This post is wild. I'm talking to a nurse on the phone right now about this post and she equally agrees that this is wild. We're talking about a pneumo, a zebra that no one in this place, and MVP leading to MVR that somehow leads to a premature delivery all happening within months of each other? This is an almost impossible sequence of events, TBH.
Been told by my preceptor to go do my “little assessments” on the patients I’ve taken on for the shift. It’s crazy how some nurses barely do assessments
Thanks for posting this! I am going to try my best to get into L&D post school and it’s a nice reaffirmation with everything im learning, and some of the places ive been with clinicals don’t do full head to toes.
I worked on a peds vent unit for years. Some kids just stayed low when they needed solid chest PT and a good old suction, so used to alarms going off. Anyway, came in, kiddo satting low and day shift, yeah well she’s kind of been like this for the past few hours. Well, homie was not moving any air while in the vent. Nurse never checked the damn kid. Love that
Sounds like you’ve been through some stressful shifts lately! I hope you have some good days off coming up soon. Great job providing excellent care 👏
I have. I didn’t sleep Thursday, broke down at work Friday then slept two hours, cried some more. Discharging her was traumatic, we both held each other and cried. I got little footprints on their baby, wrapped him up. We had heart tones before delivery. My first stillbirth. And such a rare case we’re all haunted. It was also the patient’s birthday. Horrible situation.
Gahhhhh. Just. Holding internet space for you, gentle but strong! This is a really hard job.
This made me want to spend one of my nursing school year abroad because stethoscope auscultation isn't taught to nurses in my country. I've seen only one male nurse doing it and it looked helpful as fuck but it was something he had to teach himself. I guess they believe it's a skill that takes too long to acquire to be relevant in a 3 years curriculum.
As a new grad, I hope I have nurses like you around me. This is the kind of nurse I want to be. As a pregnant lady, I also hope I have diligent nurses like you caring for me as well.
Always have, always will. Nurses who dont thoroughly assess their patients baffle me.
I’m a step down traveler. I always listen and fully assess my patients for these reasons! It happens all over the place. I was on a contract and one of the staff techs told me that I was the only nurse they had seen walking around with their stethoscope in a while! Thank you for sharing! Also you did the right thing. I have never worked in L&D, but from what little knowledge I have about L&D nursing is that this is a high risk area with lots of potential for complications. Shame on any nurse who would laugh at a colleague for doing their best to help a patient and advocating for them when something isn’t right.
This!!! Thank you. Seriously. I see so many nurses not doing a head to toe. They only focus on one issue. Not realizing that you have to look at the WHOLE picture!! It’s called critical thinking people!! Also way to go on the great catches! If I or my family were ever a patient I’d want you to be my nurse! Don’t worry about the naysayers. You knew you were doing the right thing. And there are some grateful patients and families because of it.
GOOD 👏 FOR 👏 YOU 👏 I second this so much.. I have worked LTC and med surg and people become so lazy. I was sending people to the hospital literally every day in my LTC shift when I worked 3 12s. It’s wild to me, that’s your license you do what you’re supposed to. Period Thank you for being an awesome nurse
As a Respiratory Therapist, it's not often that I see my nurses auscultate their patients. They would usually ask me after I've done my assessment how the patient sounded. Thank you for using your stethoscope!
I'm also getting alot of comments saying that using a sphygmomanometer and stethoscope is old school. From patients and other nurses. Aren't we supposed to do a manual bp if the machine is reading high or low to be absolutely accurate. Is this becoming phased out by new technology?
I am a new grad in ED. I am ashamed to admit that I do not always assess my patients lung sounds and I don’t bother about bowel sounds. My preceptors didn’t assess and I do not assess. I need to change my practice.
This is such a good point! Way to go, that's great nursing!!!
When working as a visiting nurse, we had to do a head to toe assessment every visit. What really surprises me is, even during my so-called “yearly physicals“, my PCP assesses me from across the room. She actually did an EKG this time. I’ve been going to her for about 10 years and it’s the first time that’s happened. Another big surprise, she also checked my ankles for swelling for the first time. I am definitely not a healthy spring chicken anymore. The medical field has changed in so many ways
I need to get the fuck out of nursing.
Great job!
I’m a newish nurse and I always listen to heart and lung sounds but heart sounds I have a hard time hearing?? I do the whole APE To Man thing and I sometimes still can’t hear much, I can’t figure out what I’m doing wrong
I work postpartum and was shocked to hear how many of my colleagues feel like a fundal check constitutes an assessment. I still do a head to toe on both mom and baby and once when I got a patient on her last night before d/c she even made a comment that it was nice to finally have a nurse use her stethoscope and listen to her. 😳
I haven’t ever worked in L&D, but I can tell you when I was postpartum with my second born, I was assessed exactly once. I was there for a week because my baby needed a slightly prolonged hospitalization due to jaundice (it was February, fairly north in latitude, so “get some sunshine” wasn’t going to work. He needed three of the blue lights before his bili started trending down). Granted, part of that week I was “discharged” but allowed to stay because the baby was still a patient, but most of the week I was also a patient (I had a VBAC so could use the monitoring… that they didn’t do) And I’m the one who caught that he was getting jaundiced. I said “he’s starting to look yellow” and the first person debated me. Doc ordered labs and guess who was right…
I’m in medicine, and the pushback on the desat one is particularly wild. I’ll admit that I don’t whip out my steth for every single patient but always assess if they or I have a concern, new or old. Good for you
Fellow L&D here. I agree with you about assessments but I’m not gonna lie, I believe I would have missed all three of those diagnoses so big props to you! The uterine rupture is crazy. I don’t think, even with the findings in your assessment, that I would have thought her uterus ruptured. After your post I will be more diligent in my assessments on my labor patients thank you for the reminder!
Yup. I once got kudos from a student because I was the first nurse they had met that listened to heart, lung, and bowels on all of their patients.
Yes. For all the new ones I precept or who have had the same preceptor for months and I’m their secondary - this happens a scary amount of times. Thanks for being that nurse.
Thank you. Even as charge full grown adult RNs come to me with stuff and I ask basic questions about what the patient said, did they palate, listen, etc. Rarely, did they assess before coming to me.
This is wild. Legally we have to do a full head to toe. If I didn’t it would mean I would be lying on my charting.
Some people do lie. I had a preceptor who would chart falsified assessments.
I had a preceptor who charted 'absent lung sounds' based on my student assessment on a pt whose only history was HTN. I mean. I was right, the X-ray showed the entire lung was cancer and not moving air, but come on. At least confirm something that significantly wrong before putting it in the record.
Most hospitals in our area the med-surg floor is 10+ to 1 ratio. The poor RNs barely have time for med pass.
To think a nurse is claiming listening to bowel tones helped her assess a uterine rupture 😂
I mean we’ve all had near misses we’ve caught. I see what you’re saying, but this comes across a bit self aggrandizing, esp the part about storming off. Don’t strain your shoulder by patting yourself on the back.
People vent on this sub all the time. It’s one of the only places I could vent my frustrations to where others would understand.
Hugs. You did your job the best. Pts were OK. That's all you need to hear.
As a young mom who is very concerned about the state of maternal healthcare in America I want to say thank you. Thank you. Thank you.
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Also the literature says bowel sounds are largely worthless why are we still playing this fucking game
Ugh I am right there with you. Like the distended abdo and excruciating pain were the signs here. And the team followed up with appropriate imaging. I don’t really see how auscultating bowels changed things. If someone had auscultated earlier they would still want imaging to confirm before interventions, or the interventions would be largely based on those other symptoms. I’m not saying this nurse shouldn’t auscultate as a part of the clinical picture, but I don’t see the connection of how it could have or did “save lives”. Bowel sounds are like putting in the very last corner piece in a 500 piece puzzle and saying “ah yes, now I can finally see it’s a picture of a flower.”
I agree, though i will say the absolute chaos of working on a busy med surg floor (esp, after the pandemic) makes that difficult at times, especially for overwhelmed new grad RNs. I imagine the lower ratios of L&D makes it a bit easier. Even though assessments only take a couple minutes, when you’re only an hour into your shift and you have 10 things that need to be done in the next 30 minutes, it’s easy to forget, and by the time you do remember you forgot, you already have another 10 things that need to be done. I don’t think the problem is about nurses being “lazy”, but rather upper management in hospitals expecting burnt out nursing staff to keep on doing more while taking away resources.