Which type of body sounds would the nurse be able to hear with the bell of the stethoscope?

What is auscultation?

Inhaltsverzeichnis Show

The stethoscope.
What kinds of sounds are heard best with the bell of the stethoscope?
Which type of sounds is Auscultated with the bell of the stethoscope?
Which kind of sounds does the stethoscope detects?
What do you use the bell of the stethoscope for?

Auscultation is the medical term for using a stethoscope to listen to the sounds inside of your body. This simple test poses no risks or side effects.

Your doctor places the stethoscope over your bare skin and listens to each area of your body. There are specific things your doctor will listen for in each area.

Heart

To hear your heart, your doctor listens to the four main regions where heart valve sounds are the loudest. These are areas of your chest above and slightly below your left breast. Some heart sounds are also best heard when you’re turned toward your left side. In your heart, your doctor listens for:

what your heart sounds like
how often each sound occurs
how loud the sound is

Abdomen

Your doctor listens to one or more regions of your abdomen separately to listen to your bowel sounds. They may hear swishing, gurgling, or nothing at all. Each sound informs your doctor about what’s happening in your intestines.

Lungs

When listening to your lungs, your doctor compares one side with the other and compares the front of your chest with the back of your chest. Airflow sounds differently when airways are blocked, narrowed, or filled with fluid. They’ll also listen for abnormal sounds such as wheezing. Learn more about breath sounds.

Auscultation can tell your doctor a lot about what’s going on inside of your body.

Heart

Traditional heart sounds are rhythmic. Variations can signal to your doctor that some areas may not be getting enough blood or that you have a leaky valve. Your doctor may order additional testing if they hear something unusual.

Abdomen

Your doctor should be able to hear sounds in all areas of your abdomen. Digested material may be stuck or your intestine may be twisted if an area of your abdomen has no sounds. Both possibilities can be very serious.

Lungs

Lung sounds can vary as much as heart sounds. Wheezes can be either high- or low-pitched and can indicate that mucus is preventing your lungs from expanding properly. One type of sound your doctor might listen for is called a rub. Rubs sound like two pieces of sandpaper rubbing together and can indicate irritated surfaces around your lungs.

Other methods that you doctor can use to determine what’s happening inside of your body are palpation and percussion.

Palpation

Your doctor can perform a palpation simply by placing their fingers over one of your arteries to measure systolic pressure. Doctors usually look for a point of maximal impact (PMI) around your heart.

If your doctor feels something abnormal, they can identify possible issues related to your heart. Abnormalities may include a large PMI or thrill. A thrill is a vibration caused by your heart that’s felt on the skin.

Percussion

Percussion involves your doctor tapping their fingers on various parts of your abdomen. Your doctor uses percussion to listen for sounds based on the organs or body parts underneath your skin.

You’ll hear hollow sounds when your doctor taps body parts filled with air and much duller sounds when your doctor taps above bodily fluids or an organ, such as your liver.

Percussion allows your doctor to identify many heart-related issues based on the relative dullness of sounds. Conditions that can be identified using percussion include:

enlarged heart, which is called cardiomegaly
excessive fluid around the heart, which is called pericardial effusion
emphysema

Auscultation gives your doctor a basic idea about what’s occurring in your body. Your heart, lungs, and other organs in your abdomen can all be tested using auscultation and other similar methods.

For example, if your doctor doesn’t identify a fist-sized area of dullness left of your sternum, you might be tested for emphysema. Also, if your doctor hears what’s called an “opening snap” when listening to your heart, you might be tested for mitral stenosis. You might need additional tests for a diagnosis depending on the sounds your doctor hears.

Auscultation and related methods are a good way for your doctor to know whether or not you need close medical attention. Auscultation can be an excellent preventive measure against certain conditions. Ask your doctor to perform these procedures whenever you have a physical exam.

Posted By: Paul | Stethoscopes

The stethoscope.

It’s practically the symbol of physicians and physician assistants. Most of us know the basics: you put the things in your ears, the other end on a sick person, and listen. But stethoscopes can do much more.The following are a few facts about the tool, followed by a more complete list of its uses. If you’re new to the medical field, getting comfortable with your stethoscope will make you a better student and clinician of medicine.

Origin. Early stethoscopes were little more than “ear tubes,” that were invented in 1816 by René Laennec at the Necker-Enfants Malades Hospital in Paris, France. They were updated here and there, but current designs are credited to Dr. David Littman of Harvard University who made them lighter and gave them better acoustics.

Auscultation: the act of listening for sounds within the body. Latin auscultation-, auscultatio, act of listening, from auscultare to listen.

Parts. Even modern scopes are fairly simple (except the electronic ones that digitally amplify sound). The following diagram will provide you with the important vocabulary:

A stethoscope with bell facing, diaphragm away. “Tunable diaphragms” can be used to listen to high and low pitched sounds by gently on the patient for low sounds, and more firmly for high ones.

The most important parts to know are the diaphragm, which is larger, flatter side of the chest piece, and the bell, which has the smaller, concave piece with a hole in it. Switch between the two by twisting the chest piece 180 degrees. You’ll hear a click. Then tap each side to see which one is “on.”

How it works. The diaphragm is a sealed membrane that vibrates, much like your own eardrum. When it does, it moves the column of air inside the stethoscope tube up and down, which in turn moves air in and out of your ear canal, and voila, you hear sound. Since the surface area of the diaphragm is much greater than that of the column of air that it moves in the tube, the air in the tube must travel more than the diaphragm, causing a magnification of the pressure waves that leave the ear tip. In your ear, larger pressure waves make louder sounds. This is how stethoscopes amplify sounds.

How to wear it. Place the ear tips in the ears, and twist them until they point slightly forward (toward your nose). If you do it right, you’ll make a good seal, and sounds in the room will become very faint.

Like this – the thumb under the tube keeps it from rubbing the skin, which causes extra noise

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

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

Not like this – it’s harder to control and harder to hold gently.

What you can do with it: If you learn the following, you’ll be using yours more than 90% of clinicians. The links will take you to free pages on the specific technique.

Measuring blood pressure. Probably the most common use, but often done poorly. Placement of the blood pressure cuff is critical. Also, many students are taught that the diastolic BP (e.g. 120/80) is the point in which they can no longer hear the thump of the brachial artery. More accurately, diastolic BP is the number at which the volume of the thump drops dramatically. This is often 4-10 mm Hg higher than when the sound disappears completely.
Assessing lung sounds: allows you to identify the rate, rhythm and quality of breathing, any obstructions of the airways, as well as rubs that indicate inflammation of the pleura. Don’t forget to start above the clavicle, since lung tissue extends that high. Also, when you listen to the back, have the patient lean forward slightly to expose the triangle of auscultation. Remember that for lung sounds (according to the Bates “Bible,”) we listen in six paired areas on the chest, and seven paired areas on the back. I remember this with the mnemonic “6AM – 7PM,” (6 anterior pairs, and 7 posterior pairs). Always listen to left and right sides at the same level before moving down to the next level – this way you get a side-by-side comparison, and any differences will be more apparent.
Assessing heart sounds. We listen for rate, type, and rhythm of heart sound, as well as any sounds that shouldn’t be there (adventitious sounds), such as gallops, murmurs or clicks. All hearts sound the same at first. But after listening to many hearts, eventually sounds will seem to jump out at you. For heart sounds, we listen to the four primary areas: left and right of the sternum at the level of the 2nd rib, left of the sternum at the 4th rib, and on the left nipple line at the level of the 5th rib. Remember these with the mnemonic “2-2-4-5.” The names of the valves that you are hearing in these locations are: (2 right) aortic, (2 left) pulmonic, (4) tricuspid, (5) mitral. Remember these with the mnemonic “All Patients Take Meds.” Some of my friends use the mnemonic Apartment M2245 (APT M2245).
Assessing Bowel Sounds. This is easy to do, and important if there may be a bowel obstruction or paralytic ileus. The gurgling, bubbling noises are called borborygmi. Go figure.
Detecting bruits. A bruit (pronounced “broo’-ee,”) is an abnormal whooshing sound of blood through an artery that usually indicates that the artery has been narrowed, causing a turbulent flow, as in arterioscleroisis. Bruits are abnormal – if the patient is healthy and “normal,” you should not hear any bruits. Bruits can be detected in the neck (carotid bruits), umbilicus (abdominal aortic bruits), kidneys (renal bruits), femoral, iliac, and temporal arteries. The first true bruit I ever heard was umbilical, just above a patient’s belly button, and when I heard it I knew immediately that the patient had an abdominal aortic aneurysm (AAA). It was an exciting find for me, and it might have saved my patient’s life.
Measuring the span of the liver. Usually this is done with percussion (tapping the belly), but another neat way is to place the stethoscope below the right nipple, the other index finger just above the belt line in line with the nipple, and gently scratch the skin up toward the chest piece of the stethoscope. When you are over the liver, the sound will become more dull. Marking the location where the dullness begins and ends provides a decent measurement of the liver size in that location. About 10 cm is normal at the nipple line.
Hearing Aid. Finally, the stethoscope makes a nice hearing aid with hearing impaired patients. Put the eartips in the patient’s ears, and talk into the chest piece. Handy in the ER!

Diaphragm vs. Bell. The diaphragm is best for higher pitched sounds, like breath sounds and normal heart sounds. The bell is best for detecting lower pitch sounds, like some heart murmurs, and some bowel sounds. It is used for the detection of bruits, and for heart sounds (for a cardiac exam, you should listen with the diaphragm, and repeat with the bell). If you use the bell, hold it to the patient’s skin gently for the lowest sounds, and more firmly for the higher ones.

Which one should I buy? Plan on spending no less than $60 for a quality stethoscope. Cheaper ones can work alright, but aren’t as durable, and have weaker sound profiles. The standard by which all others are measured is generally accepted to be the 3M Littman Cardiology III. Don’t spend gobs of money on a digital unless you know you will be working in cardiology – and maybe not even then. To see our stethoscope recommendations, visit stethoscope buyer’s guide page.

Infection control. Clean your stethoscope regularly, particularly the chest piece. Studies have found that stethoscopes are frequently the vectors for patient-to-patient disease transmission. Just wipe the chest piece with an alcohol prep pad to disinfect.

What kinds of sounds are heard best with the bell of the stethoscope?

The bell is best for detecting lower pitch sounds, like some heart murmurs, and some bowel sounds. It is used for the detection of bruits, and for heart sounds (for a cardiac exam, you should listen with the diaphragm, and repeat with the bell).

Which type of sounds is Auscultated with the bell of the stethoscope?

A stethoscope has a bell and a diaphragm. Your healthcare provider will use the bell to hear low-pitched sounds. They'll use the diaphragm to hear high-pitched sounds. The bell and diaphragm are connected by rubber tubes to earpieces that your healthcare provider places in their ears.

Which kind of sounds does the stethoscope detects?

The stethoscope has two different heads to receive sound, the bell and the diaphragm. The bell is used to detect low-frequency sounds and the diaphragm to detect high-frequency sounds.

What do you use the bell of the stethoscope for?

Many stethoscopes have a separate bell and diaphragm. The bell is most effective at transmitting lower frequency sounds, while the diaphragm is most effective at transmitting higher frequency sounds.