Nurses are often the first health professional contact a patient receives. For this reason, a nurses initial assessment with a stethoscope is paramount to the resulting investigations and treatment a patient receives. It is vital that nurses make a habit of auscultating with the stethoscope from early on in their training, with every patient encounter.
Each nurse will quickly develop their own examination style, and the best way to improve on ausculation skills, is to pick a suitable stethoscope early. So aim to use the same stethoscope throughout your training to give yourself the best chance of becoming skilled at auscultation. If you choose correctly, the stethoscope will also last your entire career.
We’ve compiled a list of our best rated stethoscopes for nurses to help you make the right choice. Prioritised by quality, durability, and practicality of these stethoscopes, suitable for the fast-paced and patient-focused environment nurses thrive in.
* Best Stethoscopes for Nurses 2018 *
|Littmann® Master Classic II Stethoscope||Check Price →|
|Littmann® Classic III Stethoscope||Check Price →|
|Littmann Classic II S.E. Stethoscope||Check Price →|
|Littmann® Lightweight II S.E. Stethoscope||Check Price →|
|Littmann® Select Stethoscope||Check Price →|
Why Every Nurse Should Invest in A Stethoscope
Reliability & Consistency
With healthcare costs being cut on every corner, nurses have to deal with increasingly poorer quality equipment on the wards. Sure, there are areas where using cheap disposable items doesn’t do any harm. Those of us that have had to deal with flimsy stethoscopes will have heard the joke that we’re better off placing our ears against the patient’s chest to hear anything. But when it comes to stethoscopes, a cheap poor quality stethoscope is a world of a difference from a quality one. It can be the make or break between making a correct diagnosis early and saving a life. This is the quickest way to become familiar and skilled with normal health heart and lung sounds, is to use the same stethoscope (your own) for all your assessments. This is especially important during nursing school and while you are still a student: with consistency, you will learn to hear the subtleties of healthy sounds so that abnormalities are recognised quickly.
Your Continuous Learning
There is a common fallacy that while learning and in training, there’s no point investing in an expensive stethoscope as you wouldn’t appreciate it at this stage, or even recognise the extra sound quality: This is a dangerous misconception. If you learn auscultation with a low quality stethoscope, you are setting yourself up for failure. How will you learn to differentiate one heart murmur from another if your stethoscope doesn’t even allow you to hear the difference? Learning doesn’t end when we finish nursing school and qualify as a nurse. The reality is that nursing professionals are students for life, so give yourself the best chance of mastering this difficult skill by always using your own high quality nursing stethoscope.
Your quality of work affects your career. Don’t let your work and quality of care be hampered by poor quality equipment. If there’s one item every nurse should invest in to call their own, it’s a quality stethoscope. Finally choosing your own stethoscope is a rite of passage. Congratulate yourself on reaching this stage, and enjoy choosing one that suits you. Take good care of it, and it will help you in your nursing career by leaps and bounds.
Clinical Nursing Assessments with a Stethoscope
The entire medical team places great emphasis on nurse-led patient assessments, and auscultation is a key skill to master as part of these assessments. As nurses continues to gain experience through their career, the stethoscope plays an ever increasing important role in their patient assessments. Is there a difference between a nursing stethoscope and for other healthcare professionals? Stethoscopes suitable for nurses are just made with nursing needs in mind: lightweight for daily wear and convenience, durable to withstand robust use in nursing work, and finally, clear acoustics to allow for quick identification of abnormal sounds. A good nursing stethoscope has to tick all these key boxes. Got one? Good, we’re ready to begin:
A good nursing assessment is a key component of your practice as a nurse. It’s the bread and butter of nursing care, and it’s important to be familiar with all aspects of it.
One part that many nurses find takes the most practice to perfect, is auscultation with a stethoscope. The key again is to get familiar with your personal stethoscope and practice until perfect.
Here are tips to help you master auscultation in each clinical category of the nursing assessment:
NURSES RESPIRATORY ASSESSMENT
Position the patient sitting upright or at 45 degrees incline. Ask the patient to breathe deeply through their mouth.
Listen with your stethoscope from the front and back: Move from side to side, top to bottom, to compare lung sounds at each level. See diagram below on where to position your stethoscope chest piece as you move along the assessment.Top Tip: If you only have time to listen to lung sounds on one side, make it the back, as this will give you the best coverage. Auscultating from the back will often result in clearer lung sounds and give you access to more lung area.
When the stethoscope is placed in the right position, it will avoid unwanted noise from other body processes such as gastrointestinal activity. If you place the stethoscope directly on a bone, you will not hear anything, so avoid listening over the scapula.
Ask the patient to cross their arms on their chest and lean forward. This pulls the scapulae apart, exposing more lung are for auscultation.
Listen carefully for the breathing patterns and sound characteristics of your patient’s respiration, paying close attention to the:
- pitch, and
- timing of the breath sounds in the respiratory cycle.
Assess sound quality (vesicular vs. bronchial), assess volume (quiet vs increased resonance), and listen for added sounds (polyphonic wheeze and crackles).
NURSES CARDIOVASCULAR ASSESSMENT
INITIAL CARDIOVASCULAR NURSING ASSESSMENT
Follow the systematic ABCDE approach:
- Airway: Is the airway patent? If at risk, immediately call for help.
- Breating:Take the respiratory rate, rhythm and depth. Record the O2 saturations and administer oxygen therapy as needed.
- Cardiovascular:Measure the blood pressure and obtain an ECG if indicated.
- Disability:Asses conscious status with GCS or AVPU and note any neurological deficits.
- Exposure:Ensure the patient is undressed for the full assessment and record their temperature and blood sugar levels.
It is also sensible to obtain an “AMPLE” while performing your nursing assessment: Allergies, Medication, Past medical history, Last meal, and Events leading up to admission.
CARDIOVASCULAR AUSCULTATION FOR EXPERIENCED NURSES
Start by auscultating the apical pulse. How does it compare to the peripheral (e.g. radial) pulse? Check that the rate and rhythm are similar.
Next, first use the diaphgragm (larger flat side) to auscultate the heart, moving “upwards” in a Z shape starting at the mitrat valve over the apex beat, then repeat with the bell (smaller side):
- Mitral valve: over 5th intercostal space, midclavicular line
- Tricuspid valve: over 5th intercostal space, left sternal edge
- Pulmonary valve: over 2nd intercostal space, left sternal edge
- Aortic Valve: over 2nd intercostal space, right sternal edge
As you listen to the opening and closing sounds over the valves, listen for any added sounds apart from the clean opening and closing sounds. Any abnormal sounds will suggest a likely heart murmur.
Find the carotid arteries on both sides and listen with the bell of the diaphragm for an aotic stenosis murmur. Ask the patient to hold their breath while you listen so you don’t heart breath sounds from the trachea.
NURSES ABDOMINAL AND GASTROINTESTINAL ASSESSMENT
The abomen is compartmentalised into 3 cavities:
- the peritoneum (containing the liver, spleen, gall bladder, stomach, and large and small intestines),
- the pelvis (containing the rectum, bladder uterus, ovaries, and iliac vessels), and
- the retroperitoneum (containing part of the duodenum, the ascending and descending colon, kidneys, pancreas, uterus, the abdominal aorta and the IVC)
During a nursing assessment, while these compartments should always be kept in mind, it is sufficient to divide the abdomen into four quadrants: the right upper (RUQ), left upper (LUQ), right lower (RLQ), and left lower quadrants (LLQ).
Take a full history to assess the abdoinal pain for site, quality, duration, onset, and radiation:
- Spasmodic or squeezingsuggests obstruction in a hollow structure,
- Sharp and localisedsuggests peritoneal irritation,
- Dull and diffusesuggests an organ disorder,
- Sudden onsetsuggests acute perforation or rupture,
- Relieved by eatingcommon in peptic ulcer disease (PUD),
- Exacerbated by eatingseen in pancreatitis or small bowel obstruction,
- Exacerbated by breathingsuggests disorder lies next to the diaphragm,
- Exacerbated by movementsuggestive of peritonitis.
Observe for distension, ascites, scars suggestive of previous surgeries, bruising, evisceration, and jaundice.
Using a stethoscope, auscultate all four quadrants for bowel sounds. Absent bowel sounds are a worrying sign highly suggestive of intestinal pathology, and tinkling bowels sounds are characteristic in obsruction.
Hyper-resonance suggests air within the abdominal cavity, and dulles indicates fluid or organomegaly. In cases of peritonitis or an acute abdomen, percussion is extremely painful and should be conducted with care.
- Provide analgesia generously and quicly. Give opiates IV and titrate. Consider anti-spasmodics in the event of colicky pain.
- IV antibiotics, when indicated in perforation and infection.
- IV fluids if indicated. Patients who are dehydrated, NBM, shocked, or vomiting, will require IV fluids.
- Oxygen therapy if the patient is shocked.
- Psychological support. The presence of a nurse is vital in maintaining the patient’s dignity and privacy.
- Monitor fluid balance with an input / output chart.
- Place a nasogastric tube in event of bowel obstruction and perforation
- Insert a urinary catheter in shock and measure urine ouput.
Other Considerations When Selecting the Best Nursing Stethoscope:
- The weight of a nurse stethoscope plays a more important role than for other medical professionals, and may be significant for you. Particularly when you consider that you will be carrying it around much of your practice day.
- Will it fit in your lab coat or your uniform and not wear holes in your pockets? The materials used in the stethoscope’s construction may limit your choices.
- Allergies to latex, nickel, and some plastics may require you to choose stethoscope models with hypoallergenic materials rather than standard instruments.
- Length and type of tubing are practical considerations, because in a real sense you want your stethoscope to be fitted to you and your ears.
- How does it sit around your neck? Your comfort during the whole work day is important—think 8 or 12 hour blocks of time.
- And don’t forget special applications. If you work in Peds, you might opt for interesting colors, or you may attach small toys to your stethoscope, so choose one that can take your attachments.
- If you must multitask with additional equipment, choose a stethoscope that will not get in the way of those other devices.
With the multifaceted nature of nursing today, your nursing tools may require accommodation for specific applications.
These specialty areas may require specific instrumentation in patient care:
- cardiac care
- critical care
- emergency triage and management
- holistic care
- HIV care
- military applications
- neonatal care
- nurse practitioner practice
- occupational health
- perioperative care
- psychiatric care
- trauma management
- women’s health care
- wound care
- ostomy care
- incontinence care
- And so on…
Place of care is just as important
- health care provision
- case management using a variety of collaborative models
- informatics and biometrics
- legal consultation
- itinerant/travel nursing
- training and education
- may also required instrumentation that is not “ordinary.”
The matter of preferences can be overwhelming.
The good news is that there is a stethoscope suitable for you and your practice.
Make a list of preferences that matter for you, your patient, and your nursing setting or specialty.
So, let’s look at stethoscope instrumentation.
Nurses are familiar with indirect measures of function.
Labs let us know what is going on inside our patients.
Imaging allows us to see what is happening in our sick patients.
Xrays, CTs, PET scans, and MRIs. Sometimes in real time, reveal what is happening with our patients.
Your stethoscope is another noninvasive tool for knowing what is going on inside patients.
We get basic information about circulation, digestion, breathing, muscle activity (particularly the heart), even joint function, etc. when we use our stethoscope.
A functioning body produces sounds revealing its various activities.
With our stethoscope we can collect those sounds, listen to them, and make judgments about body function.
Here are the parts of a stethoscope and their functions.
The flat plate collector of sound for your stethoscope is called its “head.”
It may vary in size and shape to augment a specific sound spectrum.
The “single head” stethoscope is designed for taking vitals and checking lung function.
This head is tuned to the heart sounds.
The conventional “dual-head” stethoscope has a “diaphragm” side for collection of high frequency sounds and a “bell” side for collecting low frequency sounds.
“Tripple-head” stethoscopes collect additional bandwidth allowing critical evaluation of cardiac function. T
he head of the stethoscope will vary in size and weight, the single-head models being lighter than the triple-head models.
Sounds collected by the flat plate head are typically transmitted acoustically.
A head with greater mass, e.g., steel versus aluminum, will exhibit more sound sensitivity for you the user. (Electronic models may transmit the sounds visually, on an amplified basis, or on a recorded basis.)
The stethoscope head is connected to your ear via flexible tubing coupled to a stiff binaural metal or plastic yoke ending with ear pieces for your pinnas.
Tubing may be made of rubber or plastic. The stiffer the tubing is, the more sound from the head reaching your ears.
Ear Pieces Part of Stethoscope Mechanism.
These may be customized by an audiologist or hearing aid dispenser with earmold expertise.
For a nurse with irregular pinna/concha structures, customizing the ear tips will provide comfort and better sound quality.
Cerumen and perspiration are very hard on rubber and plastics resulting in the need for ear tip replacement with time.
The chemicals necessary to make plastic soft evaporate with time, also bringing a need for replacement.
You need not replace your stethoscope when rubber or plastic parts fail because they are readily replaced.
5. Configuration Options for the Best Stethoscope for Nurses.
Nursing specialties have been arbitrarily assigned to several categories for stethoscope recommendation purposes.
You as a nurse may fill only one of these roles or multiple roles in the course of your nursing practice.
Stethoscopes for Students.
Training institutions typically specify instrumentation to be used by their students.
Students are best served by purchasing stethoscopes recommended by their instructors.
“Cheaper is not better” is true when it comes to technology, even when looking at replacement on a short-term basis.
Sound quality may be compromised in “economically” priced instrumentation.
“Used” may be acceptable as long as an instrument meets specifications of instructors and stethoscope components are reasonably flexible and not cracked.
Avoid the “ten dollar specials.”
It is fully capable of giving you the ability to generate accurate BPs and provide appropriate data for your basic PEs.
The head is double-sided, yet sufficiently sized to fit beneath a BP cuff.
The head is tunable by altering head pressure.
If you are latex-sensitive, this is a good choice because it has no natural rubber in it.
Many health care professionals continue to use this stethoscope throughout their careers.
There are two recommendations for the best stethoscope for nursing students. The lightweight option click here and for the mainstay option, which is the Littmann Classic II – click here to learn more about it.
Stethoscopes for General Practice Nursing.
Many advocate the Littmann Classic II S.E. stethoscope by 3M because of its sound quality, serviceability, and longevity.
If it is purchased as a student, this stethoscope will provide you with a basic tool for your practice throughout your career.
It is sufficient for many nursing applications beyond the basics. Pricing ranges from $42.99 to $85.90+ on today’s internet.
There is a three-year warranty.
Stethoscopes for Pediatrics.
The head is contoured and will be about an inch in diameter (three quarters of an inch for infants).
It may come with toy-motifs to make the device less intimidating to children.
The 3M™ Littmann® Classic II Infant Stethoscope works well with the littlest patient. It’s because the head is suitable for infants, acoustic quality is good, and ear tips seal out extraneous noise.
Materials used in its construction resist aging.Today’s internet pricing ranges from $79.99 to $115.00+. It carries a three-year warranty.
The 3M™ Littmann® Classic II Pediatric Stethoscope has a design for longevity.
Its head is suitable for use with the general pediatric population in size and contour and feel (not “cold”).
Acoustic performance is delivered through comfortable ear tips which eliminate ambient background noise.Pricing ranges from $67.00 to $102.89+ at this time. It carries a three year warranty.
(A variety of pediatric stethoscopes ranging from less than $5.00 to the mid-$30.00 range are readily available on the internet. Objective evaluation of the gadgetry is generally unavailable. Purchase of such devices may risk your professional reputation should they fail in the middle of your nursing tasks.)
Stethoscopes for Cardiology Nursing.
Here’s the deal:
Stethoscopes for cardiology are also useful for practices encountering…
- renal failure
- where patient blood pressure may be so reduced that pulse is not palpable and heart signatures are barely audible if present.
The ability to hear when competing against ambient noise is present is an extra consideration when patients are seen in non-clinical settings.
The diaphragms in their heads are tunable and are sized for both Peds and adults.
The Master version has a single-sided head with a special procedures adapter to allow additional concomitant evaluations.
Use of double tubing precludes interference from background noise during assessments.
The warranties are exceptional, five-year and seven-year respectively.
Many of us have some degree of hearing loss.
When we age we lose our inner ear hair cell sensitivity. It is called “presbycusis.”
Many stethoscopes will provide sufficient sound quality for a nurse to do an accurate BP or pulmonary analysis.
When our hearing loss is moderate, we have some alternatives.
Nurses with some degree of hearing loss can still function well in their profession with a stethoscope that amplifies the sounds picked up by the head of their stethoscope.
The amplified mechanism may be a simple add-on where the stethoscope tubing is cut and the amplifier is placed in the tubing.
Or, it may be an integral component of the stethoscope, actually incorporated into its head or yoke.
Another is the Littmann Electronic Stethoscope on first use may appear lighter than many stethoscopes.
Its stainless steel head is easy to use with the same techniques used with standard stethoscopes.
Amplification controls (volume and frequency) are on the head of the device, making it “tunable” to your nursing needs.
A USB-type plug allows interface of stethoscope with headphones or PC or recording device.
For itinerant nursing applications, this instrument would be functional with telemedicine. It would aid in the documentation of electronic medical records.
Instrument head accessories allow evaluation of Peds or geriatrics by switching diaphragms.
It uses one commonly-available AAA battery and the instrument shuts itself off to save battery life.Today’s internet pricing ranges from $313.48 to $401.96+.
Top Stethoscopes for Nurses:
- Littmann Pediatric
- Littmann Infant
- Littmann Lightweight
- Littmann Classic II S.E.
- Littmann Master Classic
- Littmann Cardiology IV
- Littmann Master Cardiology
Making decisions: Easier said than done!
To compare the different stethoscopes for Nurses, simply click and hold on the name of the stethoscope you wish to compare while dragging it to a spot.
Some great information will populate as well as a picture. There are two tabs at the bottom of each, one to view the price and the other to see our full review. Check it out now, it’s a pretty cool tool just for you!
What’s the bottom line…
As a health care provider, think in terms of what you do, what you need to do it, and then get the right tool for that job.
“Good” is getting your nursing job done well.
The right stethoscope for your job will be “good.”