The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

DOES AUSCULTATING THROUGH THE PATIENT'S GOWN MAKE A DIFFERENCE IN THE PERCEIVED INTENSITY OF THE VESICULAR BREATH SOUND?

Robert L. Wilkins Ph.D., RRT, Dennis S. McCarty, RRT, Arthur B. Marshak, BS, RRT, Lennard Specht, MD School of Allied Health Professions, Loma Linda University, Loma Linda, Ca

Introduction: Pulmonary auscultation is a frequently used assessment tool that helps evaluate the patient's initial condition and determine the effects of therapy. It is recommended that chest auscultation occur with the head of the stethoscope held directly against the skin. Some clinicians auscultate through a patient's gown either for convenience sake or to avoid embarrassment in female patients. It is not clear if auscultating through the patient's gown interferes with the intensity of the perceived vesicular breath sound. Objective: We sought to determine if auscultating through the patient's gown and gown and a light robe decreased the perceived breath sound intensity (BSI).

Methods:
A respiratory therapist was trained using a spirometer to breathe at consistent volume and inspiratory flow prior to the testing. Fifteen subjects (respiratory therapists and physicians) were blindfolded and asked to rate the BSI on a scale of one to five, with five being the loudest, as the chest piece of the stethoscope was randomly placed on the skin, over the gown, or over the gown and robe at the same position on the chest.

Results:
Four of the participants indicated no change in the (BSI) when comparing direct auscultation to auscultation through the clothing. Five participants perceived the BSI to decrease as clothing was added; and six found the BSI to increase as the clothing was added. The differences were not significantly different (p > .05). Conclusion: Auscultating over the patient's gown does not significantly diminish the clinician's perception of the BSI. Additional study of the effect of clothing on the qualitative assessment of breath sounds is needed.

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