A stethoscope is one of the most important tools a nurse uses — but knowing how to use it correctly and what to listen for makes all the difference. Effective auscultation helps nurses recognise early deterioration, validate assessment findings, and communicate accurately with the wider healthcare team.
This guide breaks down proper stethoscope use, heart sounds, and lung sounds, so you can auscultate with confidence — whether you’re a student nurse or brushing up your skills.
Choosing & Using Your Stethoscope Correctly
1. Earpiece Position
- Insert earpieces angled forward (towards your nose)
- This aligns with the ear canal and improves sound clarity
2. Diaphragm vs Bell
- Diaphragm: High-pitched sounds (normal heart sounds, breath sounds)
- Bell: Low-pitched sounds (murmurs, extra heart sounds like S3/S4)
💡 Tip: Most routine nursing assessments use the diaphragm.
3. Patient Positioning
- Heart sounds: Sitting upright or slightly reclined
- Lung sounds: Sitting upright where possible.
- Always expose the chest adequately (listen on skin, not over clothing)
Heart Auscultation: What to Listen For
Where to Listen (Aortic → Pulmonic → Tricuspid → Mitral)
- Aortic – 2nd intercostal space, right sternal border
- Pulmonic – 2nd intercostal space, left sternal border
- Tricuspid – 4th–5th intercostal space, left sternal border
- Mitral (Apex) – 5th intercostal space, mid-clavicular line
Normal Heart Sounds
- S1 (“lub”) – Closure of mitral & tricuspid valves
- S2 (“dub”) – Closure of aortic & pulmonic valves
Normal rhythm should be:
- Regular
- Equal intensity
- Clear separation between S1 and S2
Abnormal Heart Sounds
- Murmurs – Whooshing or swishing sounds (turbulent blood flow)
- Extra sounds (S3/S4) – Often associated with heart failure or ventricular stiffness
- Irregular rhythms – May indicate arrhythmias such as AF
🚩 Always escalate new or abnormal findings according to clinical guidelines.
Lung Auscultation: What to Listen For
Where to Listen
- Compare side to side
- Auscultate anterior and posterior lung fields
- Work from top to bottom
Normal Breath Sounds
- Vesicular – Soft, low-pitched (most lung fields)
- Bronchial – Loud, high-pitched (over trachea only)
Abnormal Breath Sounds
- Crackles – Fluid in alveoli (e.g. pulmonary oedema, pneumonia)
- Wheezes – Airway narrowing (e.g. asthma, COPD)
- Stridor – Upper airway obstruction (medical emergency)
- Absent sounds – Pneumothorax, severe obstruction, or effusion
Tips for Accurate Auscultation
- Always listen to one full breath cycle
- Ask the patient to breathe slowly through their mouth
- Reduce background noise
- Trust your assessment — and recheck if unsure
Make Auscultation Easier with a Quick Reference
Remembering all heart landmarks and lung sounds takes time. That’s why many nurses keep a compact auscultation reference card on hand — perfect for:
- Clinical placements
- Busy shifts
- OSCE preparation
- Quick confidence checks
👉 Our Auscultation Reference Card visually breaks down heart & lung sounds so you always know what you’re listening for.