Blood Pressure Measurement.

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    When listening to the brachial pulse I note that the needle will move before I actually hear anything, a considerable amount (about 7 - 10 mmHg). I note that the same applies to diastole. I notice the needle twitch 7 - 10 mmHg POST the last sound. I have an automatic wrist BP machine and it gives me higher readings than what I'M coming up my self. I am worried I cannot hear the first few sounds or last few sounds. I am using the correct side of the steth. I am using the correct lining of the ear pieces. I have a Littmann II Classic. Is it just Me getting anxed over my skill check off coming up in a week or what???

    We had an exam at the end of last week (the same week we were told we would have vitals check off the next week, giving us two weeks to practice. Well no one would practice with me that week. People were too busy about the exam coming up that Friday. I am becoming anxed as the exam is now a week away and the only arms I truly have are my classmates. My mom becomes very annoyed after 3 times, and I have no one else. I practice on my self just to get a feel for the sounds not to really get accurate measurements, as I'm sure that would be quite hard.
    Helllpppp.
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  3. 4 Comments so far...

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    Trust what you hear. What you are seeing is the blood pushing against the cuff, causing the oscillation, but you HEAR the blood squirting through at systole when you first start actually hearing the sounds. Same at diastole... the cuff is still tight enough to be pushed a little bit by the blood at systole, but isn't tight enough to obstruct flow during diastole. That's why you have to listen. Really listen. If you want to get used to hearing the Korotkoff sounds, inflate the cuff to a point between systole and diastole and start listening. Yes, you will make all your veins pop out and it will be uncomfortable after a couple minutes. Don't do it longer than a couple minutes at a time. You need to rest your arm and your ears.

    Try palpating the BP and note if the needle bounces before you start feeling the pulse...

    Oh, and whenever I do manual BP's, I always palpate the pulse first because that "tells" me where to put the stethoscope head. I also palpate the pulse whenever I inflate the cuff because I can then tell when the pulse stops, then I just inflate another 10-20 mmHg, place the steth head, and start deflating. Yes, this is a bit different than what's standard, but it's very accurate and doesn't inflate the cuff any more than necessary. I'm not feeling for an exact number during inflation... just an idea where I should start hearing the first sounds.

    Eventually you'll start hearing tonal differences in the Korotkoff sounds and you'll know when you're approaching diastole. It just sounds different right before you get to the diastolic pressure.

    I have done thousands of manual BP's over the years. Auto BP units are nice, but they have their limitations, just as manual ones do. I might get a different reading between the two, but either way, I'm looking for the trend of what's happening, not so much the actual values. If I take my BP manually and I get 110/76, 112/78, 110/74, 108/74... You can pretty much imagine that I'm pretty stable. If take Auto BP's at about the same time, I might get 103/69, 106/73, 103/70, and 105/71... you can pretty much tell that I'm pretty stable that way too, just the numbers are a bit "off" from what I heard manually. Now if you're seeing 150/74, then 135/71, then 115/62... you know something is quite wrong... the trend is not looking good...
    GrnTea and sugarmagnoliaRN like this.
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    My nursing program has programmable arms and mannequins to practice BP on (this is also what we get validated on). Does your school have these to work with. You could also talk to the professors to see if they know of students who are looking to practice BPs too. Any friends outside of nursing school can be guinea pigs, or other relatives/family friends. Good luck!
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    I had the same problem! I actually failed the first time because I was so nervous and worked up I couldn't hear the sounds clearly. I just went back the next day to restest and just relaxed and listened ONLY for the sounds. Don't pay attention to the needle bouncing. Also press a little hard on the steth and the sound may get a bit louder.

    I was able to practice on myself just to practice listening to the first and last sounds. Also if you google "Blood Pressure Practice" the first two website are really helpful, although a little bit easier than real life.
    GrnTea likes this.
  7. 0
    Well whether my classmates like it or not they HAVE to put in 3 hours to test so I will have my self at least 3 hours practice plus what I keep listening to with my own arm and the online resources. I figure I need to be more confident. We partner up with someone and that is the person we test with. My friends pulse is SO SO SO hard to feel, much less listen to. I know that as a future nurse (I hope), I should be able to listen to any type of pulse and take BPs on any type of patient but I just wish my partner had a slightly stronger pulse. I practiced on a non nursing friend and heard his pulse so well. I was so confident and I think I actually took his blood pressure well, came out to 110/78. I hope I get the hang of this and hearing her pulse or finding someone with a good pulse. I will of course still be her test partner; so she can test on someone... I have a rather nice pulse.


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