Help with taking BP

dave1117 · Sep 20, 2004

and taking BP's in noisy environments is very tricky. Fortuantely in EMS close BP are sometimes good enough since you are really just making sure you do not have a shocky patient. However at Possible heart attack calls and other medical calls it is more important to get closer.

The key is to listen to the first full thump you hear. In clinical it should be quiet and you should not have a problem hearing the sound. Ignore the bouncing line. It bounds with the pulse before you can hear the systolic and after you can hear the diastolic. trust your ears.

It helps to keep all stethescope hoses away from the BP cuff hoses and to firmly hold the bell housingto the arm to avoid extra noises.

Good luck. Like I said trust your ears.

By the way, you did not mention what stethescope you are using. A better stethescope definately makes a difference. The are more sensitive to sound and quieter from outside noise.

sabRN2b05, BSN, RN · Sep 20, 2004

In my first semester when I learned how to take a BP, I was SO nervous that I would never get it down pat. The systolic "sound" threw me, too. Any background noise made me second guess what I was hearing. The diastolic was easier. I used to practice on my husband, children, etc. and still do (I'm now in the 3rd of 4 semesters). I still get nervous and second guess myself especially when I'm taking a manual BP because the machine registered something funky. I agree with dave1117 - listen with your bell and get a good stethoscope - definitely makes a difference. Just practice, practice, practice...that's the best way.

NurseFeelGood · Sep 20, 2004

i would have to agree. a good stethoscope is the key along with lots of practice. i purchased a cardioscope and it helped me when i first started. i think they are easier to hear with. now that i've had lots of practice i can pick up on both the systolic and diastolic easily. hang in there it will come to you.

shel_wny · Sep 20, 2004

Thanks for the advice everyone.

Unfortunately, if it's my stethescope that is making me either not hear a thing at all or hear phantom sounds...I'll just have to wade through it. This stethescope is a loaner and although it's not in the best shape, it's all I've got! Maybe by graduation I'll have enough for a pricey good one. :)

Thanks again!

Shel

RN_2007 · Sep 20, 2004

The systolic is the first beat you hear. If you hear a scratch that usually indiates the person is breathing which is an interference in the stethescope. If your watching the needle move and it slows down as if it was a second hand on a watch, that means it's measuring the BP. Hope that helps. :)

RN_2007 · Sep 20, 2004

To reinterate what dave1117 and sabRN2b05 said, you can practice by holding the diaphraghm/bell in a way that would drown out the background noise. You can hold on do the diapraghm with your thumb and middle finger, and put your index finger on top of the bell and that'll get rid of background noise.

shel_wny · Sep 21, 2004

To reinterate what dave1117 and sabRN2b05 said, you can practice by holding the diaphraghm/bell in a way that would drown out the background noise. You can hold on do the diapraghm with your thumb and middle finger, and put your index finger on top of the bell and that'll get rid of background noise.

Covering the hole in the bell on top of the diaphragm of the stethescope helped SO much! Thanks! I could hear the sounds much more clearly. I guess it will just take some practice to get this down. I sometimes think I did it just right but I watch the darn needle and it moves to the beat even though I don't hear the beat anymore. What the heck is that!?

Maybe a pulse? :stone

Shel

Indy, LPN, LVN · Sep 23, 2004

I have an electronic stethoscope; I don't get background noise unless something rubs the head of my scope (it's a phillips- rub the head and it hisses) but I do get suggestion of sounds before the systolic on some patients.

The needle will bounce with the patient's pulse both before and after you get your readings so it's not something to go by. Although I think the karotkoff sounds follow the pulse in rythym so I do watch the needle, just don't use it as a guideline.

I've done bp's on a lot of hypertensive patients recently and can tell you that the auscultory gap can fool you a LOT with these patients. So I do see people getting in the habit of just pumping up the manual cuff to oh... some random number and then doing a reading, and you can start listening right in the middle of a gap and get a reading that's way off for the systolic. It's also not a good idea to take that bit of info and start pumping everyone up to 200 just to make sure; that can really hurt! So you might wanna go back and remember to occlude the radial pulse to figure out where to pump it to.

-Indy

lpncrew · Jun 4, 2010

Thanks for the information. I also am having concerns about bp sounds. If you hear a faint/soft sound before the clear thump do you count the faint sound as your systolic or do you wait for the louder clear thump? Sometimes when i'm taking it I think i'm hearing it and then comes the loud thump which makes me question if I was hearing it.

CrazierThanYou · Jun 4, 2010

Thanks for the advice everyone.
Unfortunately, if it's my stethescope that is making me either not hear a thing at all or hear phantom sounds...I'll just have to wade through it. This stethescope is a loaner and although it's not in the best shape, it's all I've got! Maybe by graduation I'll have enough for a pricey good one. :)
Thanks again!
Shel

Ugh! When we were learning to do BP's, our instructor had the crappiest double stethoscope on the face of the Earth. Had to be! I already knew how to take BPs but so many students had absolutely no idea and it was so frustrating for them. A stethoscope really makes a difference!