Need to vent about manual BP

[OrthoFNP]

Ok. So, I am in first semester of school and we just started clinicals. My instructors have encouraged us to buddy up with other students while caring for our patients. This is great. This helps us to learn and to be exposed to several different clinical situations. I have enjoyed this very much, but the other day I got a little frustrated. I had a fellow student in the room with me when I was getting vitals on my patient. My patient has HTN and his BP had been running very high. The "machine" gave me a BP reading of 170/127 or so. So, I reported this to my nurse as I knew it was high, and she instructed me to go in and do a manual reading on him. So, my fellow student and I went to the patient's room to take a manual reading. I know how to do BP, but just wanted to have her check behind me since this was a pretty important situation. I was getting readings of 180/120 or so consistently and she was getting readings of 160/120 right behind me like within 10 secs. This happened three times! She was looking at me like I did not know what I was dong bc she was NOT getting a systolic reading at 180. I was getting annoyed with her bc I was. So, I told her that since I was not sure and we were getting two different numbers and I did not want to record incorrect vitals during such a crucial time, I was going to grab a nurse. She was like, "It is not that big of a deal." This made me a little angry. I told her I did not want to report it wrong and she acted like the fact that we had such a large discrepancy was absolutely no big deal. So, we got a nurse to check and she got a reading of 200/120, which was closer to the reading I got and she informed us that BP can fluctuate. I knew this. I believe it did go up to 200/120 in the 5 minutes it took us to get the nurse. I DO NOT believe that it went from 168 to 180 then back to 162 and then back up to 180 consistently in 5 seconds time. I am cnvinced the other student was NOT reading it correctly. guess her attitude that it was no big deal and the way she acted as if I was the one who was wrong in a condescending manner really mad me mad. So, my question is this...Can a BP fluctuate that much (30 or so points) in literally 5 seconds then go back down to and then right back up in that short of a time frame???

[studentnurse2012]

if anything i would imagine it would continue to increase between readings (because your constricting the vessels). However, saying this, you shouldnt be doing BP consecutively within 30 seconds or so anyway....you need to give the arm about 5-10minutes in between each reading to get an accurate measurement (because really when you take BP, your restricting blood flow to the extremity and it cuts off the circulation).

[Angels_wearScrubs]

Get a dual headed steth and take a bp with one of your instructors. If she gets the same reading you do, then great!! You know how to take a bp! DO NOT get worked up over this other student! Seriously. Worry about doing YOUR skills right, doing well on YOUR test and be confident!! I am a first semester student too, and I do the skills right, but the first half of the semester I was second guessing myself.

If you find out that your doing bp's right, casually mention to your instructor that you were second guessing yourself because the other student was so off the mark. Don't throw her under the bus, just mention it.

And studentnurse2012 is right, that poor patient! I woud be p!ssed if students took bp after bp after bp. Next time, give the pt's arm a break. Not only will the pt be more comfortable, but you'll get a more accurate reading.

p.s. Did your fellow student have the bp cuff lined up with the artery correctly? I know thats a silly ?, but I have seen it happen!

Good luck! And don't let your fellow students get under your skin, it's not worth it!

[OrthoFNP]

Right, I understand how BP should be read. The only reason why we did a reading consecutively within 30 secs was in order to compare readings to report the most accurate reading to the nurse. My patient required a manual reading following a very high reading given by the machine. (I was told to gather a manual reading by the nurse per the doc). The question I have is whether or not a person's BP can fluctuate between moderately high (162/120) to severely high (185/120) in a matter of seconds or was it user error? I have had a hard time finding the answer to this question anywhere. I have read that BP fluctuates within 30 minutes to an hour or so, but not within seconds. That was my question...

[OrthoFNP]

The other student is my friend. I would NEVER EVER throw her under the bus! I am just asking this for my own knowledge. My patient was asleep the whole time btw...He was snoring like a log truck which is why we had such a tough time reading his BP! Plus he was obese and had type II diabetes and HTN and kidney failure etc and so forth. SO...it was Mandatory to have an accurate BP. His readings had been in the 200's and the doctor was closely monitoring him to see if he needed additional dosages of meds. I would personally rather do an additional BP reading than report the wrong number. I also would rather have a nurse check behind me in that situation since he was my very first patient and I have done BP a total of maybe 5 times. We all start somewhere...

[Angels_wearScrubs]

It's important to have accurate readings, absolutely. I did a google search for rapid flucuating bp's to no avail. Now I'm curious! lol. Ask your instructor why it could change so rapidy cause I have no idea. It could very well be user error, we are just students after all! First semester at that!!!!

What helped me with bp's is when my school had a health fair. I volunteered and did like 40 something manual bp's!!! eekk!! My first few readings I was like..."You have a 164/42 bp reading!" which may or may not have been correct , but after a couple of them I was very confident in my skills. Maybe you can do something like that? or practice taking bp's on your friends, family, pets, random people at the movie theater?

[OrthoFNP]

Thanks angels wear scrubs! That just made me laugh! I will be the first to admit I am not good at BP yet. My friend on the otherhand tells me what to do all the time and it drives me nuts! I know she thinks she is helping, but at times she actually has her facts completely WRONG! She asked me what renal failure was the other day and she thought an insulin injection could be given IM. Yeah, I know we are first semester but ummm...she should know that stuff by now. I was just really concerned bc she was acting like if I recorded the wrong number for my patient it would be no big deal. To me it would have been a nightmare. He had HTN and a terrible headache. Thing is he was also schizophrenic. He was not one to really be able to tell us what was happening to him. So, it was a big deal to me to do things right. She is ten years younger than me and she thinks she is teaching me all these little "life lessons" all the time and I just go umm hmm...ok...whatever. Simply bc I have experienced far more and already know these things first hand, but I don't want to be mean so I just try and try to ignore it, but when she tells me what to do when I am well aware of what to do in front of my patient, as if she is the instructor it really does make me nutty! I am two points from an A in Fundamentals and she has a C. It just makes me crazy!!! I am trying so hard to be nice. I have half a togue now from biting it so much...

[Angels_wearScrubs]

Wow, are we twins? I am two points away from an A also. :wink2:

Well, if she is your friend, sit down and tell her how you feel. You don't want it to all build up and then snap at her, know what i mean? I had a fellow student during one of our lab practices tell me how to do sterile gloving and gowning at the SAME time the instructor was telling me!!!! :uhoh21: I almost went off on her! She is a CNA and is great at what she does, but our clinical instructor had to talk to her becuase she thinks she knows it all and does stuff at the hospital without making sure it's ok. Your friend is young and has a lot to learn. She will learn these life lessons on her own, but she just may be immature.

Hopefully she doesn't cause harm to a patient with her "it's not that big a deal" attitude You can be nice to your friend and still tell her to eff off lol. well, not that, but tell her you don;t appreciate her telling you what to do in front of patients. That is NEVER ok unless you are about to kill someone. Seriously insulin= IM??? Uhhhh......FAIL.

Good luck with your friend. I hope she gets her head out of her @ss before she fails out/hurts someone.

[rmkelly]

Yes, BP can fluctuate. Taking it repetitivelywould cause variation and a difference in technique could cause variation. AND, I wonder did you use the same arm? I wish I could remember the publication, but I read a great article on the 5 blood pressure sounds years ago. It was a terrific article that truly improved my practice.

[studentnurse2012]

You are completely correct in that we all start somewhere and it is a difficult skill to master. Also, i agree with you, in that i would rather take the BP a couple of times than report it wrong (and i have taken readings a couple of times on my patients during clinicals..both in first semester and subsequent rotations, if im not 100%). However, in order for it to be accurate you do need to wait in between.

I found an article saying that BP will fluctuate..and i have experienced this. I had a patient whose BP went from 118/78 to 64/37 in the space of 5 minutes (he ended up needing a code).

However, i think going the readings between you and your friend where more likely due to the user (i dont think it would continue to go up and down each time).

Congratulations on having the right attitude and thinking it was a "big deal"...at the end of the day i'd rather be a patient knowing that my nurse was advocating for me and using critical thinking skills to determine whether my treatment plan needed to change, than have a nurse think it was "no big deal"...especially given the comorbidities.

[OrthoFNP]

Thanks! I thought so too.

[ghillbert, MSN, NP]

It doesn't matter if it can fluctuate that much (although it can - if you wonder, go look at an ICU patient with an arterial line measuring direct BP and watch the variation). It would be unusual for it to go up/down/up/down though.

What is important that you are not hearing from the first replies is that you will not get accurate BPs when you take them within 10 secs of a first reading.

I agree with the poster that said you should worry about your own practice and not your fellow students'. If you are concerned that your own readings aren't accurate, get an instructor or your patient's nurse to check your measurements, not another student whose skills you cannot assess.