Taking Blood Pressure - I feel stupid

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Ok, to get it out of the way, I've taken probably few hundreds blood pressures, so it's not like I don't know which way of the stethoscope to stick into my ears.

Today I volunteered for diabetes day, and did BP for 4 hours straight non stop. While most of the time I had no problems, a few patients were a problem to me.

1. Patients that get readings all over the place. First time - 145/90 (LA), second time it's 116/70 (RA), third time 130/86 (LA), fourth time 120/80 (electronic, RA). I feel like a total idiot. I hear the sounds ok, but that's what I get. One patient asked "for someone more experienced". Well, I was glad to call instructor too...

2. I must have bought the wrong stethoscope - Littman Master Cardiology. It's a good stethoscope for heart and lungs listening, but OMG what a nightmare it is for BP!!! It picks up pretty much everything that's going on in the room, and even slightest move of your finger on it, or if you move it a little (press on it), you get all kinds of squeaks and pops and crackles and rumble. I noticed I often confused these cracks with K-sounds. I often have to switch to cheap ones, they don't transmit all that noise, so I can clearly hear the thumps.

3. Some people have weird Korotkoff sounds. It's like there's a very long and smooth transition from silence to heart beat, it starts at like 160 with a very distant and barely audible thumping that you more feel than hear, and gets louder and louder until it's VERY loud, like BANG!, BANG! BANG! at about 120, and then goes away very slowly all the way to about 50. Frustrates the heck out of me, cause I have no idea what to write because you don't get that clear cut-off moment. And then I ask the patient, what's your usual BP, and they say 120/70. I use electronic for double-check, and yes, I get about 120/80. And I'm idiot again!

4. People with very thick hands that no cuff can embrace - what do you do with those? Use a wrist BP? My instructor told me to, but I don't feel I'm gonna get accurate readings.

Sorry for long rant... But this is getting to me, I normally feel confident in my BP skills, but accidents like this make me fee llike a n00b. Not to mention, the patients probably thinking "where did they get all these incompetent n00bs to do such an important job?" :uhoh21:

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I am surprised that you don't have a bp machine. I had my first experience taking vitals on real hospital patients yesterday and I realized as I wheeled the bp machine into a room with me that I had never even turned one on before :uhoh21:. Thankfully they are dummy proof and it was just a matter of finding the "on" switch :mad:. I can't imagine sitting taking manual pressures for four hours and actually getting them all accurately. I feel your pain!

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Specializes in Family Nurse Practitioner.

When we did BP booths I don't recall retaking them or switching arms like that. I had maybe one or two that I re-pumped up but didn't switch arms or anything like that. Hang in there!

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Specializes in LDRP.

Just a tip--in the hospital we take blood pressures on the same arm using the same method (usually a dinamap) w/ pt in the same position to get a consistent reading! Otherwise you WILL get readings all over the place!! Dont feel stupid--you are learning! :)

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Specializes in LTC, Nursing Management, WCC.

Hello,

I actually prefer to do manual BPs and have a Littmann steth. I agree they pick up everything including my creaking joint fingers. LOL. But I found a way that works better for me. I place my thumb on top of the steth and then lightly place my hand around the arm...kinda like a C configuration.

See if that helps.

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Hello,

I actually prefer to do manual BPs and have a Littmann steth. I agree they pick up everything including my creaking joint fingers. LOL. But I found a way that works better for me. I place my thumb on top of the steth and then lightly place my hand around the arm...kinda like a C configuration.

See if that helps.

Thank you for that suggestion! I'll try it! I bought a Littmann Cardiology III and thought I was doomed because I couldn't take a BP with it. I figured if I couldn't hear clearly with it, I was in BIG trouble. I'll try your technique and see if that helps.

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Hello,

I actually prefer to do manual BPs and have a Littmann steth. I agree they pick up everything including my creaking joint fingers. LOL. But I found a way that works better for me. I place my thumb on top of the steth and then lightly place my hand around the arm...kinda like a C configuration.

See if that helps.

Interesting idea, I'll try it out the next time! :up: :bow:

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Nuieve. . .it's been a very long time since I've seen a post from you on this or the Nursing Student Assistance Forum. I thought you were studying to take the NCLEX. What happened with that?

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Ok, to get it out of the way, I've taken probably few hundreds blood pressures, so it's not like I don't know which way of the stethoscope to stick into my ears.

Today I volunteered for diabetes day, and did BP for 4 hours straight non stop. While most of the time I had no problems, a few patients were a problem to me.

1. Patients that get readings all over the place. First time - 145/90 (LA), second time it's 116/70 (RA), third time 130/86 (LA), fourth time 120/80 (electronic, RA). I feel like a total idiot. I hear the sounds ok, but that's what I get. One patient asked "for someone more experienced". Well, I was glad to call instructor too...

Manual BPs are tough for me, too. In looking at your example, I note that you switched arms between reads, yet the two reads on the same arm are relatively close together. Is it possible you were working with elderly folks who might have plaque buildup in one arm? That could account for the difference in arm readings, couldn't it?

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Nuieve. . .it's been a very long time since I've seen a post from you on this or the Nursing Student Assistance Forum. I thought you were studying to take the NCLEX. What happened with that?

Thanks for remembering me. :) I passed NCLEX last July with 75q. Right now I'm just staying in MA program brushing up on my rusty clinical skills and waiting for retrogression to lift. :)

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Manual BPs are tough for me, too. In looking at your example, I note that you switched arms between reads, yet the two reads on the same arm are relatively close together. Is it possible you were working with elderly folks who might have plaque buildup in one arm? That could account for the difference in arm readings, couldn't it?

I would like to know about it too. Is this possible (to such an extent)? One of the patients actually asked me about it yesterday, and I was not sure what to reply... She said she always gets a difference of about 10 between both arms.

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