Can't take blood pressure

  1. I am trying to help my wife out. She is in her senior year of her nursing program. She has never been able to take blood pressures accurately. The way she describes her problem is that she hears her own pulse in the stethoscope instead of the patients. She doesn't seem to be getting any help from her instructors, in fact the current instructor is "God's infallible gift to nursing" so therefore can not imagine anyone else having problem that is legitimate. Has anyone heard of someone else having a similar problem? How did they work around it? My wife's instructor says she aware of some nurses paying other nurses to take BP's for them because for one reason or another they are unable to. Thanks in advance for your help.

    Dan
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  2. 16 Comments

  3. by   Larry77
    Sounds like there is a "technique" issue...possibly one of the staff CNA's or nurses could help her during her clinicals. I know if I was staff I would be happy to help her but it is hard for me to see what she could be doing wrong without being with her.

    Try different steths, make sure she is holding the head of the steth with her first two fingers--not her thumb...
  4. by   futurecnm
    I am a nursing student (1st year) and we had to pass a performance test for taking BP. How did your wife pass hers??? Anyway, I would have her try different ear pieces and different brands of stethoscopes. There are good ones that may work better for her. Also, I am not really sure how she would hear hear own pulse, unless she is putting the bell on herself. I don't really see how that would happen. But maybe I'm wrong. I think she has to play around and keep practicing until she can hear it. Men are easier to hear than women. It is something she should know, as all nurses should, but in a hospital setting, many of the BPs are done by machine. Obviously,she still needs to know how to do it manually.
  5. by   Rabid Badger
    She needs to know how to do a manual BP. Period. She needs to find someone in her class or a nurse who would be willing to sit down with her and make sure she gets her technique right. We use BP machines a lot, but they are unreliable, and we often have to do manuals. It is a very basic but essential technique, so if she has trouble, with a little guided help she will be able to figure it out. There's no way she can function without it.
  6. by   TigerGalLE
    I agree with Larry... she might be holding the bell with her thumb.. Your thumb actually has a pulse and that may be what she is hearing...
  7. by   Indy
    Ear pieces: Littman steths have a shape to the thing that angles it toward the adult eardrum a weensy bit better, plus soft eartips help seal other sounds out. However, I have occasionally noticed my own pulse when I have a bad cold. So have her clean her ears out once a week (not more often) with those oily drops you can get from the drugstore, rinsing with warm water. I used to do that in school the night before clinicals.

    And yes, to echo the poster who said not to put your thumb on the head of the steth. Also don't let the rubber cord things flap around while listening, they can hit the steth and make little bumpy sounds that could fool ya.

    Where is the steth head placed? Feel for the brachial artery and where you feel the strongest pulse, stick the steth head right there.

    Practice, practice, practice. You can help with this. You set the bp cuff up on your girlfriend's arm, let her have the steth, you hold the thing where she can see the dial and help her take her own, so she knows what it sounds like. Then have her take yours, so she can hear the difference. Let her try on both arms, and forearms too! With forearms the steth goes over the inner wrist. Works just fine, and good to know for obese people when you can't find one to fit the upper arm.

    Also know that if the whole pulse is thready, the loud "bump" that's the first karotkoff sound will be barely audible. If the pulse is good or bounding, there will be no mistaking that first sound.

    How is your girlfriend at listening to apical pulses? Does she hear sounds fine on the chest wall? If not, perhaps she's got a hearing problem. Electronic steths, or ultrascopes if it's very mild, are wonderful. I've got an electronic and wouldn't have made it past my first quarter without one. Good luck!
  8. by   djmac
    there will be no mistaking that first sound.

    How is your girlfriend at listening to apical pulses? Does she hear sounds fine on the chest wall? If not, perhaps she's got a hearing problem. Electronic steths, or ultrascopes if it's very mild, are wonderful. I've got an electronic and wouldn't have made it past my first quarter without one. Good luck![/quote]

    Thanks for the tips. She has been practicing for a very long time without much improvement. It is very embarrassing for her to be so far along in her training and still struggling with such a basic technique. She has done very well in within her program but this one thing has been very tough for her. Would you mind telling me which electronic steth you have used with success? She has tried at least 2 standard instruments without improvement.
  9. by   HeartsOpenWide
    Quote from djmac
    I am trying to help my wife out. She is in her senior year of her nursing program. She has never been able to take blood pressures accurately. The way she describes her problem is that she hears her own pulse in the stethoscope instead of the patients. She doesn't seem to be getting any help from her instructors, in fact the current instructor is "God's infallible gift to nursing" so therefore can not imagine anyone else having problem that is legitimate. Has anyone heard of someone else having a similar problem? How did they work around it? My wife's instructor says she aware of some nurses paying other nurses to take BP's for them because for one reason or another they are unable to. Thanks in advance for your help.

    Dan
    My friend has this same problem. She say that it is because her ear canals are so small. She can even hear hear own heart beat when she uses those little ear peices on her I-pod. Tell your wife to go to a medical supply store and get smaller and softer (some have jell) ear peices. I bet you anything this is her problem, which can easily be fixed
  10. by   TazziRN
    Quote from futurecnm
    I am not really sure how she would hear hear own pulse, unless she is putting the bell on herself. I don't really see how that would happen.
    Not unusual at all, actually. If I lay on my side, I can hear my heartbeat in that ear. Before I had my baby and needed to be able to hear the monitor, I used to wear earplugs to sleep. The sound of my own heartbeat was very soothing to me. When I have my steth earpieces in my ears, I can hear my own heartbeat.

    DJ, have your wife try this: when she puts the earpieces in her ears, have her listen to the rhythm of her own pulse before placing the bell on the patient's arm. Then she might be able to differentiate between hers and the patient's. That's what I do.
  11. by   djmac
    Quote from djmac
    there will be no mistaking that first sound.

    "How is your girlfriend at listening to apical pulses? Does she hear sounds fine on the chest wall? If not, perhaps she's got a hearing problem. Electronic steths, or ultrascopes if it's very mild, are wonderful. I've got an electronic and wouldn't have made it past my first quarter without one. Good luck!"
    Thanks for the tips. She has been practicing for a very long time without much improvement. It is very embarrassing for her to be so far along in her training and still struggling with such a basic technique. She has done very well in within her program but this one thing has been very tough for her. Would you mind telling me which electronic steth you have used with success? She has tried at least 2 standard instruments without improvement.[/quote]
  12. by   Daytonite
    Dan. . .your wife is a senior in a nursing program and has a problem and YOU are posting about it? What's really going on here? Can't she speak for herself? Is the problem with taking blood pressure or with the spouse?
  13. by   djmac
    Quote from Daytonite
    Dan. . .your wife is a senior in a nursing program and has a problem and YOU are posting about it? What's really going on here? Can't she speak for herself? Is the problem with taking blood pressure or with the spouse?
    Glad you asked. My wife was a stay at home mom for 30 years so her children would benefit at the expense of her career. She just now is finishing her nursing training she started when she was 20 years old and then delayed for the sake of our family. That time lapse has left her behind the times as far an the internet and web bases information sources go so I pitch from time to time to support her. But you might reconsider your aggressive attitude toward other nurses as a fellow nurse. It was not long ago that I was surfing a nurses forum and it might even have been this one where an enlightened author wrote that one of the biggest problems in nursing is that you nurses are so cannibalistic towards each other. I in the construction industry and frankly I have seen more unity and support from the sewer cleaners local than many nurses. Please don't feel that I am singling you out alone. As I observed my wife complete her training in the WCCCC nursing program I wonder if they are running a boot camp or school of higher learning judging by the day to day conduct of SOME of the instructors and administrators. Often what I have observed bears no resemblance to the their stated mission statement of encouragement and enlightenment. The attrition rate is pretty impressive. Although my wife and her classmates have worked with many find caregivers and instructors there are too many who have no clue as to how to inspire and educate their students. Well this is getting long so I will end it by saying I admire your vocation it certainly takes plenty of determination and stamina to train and to remain in it. It just y'all should be a little kinder to each other.
  14. by   VickyRN
    ***ahem*** everyone, let's keep this conversation civil, please. address the issue at hand and avoid personal attacks or unnecessary harsh over-generalizations. thank you.

    as for the nursing student, i would suggest she get a part-time job as a nursing assistant. when i was in nursing school, i landed a job as a cnaii in a ventilator unit. i only worked one 12-hr shift every other weekend, which was very doable with my rigorous adn schedule. we had to take manual blood pressures and some of the patients' pulses were so weak. it was great practice for me and i really got to be a pro after awhile. i think this would be an excellent strategy for her to pursue.

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