Blood Pressure Blues

BellsRNBSN · Sep 17, 2010

I recently started nursing school as well. I'm in an accelerated program, so we were taught how to measure vital signs during our first week. We had half of an entire school day devoted to taking vital signs on each other and I remember blood pressure being really difficult to read on a lot of the other students as well - and we're all relatively healthy.

So here are some tips that I picked up on: when looking for the brachial pulse, have your patient hyper extend their arm so that the antecubital space is sticking out rather than depressed, like when the arm is bent. This makes the blood flow a little better and makes the pulse easier to palpate. Make sure you are placing the cuff in the right position: there should be a little line on the cuff, or the word "Artery," which you should be placing one inch above where you felt the brachial pulse. Remember to place the diaphragm of your stethoscope over the place where you felt the brachial pulse.

***Make sure the stethoscope you are using is adequate. The stethoscopes that our faculty let us borrow in class were pretty poor quality and it was really hard to hear the Korotkoff sounds through them. But when I used my own personal Littman Classic, I could hear A LOT better.

Also try to make your surroundings as quiet as possible. Of course you won't always have this luxury in a hospital setting, but A) practice, practice, practice in quiet areas and then progress to practicing in louder spaces and B) even in the hospital, you won't be in a classroom full of 20+ students all talking to and assessing each other while trying to take someone's BP.

Practice on as many friends and family members that will let you. I'm not sure about how things are where you live, but for my class, the instructors just wanted to make sure we could manually take a BP with the sphygmomanometer. The hospitals in which we have clinicals all use the automatic BP machines in which all you have to do is hook it up to the cuff, place the cuff in the right spot around the patient's arm, and press a button. If this is the case for you as well, then you will not need to be an *expert* at manually taking BP - but I'm sure that will come with time anyway.

Good luck to you :nurse:

BacktotheBeach, ADN, BSN, RN · Sep 17, 2010

I'm just starting too. This website helped me to get good at what to 'listen' for. http://www.abdn.ac.uk/medical/bhs/tutorial/q1.htm

gumby1411 · Sep 17, 2010

I had trouble at first, too. My problem was not pressing hard enough with the stethoscope. I was afraid to hurt the person I was practicing on, but you have to press hard enough to create a seal on their skin....and it didn't cause anyone any discomfort like I feared it would. Also, make sure the diaphragm of the stethoscope isn't touching the cuff or anything else because it can interfer with the Korotkoff sounds.

cmw6v8 · Sep 17, 2010

I agree that a good stethoscope helps a TON (I'm new at this too). I try to practice on whoever will let me, when I can remember it. Mostly my husband has been my guinea pig. I do have a question though--my health assessment book (Jarvis) says that for BP we should use the bell and not the diaphragm. Is this correct? I tried it with the bell once and I couldn't hear as well as with the diaphragm, but maybe I wasn't pressing hard enough?

SingDanceRunLife · Sep 17, 2010

I was having major trouble at first, and in all honesty, the most important tip I can give you is practice, practice, practice! I texted all my friends and asked them if I could use them to practice, and they all said yes, and that is exactly what I did. I passed my competency on vitals, but I'm still going to use my friends to practice on to gain more confidence because it's such an important skill.

NurseLoveJoy88, ASN, RN · Sep 17, 2010

Practice, practice, and do more practice. You are not going to be successful of taking BP after one class of learning. In CNA school my instructor told us it may take several months of doing BP for us to become accurate and efficient at it. There are times I have to do two BP because I may have missed a systolic or diastolic and I've been a cna 3 years and nurse 1 year. SO it just takes practice.

metal_m0nk, BSN, RN · Sep 18, 2010

Try palpating the pulse first (if you haven't already). If you have trouble palpating it in the antecubital space, try moving to a spot just above the fossa and medial - along the medial edge of the biceps brachii.

Hope that helps.

Tarabara · Sep 18, 2010

If you notice you can see the needle jumps a little when the sounds start and stop, do NOT only go by the needle movement but if you think you heard it and you see the needle jump at the same time you can be pretty sure that you did in fact hear it. Its hard at first because you're not really sure what to listen for but as the above posters already said, practice practice practice! Good luck!

starmickey03, MSN, RN · Sep 18, 2010

I agree that a good stethoscope helps a TON (I'm new at this too). I try to practice on whoever will let me, when I can remember it. Mostly my husband has been my guinea pig. I do have a question though--my health assessment book (Jarvis) says that for BP we should use the bell and not the diaphragm. Is this correct? I tried it with the bell once and I couldn't hear as well as with the diaphragm, but maybe I wasn't pressing hard enough?

No, thats not correct. You use the diaphragm for BP. As a matter of fact all of my instructors keep saying that nurse generalists usually do not use the bell at all. They say that cardiac and ICU nurses tend to use the bell, and ER nurses may use the bell sometimes as well, but all other nurses will most likely only use the diaphragm.

To the OP, another thing to check for is to make sure you're palpating close to the inside of the arm rather than in the middle. The brachial pulse is felt better at least an inch from the middle of the arm. And as someone else stated, make sure you're pressing down hard enough because if not you wont feel anything when you palpate and you wont hear anything when you're trying to get the BP reading. This was a problem one of my clinical members had. She wasnt pressing down hard enough and when she finally pressed a little deeper she felt and heard the pulse. Good Luck!