Blood Pressure...am I really this stupid?

military spouse · Dec 3, 2009

It's the end of the semester and my practical includes blood pressure. My college doesn't have the best reputation ..and I'm starting to see why. But I'm trying so hard to hang in there and self-teach if I can..then maybe I will volunteer for more experience. Anyway..I was practicing and my teach was listening in. Everyone kept telling me to calm down and not be nervous. I thought I appeared calm. But it's extremely hard for me to take BP when the student and teach are talking to me at the same time. I never know what to do. They say..." Wait..go up to 160...no, don't do this...wait, you have to hurry...don't go too fast...this won't be the right reading". My professor ended with saying " You better get on top of your game or else I can't pass you Monday". I'm stressed beyond belief because this is a PASS/FAIL portion of our main class. They call this clinical. We don't have bags with supplies of our own...we have ONE mannequin for 12 students..and I just feel like I am totally unprepared. I also feel like I have a hard time remembering the first number, and not forgetting it..and then the second. I have As in ALL of my classes..and a B in this one. A lot of people are complaining about this class because the teaching truly is poor. But I'm trying not to make excuses and just do the best I can.
I am near tears. I'm practicing on my boyfriend. I am attempting to hold the steth diaphragm with my two fingers (since the thumb has a pulse) and find his brachial artery. It's not so easy. I believe I am positioning the cuff correctly. I just can barely hear.
I thought that the VERY first beat that you can hear is the SYSTOLIC and the LAST beat is the DIALOSTIC. But when I do it this way in class, I always seem to be off by 2 with my readings in comparison to my classmate. Wow, I just feel like such an idiot and I'm so upset because if you do not receive a Satisfactory, you can have a 98.9 % GPA and STILL fail this class. It seems like I am the only one who doesn't have a medical background..so I feel just completely mad at myself for not even being able to get down the basics. I have this and 15 chapters to study. I also have sterile changes to do. So confusing...I write notes..but whenever the teacher performs the stuff it's " Or this way..if this is that then maybe you can do this...or even that way, etc.". It's just not straightforward no matter how many times I ask.
Nursing school is giving me the worst depression of a lifetime. Not because of all the work, but because of the disorganization of the staff there. I have already addressed this. But since I started this semester, I am going to at least try to finish the first part of the program before transferring to a better school. I just cannot go to a class where we are being told that there is a test on Chapters 20-24 and then, instead, are tested on Chapter 8. Whenever anyone says anything, they are met with " You should come to class prepared". I feel like I should be a mind-reader by now. I don't mind working hard..but again..I don't feel like I know what I am doing. Tips?
I'm just going to keep practicing. I'm trying SO incredibly hard to have a positive attitude about this program. BUt it's a little hard when all I have learned, in my first semester, is how to wash my hands, put on gloves, and a stupid gown. They barely touched on BP & dressing changes. I'm thinking of looking for a place where I can have more hands on experience.

Take a deep breath. You can do this!! One thing I would recommend is trying to turn around the stethoscope ear piece. There is a "right" way to put it in your ears. Try it both ways and see if you hear better one way. Honestly, your fellow students could be off by two and not you :) Unless your manual or book tells you differently, hold the diaphragm of the stethoscope with your index finger on one side and your middle finger on the other. Apply a bit of pressure. I would maybe try youtube and see if there is a good video. This really is a simple skill, but it sounds like people are going a bit overboard with it and trying to make it seem difficult or intimidating. In nursing school I think it is important to sound confident, but never cocky. Don't act like you think you can't do things correctly. We had a girl like that and the instructors were so hard on her, but she didn't really deserve it.

Forever Sunshine, ASN, RN · Dec 3, 2009

http://www.abdn.ac.uk/medical/bhs/tutorial/tutorial.htm

Someone posted that awhile back, it will help you with practice to read blood pressures. But you can only practice so many times on your boyfriend and family before they have marks on their arms.

Try practicing on yourself..

Make sure its not too loose or else you will get an inaccurate reading. It should be able to fit the stethoscope though.

caffeineRx · Dec 3, 2009

Thanks you guys. I'm having an extremely hard time practicing on myself...holding it right..and I don't even know if I am position the cuff the correct way. I'm trying. Thanks a lot.

rn/writer, RN · Dec 3, 2009

When I tested out many years ago, we had to come within 5 points of the instructor's numbers for both systolic and diastolic. If you are off by only 2, that should be good enough.

Can you go in apart from class/clinical time and practice with someone using the dual stethoscope? Practicing at home is great for technique, but it won't tell you if another person would get the same reading.

Try not to psych yourself out too much. I wish you the best.

Let us know how you do.

Forever Sunshine, ASN, RN · Dec 3, 2009

Thanks you guys. I'm having an extremely hard time practicing on myself...holding it right..and I don't even know if I am position the cuff the correct way. I'm trying. Thanks a lot.

Upper arm above the elbow. If it inflates up weird like a balloon you have it on wrong.

caffeineRx · Dec 4, 2009

Where are the black tubes supposed to lie if you are taking someone else's BP? When I put the cuff on my guy, I feel for his brachial. It seems to be on the left (his right arm). So when positioning the cuff, I align the black tubes to the opposite side, as my stetho will be going onto his left brachial point. It seems that I have the cuff about 2 inches above his antecubetil area.

What I find to be the biggest pain is holding the "reader", his arm, and pushing the diaphragm with my two fingers. Is it me, or does it feel like it's harder than it looks? I never in a million years would have guessed that BP was going to be a bit of a pain for me. It's really quite shameful.

Aberdeen · Dec 4, 2009

I can't give you a lot of first hand knowledge, but maybe this will help:

NamasteNurse, BSN, RN · Dec 4, 2009

What I find to be the biggest pain is holding the "reader", his arm, and pushing the diaphragm with my two fingers. Is it me, or does it feel like it's harder than it looks? I never in a million years would have guessed that BP was going to be a bit of a pain for me. It's really quite shameful.

This is a new skill for you and your fingers, be gentle with yourself! What if your best friend was having all this trouble? Would you call her stupid and shameful? Of course not, you'd encourage her and give her lots of benefit of the doubt....now,

you don't hold the 'reader' (its called a sphygnomenometer) and there should be a clip on it to clip to the pts clothes or to the cuff. If there's no clip, set it on the pt or the bed where you can see it.

It doesn't matter where the black tubes hang, it's better if they aren't in the way of your stethoscope tube though because you will tend to hear them all scratching against each other.

taking a bp is vital, as in "vital sign". you will do it a million times a day in practice. and the person who said you can get it within 5 and that should be good enough, maybe hasn't started giving meds that depend on bp, because that's not good enough! we had to get it within 2 as well.

don't practice more than two times on any one arm! you can damage the blood vessels. give it a half hour rest in between.

it took me awhile to do this too, but once you get it, it's easy. many people have learned this skill, and you will too. wait till you get to catheters and NG tubes!! :)

rn/writer, RN · Dec 4, 2009

the person who said you can get it within 5 and that should be good enough, maybe hasn't started giving meds that depend on bp, because that's not good enough! we had to get it within 2 as well.

I had to test out on BP for both nursing (started clincals in '91) and EMT training (in '89). The instructors told us that we would improve with practice, but for our initial testing, coming within 5 was acceptable. By the time we were doing patient care, we were all doing very well. I think they recognized the "freak out" factor and tried to give us the confidence we needed to git 'er done.

caffeineRx · Dec 4, 2009

Thanks you guys. I'm stressing because my grade for this portion of the class depends on her written test, and this. She is not an easy "test-giver". So I'm really stressed. I hate this college and feel like I would have received better training at a CNA school. It's pathetic. I'm trying not to be bitter and mad with myself. I just looked at that link and have done about a dozen of the listening exercises..and now my guy has had an hour rest on his arms. I did it once each side. So he said he's ready to let me try again.

dsomday · Dec 4, 2009

Oh boy does your post bring back memories. I too had no clinical experience and was terrified, but it will come easier and easier, and pretty soon it will just be automatic. It took me a while to be able to remember both numbers, i would concentrate on remembering the one, and forget to listen for the other. I have even forgot to take the cuff off the patient, and I about drug this poor little lady out in the hallway with me!!!! Thank goodness she had a sense of humor about it. She would just bust out laughing every time she saw me coming with my cuff. Good luck...