Blood Pressure...am I really this stupid?

caffeineRx · 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...

This is ME. I'm a pretty hyper person..and my instructor and classmates (bless them) don't really help.

I cannot believe that if I don't get this down I can fail out of this class and be behind a semester...not to mention having to pay 4k+ to retake it again. I'm just praying and practicing as much as I can.

CBsMommy · Dec 4, 2009

A couple of tips for taking a BP:

1. Have your "patient" in a sitting position with their arm resting on a hard surface (like a table) if possible. If not, make sure their arm is between your opposite arm and your body.

2. The BP cuff should be right above the crease in the elbow. Not two inches above.

3. Make sure part of the bell of the steth. is placed slightly under the cuff. This will make it easier to hold the cuff and steth. in place.

4. To make it easier to hold everything that is going on...make sure you place your hand on top (using 4 fingers) and wrap your thumb around the back. This will help to ensure that one of the fingers is holding the bell of the steth. (and thus holding the cuff in place) and two of your fingers are holding the BP cuff gauge and one finger is resting on the patient's arm. Without pictures it's kind of hard to explain. This is only to be used when the gauge is attached to the BP cuff.

5. You start the BP reading when you can hear CLEAR thumps. Usually the gauge needle will start jumping along with the thumps but you should HEAR them.

6. Turn the dial to loosen the air SLOWLY. If you can't hear the clear sounds and need practice, do it slowly. They can't fault you for that (even if it makes their arm sore).

7. Try to get the clearest sounding heart in your class. I know that mine has been used before because you can hear my heart without a stethoscope.

8. If you can, go to Walmart and get a BP cuff with the stethoscope built in. It really helps to hear what you are listening for. Once you know what you are listening for, you can practice with your stethoscope.

9. You can ask people to be quiet. Even the most experienced nurses do this. It's hard to hear when people are talking! Ask the instructor to go out in the hall if you must.

10. When you are learning, inflate the BP cuff to 200. It normally wouldn't be that high but in the case of high BP patients and when you are learning, it will probably help to pump it to 200.

I really hope this helps. BP was one of the hardest skills to learn for students in our CNA class and many of them didn't get it right away. Also, if you can, I use a Littman Classic steth. It's mine and it really helps to hear. I would suggest buying one! If you can't find one in your area, ask around the class to see if someone would loan you there's. Good luck. Keep practicing and you will get this!

JessicaMarie · Dec 4, 2009

Personally I find BP hard as well. I'd give 5 million catheters before having to use a manual cuff...

cory39 · Dec 4, 2009

You said you were having trouble hearing it. This may sound dumb, but if your stethescope has a double bell make sure you have it turned the right way for the right bell. I'm also in nursing school and I have to tell you, I think all nursing schools make their own rules as they go. If you were suppose to take a test on a certain chapter but they tested you on a completely different chapter, then I would definitely go to the teacher and voice you concern and if that does not help, go to the director of the school. But you have to remember, they can test you on chapters that you have PREVIOUSLY went over because it is cumulative. Don't be afraid to stand up for what is right. Bottom line is your paying thousands of dollars to get a degree, so they need to be held accountable if they are not giving you the right information. As far as helping you with the BP's, wow, about all I can say is keep practicing. I have found that in nursing school you cannot go wrong with repetition. I also don't know if I would initially inflate the cuff to 200. That seems a little high to me. Best thin to do is ask the person what their normal pressure is and go from there. You were talking about the "tubes" coming from your cuff. Those are usually real close to where you place your stethescope because you have to be over the artery. Of course cuffs can be different. Someone earlier told you to put your hand on top of the bell. You do not want to do that. Hold the bell on the arm using your first and second fingers (they should be on top of the bell that is touching the pt. but under the smaller bell that is on top). So basically, you two fingers are in between the two bells. Good luck and I wish you well...

amglpn · Dec 4, 2009

BREATHE You will get this!! My problem in school was breath sounds. Just remember not to be breathing to hard while trying to hear, it might sound stupid by you could be breathing to loud to really hear the thumps?

Good luck and remember you will get it!!!:heartbeat

tlc2u · Dec 4, 2009

When you say' "I always seem to be off by 2 with my readings in comparison to my classmate." Is that when you are using a teaching dual stethoscope? One that lets you and the classmate listen at the same time? Or are you taking the blood pressure and then the other student taking a blood pressure right after you? If you take blood pressure in the same arm back to back readings you may get a slightly different reading each time.

When we tested out on BP we used a dual or two person stethoscope that the instructors had. The instructor listened at the same time as the student and we had to be within a certain number of what the teacher got.

I thought I was doing well with BP and so did my clinical partner however when I tested out in front of the instructor I was a little nervous. The blood pressure reading I got was only one number different than my instructors so I felt I did well. However my instructor claims I did not position the numerical dial directly in my line of site and so I had to test out again another time. Our school allowed us a second chance on another day to test out on BP.

My partner and I both felt I definitely had the dial in my line of site but it was not worth arguing with the instructor. I knew I had the dial positioned in site as I had recently begun needing to wear reading glasses and there was no way I would have been able to read the dial if it was not positioned well.

When I did not pass on the first test out I contemplated asking my sons boy scout troop if I could practice on some of them or either going by our local firestation and asking if I could practice on them. Before I got the chance to ask them our school was offered for student volunteers to do blood pressure screenings for police and state employees. I volunteered for that and must have improved as I passed my next check off.

Have you begun clinicals in a hospital yet? I was so concerned about whether my BP readings were acurate and then when we got into the hospital I learned that they don't even take the blood pressures manually most of the time. They use a dynamap which gives you a digital reading of the blood pressure and you don't even use the stethoscope when taking blood pressure with a dynamap.

As for positioning the BP cuff. Mine has two arrows on the cuff to show which area to place over the artery of the left or right arm. These arrows are just to the left and right of the center of the bladder or inflatable part of the cuff. Our fundamentals textbook states if you don't have these arrows just place the center of the bladder over the artery.

When I put my cuff on my left arm with my palm facing up then for the arrow to be over the artery the arrow is nearest to the inside of my arm or nearest to my body and the black cords or hoses are dangling to the outside of my arm or further away from my body. My BP cuff has a place to hook or attach the dial. We were taught to have the patient sitting up and their arm resting comfortably on their lap or the overbed table etc. This way the only thing we had to hold onto was the bulb or pump to inflate the bladder and release the pressure in one hand and our stethoscope in our other hand.

Best of Luck

CBsMommy · Dec 4, 2009

The reason that I said to inflate to 200 is because you should not hear anything at 200. Once you start deflating slowly, you should start to hear a muffled sound, then clear thumps (record starting point = systolic) and then you will hear the thumps stop (record end point = diastolic). You could reasonably start at 180 or 160 but if you start at 200, you shouldn't hear anything. For normal patients, yes start at 160. For learning, reasons stated above, start at around 180 - 200. It helped myself and some other classmates and certainly won't hurt. Well, maybe someone's arm for a minute...:wink2:

Halinja, BSN, RN · Dec 4, 2009

I had a harder time hearing with the dual stethoscope than with my own. If it is hard to hear, it is perfectly acceptable to ask everyone to be quiet. You NEED to be able to hear.

And once you pass (you will, I think instructors like to scare students, but usually it all works out fine) get a stethoscope that you can hear with. I spent quite a bit of money in nursing school to get a GOOD 'scope. It was worth it, I didn't have to strain to hear.

Good luck!!!

elprup, BSN, RN · Dec 4, 2009

You are not stupid. Nursing school makes one feel stupid (my classmates and I included). Search YouTube for videos. There are a ton of great ones if you search on nursing, medical, health or just what you are looking for like blood pressure. I use them all the time to go over stuff.

Also you should be able to rent clinical skills videos/cd's at your school library that go over everything step by step. Ask librarian.

You can do this. My problem was and still is breath sounds. Hang in there.

ShelbyP · Dec 4, 2009

I'm not a nurse yet, so take this for what it is, but I have done internships in clinics. I had a difficult time learning to take BP, especially "hearing" it, like you. Here are a couple tips that worked for me:

-the medical field, while scientific, is still subjective. I had different, qualified, well-trained nurses teach me the same things in different ways. It's a good idea to get different input, keep asking until someone's answer "clicks" with you, and to know that two people can do the same thing (or one person & a machine could do the same thing) and get different, and yet still, acceptable answers.

-I would not advise to keep practicing on the same person over and over. For one, his BP will change. Secondly, if no one is there checking you, how are you even sure you're doing it right? You could just be making yourself more frustrated and working yourself up without need.

- use all your senses. I am a very visual person and what I saw on the stethescope was a little "jump" of the needle that corresponded with the Systolic (Top number) that kept "jumping" and finally stopped and went straight down when it hit Diastolic (Bottom number).

Good luck!

piperknitsRN · Dec 4, 2009

Many of the other posters have addressed the techniques used to obtain a blood pressure cuff, and I'll let those stand on their (considerable merit).

I just wanted to let you know that you are not alone in feeling this way! I remember having the exact same kinds of stress when I was learning to take vital signs, and fearing I wouldn't make it in clinic. I took a job as a CNA at the bedside to get used to the "life" of a hospital and get some of these skills mastered, and it helped a lot.

To help decompress your stress over this incident, I would say the first rule of my practice is: when in doubt, go seek help. Pull a colleague aside, "Could you please listen to this BP? I think it's 120/65, but what do you think?" I have done variations of that last sentence multiple times, and it has always been helpful. I have nearly 5 years of acute care/telemetry and 1.5 years of critical care experience in the hospital setting--and the anxiety and fear is only because it is new and you are getting used to it--soon you will feel amazed that getting a BP was such a challenge, because you'll be able to do one in your sleep. (I promise, it gets easier, and the fun is looking back to see "the way we were." as time goes on. Any way, I feel that way every time I am exposed to a new technique or procedure or protocol--and 9/10, if I'm uncertain about a technique or procedure, I grab another nurse and we go in and do it together. The mentor has an opportunity to teach, I learn, the patient stays safe, and everyone comes away from the experience for teh better.

This is the way it's done "on the floors"--don't be shy about asking more experienced nurses for help, even with something like a BP. Most nurses would be happy to help you learn or show you something. Personally, I enjoy mentoring new students and graduate nurses, and in any case, I try very hard to foster a collegial atmosphere. It decreases stress levels--and that's what I think might benefit you: a good support group and mentors.

It is normal to have anxiety, especially when it is a skill that is going to be "tested" on. But step back a minute, take a deep breath, and think to yourself that you can do it, just like all the other nurses before you did it.

I have never forgotten that feeling of being "new" and anxious over new skills--even now, every time I learn something new or am exposed to different critical care situations, it can be very anxiety provoking. So use your peers, use your mentors, if possible, even foster relationships outside of your school group to support you.

And take care of you! reward yourself with something you enjoy--long walk, hot bath, chocolate dessert maybe? You sound like you have the makings of a very conscientious nurse, good luck to you!

Emergency RN · Dec 4, 2009

what piperknitsrn suggested is actually a great idea; go to other nurses and ask them for help. i'm sure that nearly all of them wouldn't mind helping a fledgling colleague earn her wings. remember, we were all there at one point (nervous, scratching our heads, and desperately not wanting to fail...) and there were also some great comments already made so i won't belabor the point by repeating already given advice.

that said, i'm going to steer this into a driving road test analogy, and you'll soon begin to see my point. suppose you were the test inspector, and you get into the vehicle of a young driver, who's hand is shaking as he's putting in the key, who has to look twice at and fumble with everything that he touches, then nearly burns out the starter because he kept the ignition key firing long after the engine had already started... what would you do? that's right, he's failed and he hasn't even moved the car an inch. why? the poor kid is probably so unfamiliar with what he's trying to do, that to allow him on the road would be criminal. his actions certainly don't look the part.

now i suspect that you're more or less in the same boat. you're being told that you may fail simply because you don't look the part. my suggestion is, practice putting on the blood pressure cuff and finding the brachial pulse and then putting the scope on it. put the sphygmomanometer's reader dial into a spot where you can see it, while you're holding your scope over the pulse and get ready to inflate... now stop.

take the thing off and do it again...

and again...

and again...

do it a hundred times if you have to. do it so many times that you'll get to a point where you look like you've been doing this for years. this is what your instructor is really looking for, ie ...that you look like you know what you're doing.

as for the admonishments of don't take a blood pressure twice in succession on the same arm? lol... i know everyone (myself included) in school were taught that and all the text books say that; but in real practice, no one really cares. if you don't hear it right the first time, most people (including rns nps pas & mds) will just go ahead and take another reading immediately after the other. some nursing perfectionists may call that "bad practice" but that's the reality of the profession. frankly, in all my quarter century experience, i haven't yet heard of one (as in never) case of anyone's arm being damaged from repeated blood pressure taking. however, since you're doing this in front of your instructor, if they ask about it, just parrot back what they want to hear, that "doing it immediately without allowing the arm to rest may damage blood vessels or patient tissues" but you can probably practice as many times on your bf as you would like without fear of harming his vessels or patient tissues.

best of luck!