Blood Pressure...am I really this stupid?

cory39 · Dec 4, 2009

You have some good points EmergencyRN, but I have one comment. Another reason they say to wait a certain period to obtain a blood pressure on the same arm is also because you will possibly get false readings. But I am with you, in the real world you don't see nurses looking at their watches and waiting until the next time they can take the pressure, lol. It has been my experience that almost everytime you take a pressure, your going to get a different reading than the one you got before anyway. Of course it will be close, but as far as the systolic and diastolic being the same exact number, NOT going to happen most of the time. And I also agree with another point you made, DO NOT go in the check-off acting like you don't know what your doing. DO NOT tell them anything like "oh I have been having a problem with that," or anything that portrays you as being inconfident about it. My check off's I have coming up are trach suctioning, foley catheters, NG tubes, central line dressings, and enemas (all at the same time!). Of course, I have been working in this field for years prior to going to nursing school so I already know how to do most of those things just from doing them on the job. I thought it was kind of funny because my instructors did not even know that you could plug the NG tube up with the anti reflux valve. In fact they were telling people NOT to do that, lol. But what it boils down to is you have to do things the way your teachers are telling you, even if it may not be accurate, lol

systoly · Dec 4, 2009

The BP cuff acts as a tourniquet. Once inflated past the patient's systolic pressure, you have effectively stopped arterial flow. The point at which arterial flow resumes is the systolic pressure. With this in mind, you can obtain a systolic pressure by palpation. Palpate the radial pulse while inflating the cuff. When the radial pulse is no longer palpable, continue to inflate by another 20 to 30 (mm Hg). This is how you know how far to inflate. Now slowly release the air in the cuff and the point at which radial pulse resumes is the systolic pressure. Now you know how to obtain a systolic without the use of a steth. To use the steth, repeat the above steps, but place your steth before releasing the cuff. If you have a really inexpensive steth and you have trouble hearing with it, you can shorten the tube. Just cut off a few inches (don't do this if you have a Littman cardiology). I agree with Emergency RN, if you don't arbitrarily inflate the cuff to way beyond the systolic pressure, several successive BPs won't harm a healthy person. Even in the clinical setting, we sometimes take BPs q 5 minutes.

cory39 · Dec 4, 2009

The BP cuff acts as a tourniquet. Once inflated past the patient's systolic pressure, you have effectively stopped arterial flow. The point at which arterial flow resumes is the systolic pressure. With this in mind, you can obtain a systolic pressure by palpation. Palpate the radial pulse while inflating the cuff. When the radial pulse is no longer palpable, continue to inflate by another 20 to 30 (mm Hg). This is how you know how far to inflate. Now slowly release the air in the cuff and the point at which radial pulse resumes is the systolic pressure. Now you know how to obtain a systolic without the use of a steth. To use the steth, repeat the above steps, but place your steth before releasing the cuff. If you have a really inexpensive steth and you have trouble hearing with it, you can shorten the tube. Just cut off a few inches (don't do this if you have a Littman cardiology). I agree with Emergency RN, if you don't arbitrarily inflate the cuff to way beyond the systolic pressure, several successive BPs won't harm a healthy person. Even in the clinical setting, we sometimes take BPs q 5 minutes.

But "technically" they say it causes false readings as well. I'm not saying I agree with that theory but for learning purposes she has to know that. In the real world I have found that theory to be false. I have had pt's hooked up to dynamaps and taking their pressure every 3 minutes when they were coding or had really low pressures. I have yet to see any inconsistencies while doing that. I think there needs to be some updated research concerning blood pressures. And they need to include the people that are actually out their on the front lines taking pressures.

murphyle, BSN, RN · Dec 4, 2009

First, take several deep breaths and get yourself centered. I work as a teaching assistant in our nursing education lab, and you don't know how many students have come to my vital-signs validation horrifically tachycardic, tachypneic and hypertensive from the stress, and unable to hear anything from their own pulses hammering in their ears.

I'd second just about everything the other contributors have said, and would definitely tell you to practice with one of the teaching stethoscopes if they'll let you take one home. The sound quality tends to be less than optimal, but at least you'll be working with the equipment you'll use to validate, which will help improve your familiarity. (Remember, always look like you know what you're doing, even if you don't.) If you're having difficulty with holding the equipment, try either clipping the sphygmomanometer to the cuff (there should be a little loop on the cuff exterior for that purpose) or simply setting it on the table. Practice on as many people as are willing to donate you their arms, not just your boyfriend. (When my cohort went through, we used to have "vitals breaks" during study group where we'd all pull out our gear and check each other's vitals for practice.) Whatever you do, though, find one practice that works for you and stick with it.

Once you're past the validation, go invest in a good stethoscope. Cheaping out with one of the little single-head "nurse stethoscopes" is just a good way to frustrate yourself and get false results - if you're having trouble now, just wait till you get to actual auscultation. We were all told to get Littmann, and that's what I have (Master Classic II got me through school; just got a Cardiology III as a graduation present), but I've heard good things about ADC too. Ask your fellow students if you can "test-drive" their scopes - you may find a model you really like.

And a final note: Don't be like the student who came to my validation with the lab's Dynamap. This individual hadn't practiced manual BPs, pulses or resps even ONCE, because "I'm a CNA and all we use in the hospital is the machine." Needless to say, that student wound up failing spectacularly. (To wit, the lab partner's pulse, resps and BP were 120, 22, 148/98 - student came up with 72, 12, 120/80... :eek: )

systoly · Dec 4, 2009

Quote: "And a final note: Don't be like the student who came to my validation with the lab's Dynamap. This individual hadn't practiced manual BPs, pulses or resps even ONCE, because "I'm a CNA and all we use in the hospital is the machine." Needless to say, that student wound up failing spectacularly. (To wit, the lab partner's pulse, resps and BP were 120, 22, 148/98 - student came up with 72, 12, 120/80... :eek: )"

Bringing the Dynamap ?!? That's awesome! And furthermore, the student improved the lab partner's health (72, 12, 120/80 sure looks like out of the textbook). "A" for comedy and a well deserved "F" for nursing.

cory39 · Dec 4, 2009

Quote: "And a final note: Don't be like the student who came to my validation with the lab's Dynamap. This individual hadn't practiced manual BPs, pulses or resps even ONCE, because "I'm a CNA and all we use in the hospital is the machine." Needless to say, that student wound up failing spectacularly. (To wit, the lab partner's pulse, resps and BP were 120, 22, 148/98 - student came up with 72, 12, 120/80... )"
Bringing the Dynamap ?!? That's awesome! And furthermore, the student improved the lab partner's health (72, 12, 120/80 sure looks like out of the textbook). "A" for comedy and a well deserved "F" for nursing.

ROFLMAO, that is rather hilarious. But hey, I would give the student a thumbs up for critical thinking, lol

CrunchRN, ADN, RN · Dec 4, 2009

In real like i just grab their arm and hold it firmly on my side. Wrap the properly sized cuff 1 inch above the crook of their arm. Stick your stethescope over your target area and at moderate speed pump it up to whatever you have chosen 160, 180, 200. I always do 200. Then slowly release till your needle is moving at a moderate pace and listen up. Soon as you hear the thump - boom - you have your systolic. Soon as it stops - your diastolic. Open her up and deflate the rest of the way.

Oh, and I held the bell with my 1st 2 fingers.

Also, if it is a skinny little thing with low BP just stick their hand on the top of your shoulder the 2nd time you take it and you will hear it.

I don't **** around feeling for the brachial. You really cannot miss the right spot.

To me it is all about proper cuff size. Proper body dynamics. Come on over here and I guarantee i can make youa pro in 10 minutes!