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BP on elderly


I'm about to graduate in 3 months and suddenly I am doubting my BP skills. I usually never have a problem hearing, but occasionally on certain elderly people it's too soft to hear, so I was told back in my first clinical, to just notice when the needle starts and stops bouncing. However, last night at work I took a BP on an elderly woman. The needle started bouncing at 140 while I didn't hear the first sound until 120. I listened several times to make sure this is what I heard. But about 10 minutes later another aide came in and got a systolic of 140. I am incredibly embarrased about this and don't want to ask the nurses at work, since I'll be an RN is 4 months. So can someone just clear up my question - is the systolic when the first beat occurs or when the needle first bounces?

Thank you so much:imbar

BPs are like chief complaints....

Always changing from minute to minute.

Don't stress, just practice...

And when in doubt write "144/86".

Chances are you'll be close enough to the real one.

The above was meant as humor, so please no replies to have my post removed because it violated your "TOS" and someone performed a funny bonectomy and denervated your sense of humor.

While mastering BP I had the exact thing happen. The needle started bouncing at 140 but I did not hear it until 102. When we finished my instructor said "what did you hear?". I said well I saw and she said sternly "I don't care what you saw. What you heard is what is important." I would go with what I heard unless I never heard anything. LOL Then I would do it again and probably use the bounces. Good Luck! :) ~twintoo

Elderly BP's are tricky. I just finished a four week rotation at a nursing home and decided instead of repeatedly inflating the cuff on those frail little arms five times, I relied more on the bouncing needle on the cuff. Then to clarify my reading, I looked back on the chart and noticed the pt's prior readings, and what I got looked very consistent with the others.

When I hear no sounds, I do just take the readings of when the needle bounces. But what happens when the bouncing of the needle does not correlate to when you hear the first sound?

Originally posted by Carolanne

Elderly BP's are tricky. Then to clarify my reading, I looked back on the chart and noticed the pt's prior readings, and what I got looked very consistent with the others.

I do the opposite. Pulses can be hard to find also, so I look at priors so I don't overinflate unnecessarily. But I go by the sound. If it is inconsistant I'll try the other arm. But is also helps that I have an electronic stethoscope that really helps with the hard to hear BPs.

My assessment instructor was VERY firm on this also. It is when you hear the first sound - not when you see the needle bouncing. In fact, she taught me to not even look at the needle until I heard a sound. You should never base your assessment decision on what someone else got before you. What if the needle is bouncing but you don't hear the first sound until a systolic of 80 or 90 and the last recorded BP was 140? Take it again, verify what you heard, and then you better be concerned about hypotension. This is how good nurses miss clinical signs of a change. Nothing irritates me more than the nurse who takes my BP and finds it to be 20 points above my normal because she's watching a bouncing needle.

Are you palpating the brachial pulse before placing your steth? Another hint, sometimes you can put your steth just above the antecubital space, slightly under the cuff for a better sound.

Finally, when in doubt, check to see if there is an automatic cuff you can use to verify your reading.

gwenith, BSN, RN

Specializes in ICU.

And always always ensure that your earpieces are facing forward in your ears. I always amazed at who few people actually move the earpieces to correct position.

Re: preventing overinflating cuffs on elderly, our instructor told us to palpatate the radial pulse, inflate the cuff while palpatating and stop inflating when you can no longers feel the pulse. Then deflate & take the bp, inflating the cuff 30 more than where it cut off the pulse.

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