can someone help me with blood pressure sounds/validations?

JDZ344 · Feb 7, 2011

All I can say is, I struggled and still struggle. If the HR is low, then I find the sounds are less clear and harder for me to hear. It also needs to be pretty quiet for me to pick it out. I hope someone on here can help you but I just wanted to let you know you are not alone!

guest64485 · Feb 7, 2011

Ask your instructor if she would be OK if you took a "preliminary blood pressure" before getting the actual reading.

To do this, you do not need your stethoscope. Simply secure the blood pressure cuff on the person, find their radial pulse, then while continuously feeling the pulse, pump up the cuff with your other hand until you can no longer feel the pulse. Slowly release the air until the pulse is palpable again. This will give you an idea of the approximate systolic blood pressure of the person, (and you may sometimes see this in a patient's chart as "75/x or 75/palp"). Let the person's arm rest for a minute or two and then try getting the blood pressure the "normal" way, now that you know what their approximate systolic is.

If you can, get your own steth and blood pressure cuff and practice on family. It takes time to get blood pressures down, and it takes practice to distinguish pulse sounds from artifact sounds of the tube rubbing, for example. It makes it harder when you have to use the crappy double steth for testing, but you can get through it! Good luck!

shiccy · Feb 7, 2011

Here's my 'tips and tricks' to being able to hear better.

*I* found that when I was going through nursing classes, the sound wasn't as muffled as what I thought it was ... I was just getting a lot of feedback from stethoscope movement and the cuff when it was deflating. Here are some suggestions:

Pick a partner that is skinnier. It's easier for cuff placement. Larger individuals tend to have weird shaped arms and it makes placement of the cuff more difficult.

Put the cuff as high up towards the persons axilla as possible. The purpose of doing this is so that when you are auscultating for the systolic and diastolic your cuff and cuff cords are not touching the stethoscope.

When you're holding the stethoscope bell, keep your fingers apart and NOT TOUCHING each other. Also only hold onto the rubber portion. This will minimize the noise from your fingers moving on the scope.

Try a couple different things, but sometimes it's easier to hear higher blood pressures and it's also easier to hear it when the heart rate is faster. If they'll allow it, make your partner do a few laps around the parking lot to get their rate up. If they won't, then do this next step.

There's nothing saying that you can't take your time. It's class, so you typically get a few attempts. If the person is at rest, the blood pressure shouldn't vary much. Take the blood pressure SLOWLY... only a few mmHg at a time. Listen intently for your systolic (first few wooshes... it's subtle at first). Once you hear your systolic, make note of that number, and pump the cuff up 20mmHg higher and repeat. If you get the same number, then you're golden. If you don't, then try it again. Doing this will make sure you get the right number. Go a bit quicker till the sound disappears, which is your diastolic. It, for me, is a bit more obvious than systolic sometimes. Once the sound disappears, try the above (increase pressure to 20mmHg or just an estimated few pumps) again and make sure you get the same number. THIS way you will look like you've done it before, AND it also makes the teacher know you're double checking your work.

When *I* did it I had to be within 4mmHg of what we got and the teacher got... 2mmHg on either side, and I did well. The importance to me is eliminating every noise you possibly can get.

Oh and don't forget to take the pulse before you do all this so you don't forget to when you get your BP correct!

BacktotheBeach, ADN, BSN, RN · Feb 7, 2011

This website will allow you to practice "listening" to BP sounds. It helped me so much!

http://www.abdn.ac.uk/medical/bhs/tutorial/q1.htm

bednar275 · Feb 25, 2011

That was the biggest help listening to sounds I have found, Thanks for posting

CrazyGoonRN · Mar 1, 2011

I started nursing school and we have validations on taking blood pressures. I had horrible trouble hearing the sounds, and I know I'm not prepared at all to pass off on validations. Are there any good websites online to practice hearing the sounds? I'm a bit shy and suffer from social anxiety so I get so nervous and sweaty. we have to use generic double-headed steths for validations so the instructors can check. any tips? suggestions?

This may or may not be your problem, but here is what worked for me. My steth came with the squishy ear pieces and I couldn't hear anything. It was awful! I changed the earpieces to the hard ones and could suddenly hear everything!! I finally realized that the squishy ear pieces were closing up in my ear and making it extremly hard for me to hear anything. The hard ear pieces are less comfortable, but at least I can hear

Anne36, LPN · Mar 13, 2011

Super stupid question, but bear with me. Since I have been in Nursing school I have watched videos and read all the directions on taking a blood pressure but I have not been shown how to actually do it. We were expected to already know how to do it from the reading we were assigned. Nobody has ever explained to me about the tiny screw you have to tighten and loosen up. When I have my cuff inflated and need to let the screw loose, how far do I let it go? Do I only unscrew it once a little bit or I do I continue to unscrew it further during the pressure reading?

BacktotheBeach, ADN, BSN, RN · Mar 13, 2011

unscrew it once just a little bit, watch the dial, you want the needle to go down about 2 mm/Hg a second. It you unscrew it too far, it will deflate too quickly and you won't be able to hear what you need to listen for. Then at the end, after you have heard the last sound, you can unscrew it all the way to totally deflate the cuff. Hope this helps!

CrazyGoonRN · Mar 14, 2011

Super stupid question, but bear with me. Since I have been in Nursing school I have watched videos and read all the directions on taking a blood pressure but I have not been shown how to actually do it. We were expected to already know how to do it from the reading we were assigned. Nobody has ever explained to me about the tiny screw you have to tighten and loosen up. When I have my cuff inflated and need to let the screw loose, how far do I let it go? Do I only unscrew it once a little bit or I do I continue to unscrew it further during the pressure reading?

That is not a stupid question at all. Sounds like our teachers are the same. I was completly lost when we first started doing BP's because the teacher never actually showed us how to do it. She just expected us to know how and we were never checked off on it and expected to do it in clinicals. Some people think that since it is a basic skill that it is so easy that they don't have to explain it, but when you are new to it then it is not easy. I wish that some teachers would actually teach. Anyway, you only unscrew it once a little bit until you have the blood pressure then you unscrew it quickly to deflate it. For example if you get to 75 and have already gotten your top and bottom numbers then go ahead and unscrew it fast so that it will deflate quickly and won't continue to be unecessarly tight on your patients arm. Good luck! :)

Queen Tiye, CNA · Mar 14, 2011

thanks superv, this site is awesome!