difficulty hearing blood pressure

[NancyRNHospice]

I have a patient whose blood pressure is almost impossible to hear. I can palpate a systollic about 110 to 120 on most visits. She has a very pronounced heart murmur with no auscultated S1, S2, just the "whoosh". She does not appear to be actively dying at this point. Other nurses have just noted that they cannot get a blood pressure. I'm curious whether the murmur is affecting the sounds of the blood pressure and I haven't found this in my readings. Any suggestions or information?

[Virgo_RN, BSN, RN]

Yes, it can be very difficult to auscultate a BP on someone with a very low cardiac output. One trick is to turn off everything in the room that makes a noise, inflate the cuff, and deflate it very slowly. Another trick is to use an electronic BP cuff.

[NurseNature]

I've been told that left side lying can help... haven't personally experienced this though.

[ZippyGBR, BSN, RN]

how good a stethoscope areyou using

comparing cheap steths to littman select /classic to specialist scopes does show that you get what you pay for up toa point ( some of the hugely expsnive cardiology scopes miht be worth while if you worked in a teritary ardfiology centre ut a lost on the average doc or nurse outside that setting

[pagandeva2000, LPN]

I am interested in this, also, because I have cheap and Littman stethoscopes and still occasionally experience difficulty. I am considering purchasing one that amplifies because I do get patients that are difficult to hear. My only concern about using the electronic ones on occasion is if administering medication depends on my reading. We have a few patients that have to get blood pressure checks a week or two after a clinic visit due to medication changes. I want to be sure that I have an accurate reading then, also, because the doctor will change orders based on what I tell him.

[RNAnnjeh, MSN, CNS]

Close your eyes while listening.

I know, how can you see the reading....but if you close your eyes and listen then you'll know what you're listening for. Then take it again (eyes open).

It helps me....

[Virgo_RN, BSN, RN]

I have a Littman Master Cardiology, and still have difficulty hearing sometimes. LOLs with little to no cardiac output can be really tough to hear a BP on.

[iluvivt, BSN, RN]

In situations like this you can palpate the brachial artery before placing the stethoscope onto the skin, then you are more apt to hear it as it refills