Need help on blood pressure skill

Nursing Students General Students

Published

We had our vital signs clinical today I could get everything but the freaking BP. I could do the technical part (putting on cuff, positioning stetho, palpating for brachial pulse) and according to my instructor I had that part down pat but I'm having a hard time hearing the sounds. We did a brief video before starting so we'd know what the sounds were and I managed to get all of those right. Is there a trick to placement to hear the sounds and or any special tricks to the cuff? I'm having a hard time getting it to deflate just right either I'm doing it too slowly or too fast. I felt like such a failure since out of our group of eight I was the only one who had issues. My instructor is confident that I just need practice its just so frustrating

Up Vote Up Vote ×
Specializes in ICU.

I'm a pre-nursing student, but I took a CNA class at the Red Cross and I have the SAME EXACT problems as you. It is like I cannot hear the "first" one...I dunno what the heck is wrong with me, I guess we just need to practice like your professor said. It is frustrating, I'm sure you'll get the hang of it.:p

Up Vote Up Vote ×
Specializes in Urgent Care.

You could try a different stethescope, or readjust the ear peices?

Up Vote Up Vote ×
Specializes in Infection Preventionist/ Occ Health.

If you palpate the brachial artery first, it will be pretty easy to know where to put the diaphragm.

Also, you might want to try out some of your classmates stethoscopes. The cheaper ones don't always work well, and some students swear by a certain brands or models.

I believe that a few of my classmates discovered that they have (mild or moderate) hearing impairments after having difficulty with BP's. One ended up getting hearing aids. I'm not saying this is the case with you, but you might want to get your hearing checked if you've tried everything else.

Good luck!

Up Vote Up Vote ×

Practice, practice, practice! The more you do it, the easier it becomes (particularily in terms of technique, and how fast or slow to release). Start out releasing the air very slowly and as you get a feel for it release it a little bit more. Don't be discouraged! Lots of people have trouble doing bps when they first start- you are certainly not alone. I agree with the others about maybe trying a different stethoscope and make sure that isn't the problem. If the stethoscope is ok, try opening your mouth really wide as you put the earpieces in your ears and once they are in, then close your mouth; it sounds a little stupid, but it helps to get the earpieces in place correctly. Also, look for the when the needle starts 'jumping' - if you can't hear it when the needle is jumping than perhaps you aren't listening in quite the right place, or the stethoscope isn't good enough. Have you used a double stethoscope with an instructor? If so, could they hear it and you still couldn't? If that is the case, than perhaps you should consider getting your hearing tested. Don't worry though, I'm sure that you will get it!

Up Vote Up Vote ×
Specializes in Med-surg > LTC > HH >.

PRACTICE IS THE RIGHT ANSWER. I HAD TO PRACTICE BEFORE I COULD GET IT. EVERYONE AROUND ME GOT THIER BP CHECKED READY OR NOT. EVEN MY THEN SMALL CHILDREN WEREN'T SAFE:chuckle .ALSO DO WRIGGLE THE EAR PIECES AROUND IN YOUR EAR, THEY DO HAVE TO BE ADJUSTED. AND REMEMBER YOU HEAR DIFFERENT SOUNDS ON DIFFERENT SIDE OF THE DIAPHRAM OF THE STETH. GOOD LUCK AND YOU WILL GET IT.:balloons:

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

http://homepage.smc.edu/wissmann_paul/anatomy1/1bloodpressure.html - here is another explanation of the procedure for you.

the trick is that you have to get the bell of your stethoscope over the artery so you can hear that bruit loud and clear. palpate for it with your fingers. if you are having trouble finding it, have the patient extend their elbow as far as they can. sometimes you can palpate the artery better when you can compress it against the bone of the elbow (sorry my anatomy fails me with the name of this part of the bone). you will sometimes find the artery more toward the inside (medial) part of the arm nearer the trunk of the body. inflate the cuff slowly and listen. as you do, you will start to hear the bruit as the cuff begins to compress the artery. once i can no longer hear the bruit, i usually pump enough air to take me about 20 or 40mmhg higher and then start releasing the air--slowly. you have to learn to coordinate your fingers so that they are just barely turning that screw. by the time i'm ready to release the air i already have an idea of what the blood pressure is.

Up Vote Up Vote ×

Daytonite, I think you should consider getting your PhD and become a nursing instructor. You have a real knack for teaching as evidenced by your posts on many threads.:)

Up Vote Up Vote ×

tap the diaphram of the stethoscope to make sure its working. Good luck!

Up Vote Up Vote ×
Specializes in ER.
tap the diaphram of the stethoscope to make sure its working. Good luck!

...while saying, "Is this thing on?":chuckle

I agree that the only real way to get this down is to practice 'till you get it, particularly as far as how quickly to release the air. When you finally get it just right, you'll wonder what in the world you thought was so hard....I promise:) People gave me all kinds of advice when I was learning, but the only way I finally got it was to bring a cuff home and accost all my family members several times a day.

Up Vote Up Vote ×
Specializes in Psych, Med/Surg, LTC.

You will get it, don't worry! Like everyone else said...... PRACTICE!!!!!!!!

Up Vote Up Vote ×

Thanks guys I tried the suggestions and tips and they worked. I have to really strain to hear the first sound since I always want to go early but I'm paying attention to the pressure needle and the sound before doing the reading. I had another duel stetho day today (different clinical) and actually was able to get an accurate reading.. 2 Cool!! :balloons: Then I was showing my fellow clinical mates how to get a good brachial reading from the advice I was given on here, I was even able to feel the pulse on my lab partner who's really hard to palpate. It helped a lot of people since they were able to palpate without applying as much pressure as they had been before.. :)

So I'm back to practice practice practice and giving my ears a rest.. I'm having a slight earache so I'm sure that's impacting my auscultating ability as well. :chuckle

Thanks Again you guys are GREAT!!

Up Vote Up Vote ×
+ Add a Comment