Nursing student freaking about BPs

  1. I suppose I should post this on the student forum but I think I need the help & advice of seasoned nurses. I just started nursing school (LPN) 3 weeks ago. I have no former experience in the health field so one of my classes is designed to get us all on a par with the CNAs who have those skills down pat. I'm doing OK with most everything but vital signs, most specifically, blood pressures.
    I can't seem to "hear" that first beat or realize that it was the first clear beat, so my systolic is usually a bit low. And then the beats stop & I don't realize it until too late. I also just plain have a difficult time hearing the beats with all the other extraneous sounds probably caused by movement of the person or the stethoscope. I am an older student & my hearing isn't what it used to be but I'm not deaf by no means. The more frustrated I get the worse it is. I have to test out with an instructor soon & I have to match her numbers within 2. The way things are going, it's not going to happen. This is realy stressing me & it's carrying over to my other studies. Yesterday I took a quiz that was pretty easy & I made two very stupid mistakes. I know it's because I am letting this get to me.
    PLEASE, do you have any suggestions or advice? Any "tricks of the trade" you'd be willing to share?
    Dixie
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    About midcom

    Joined: May '06; Posts: 435; Likes: 87

    19 Comments

  3. by   mkcrturner
    ok, i'll 'fess up to this....... but my mistake may help you.

    Are you properly placing the earpieces in??? When they are backwards you CAN still hear, but flip them around to the correct listening side and WOW what a difference!!!! I feel silly now, but I still say that the wrong way looks like the correct way- LOLOLOL
    I also bought my own stethoscope instead of using the schools so I could practice at home, and it is in far better condition.

    Also. A tip to help- when listening you will hear background noises, then a loud beat will come in (systolic number) , then it goes away (dystolic number). A classmate said to think of it like an annoying neighbor playing their music too loud. You want to report it- so you note the time they turned it up (systolic), then the time they turned it off (dystolic)

    Hope that made sense, and that it helps somewhat. From one student to another...
  4. by   mamason
    Could it be your stethescope? I had a hard time with BP's while in school. Found out it was my stethescope. I invested in a Littman and it made a world of difference in being able to hear the first "THUMP". Also, try to make sure the room is void of any type of audible distractions when you're taking BP's. Not always easy to do. I usually tell the pt or family memebers that I have a hard time hearing the BP"S and I really need absolute quiet when taking BP's. Of course I do this in a nice way, and, they are usually happy to comply.
  5. by   Agatha
    I know just what you mean!! I used to be an NA years ago, and it seemed so easy to hear the beats when I was 20.

    Do the earpieces fit into ear? I've found that the smaller ones fit more snugly, while some just rather sit there. I don't have a solution, but my smaller ones are definitely easier to hear through.

    Good luck!!
  6. by   meownsmile
    Dont be afraid to turn off the patients tv. Just tell them you need to turn it of so you can hear better and will turn it back on when you are done. They shouldnt care as long as you actually DO turn it back on.
  7. by   MrsMommaRN
    check out this site it may be helpful....


    http://www.wilkes.med.ucla.edu/intro.html

    :spin: :spin:
    Last edit by MrsMommaRN on Oct 28, '06
  8. by   kranken_schwester
    I'd also recommend making sure you're placing the stethoscope at the right point on the patient's arm. Palpate first to feel the pulse, then place the stethoscope at that spot and hold it firmly in place. Also don't be afraid to ask the patient to hold still; the sounds of movements and rustling can really interfere with your ability to hear the beats.
  9. by   vampiregirl
    Do you have a local EMS station near you? If so, you might see if someone there would work with you for a few minutes or if there would be a good time to stop by. Often they have a two-headed training stethoscope. Sometimes, just having someone different work with you might make a huge difference. Plus, BP's in a bumpy ambulance are tricky anyways and you might get some great tips from a seasoned person. If you do this, take your stethoscope with you, sometimes if I take a BP with someone's stethoscope who having trouble hearing with it, I can give them a better idea if there is a problem with the scope or the earpieces themselves.

    As another poster referred to, the earpieces can make a huge difference. Some people have to have hard tips, other have to have soft tips.

    Good luck~
  10. by   vampiregirl
    Also, a word of encouragement. Some of the skills I've had the toughest time learning are the same ones that I now consider to be my strongest skills. If you take the time to really work on them, in the long run it can really pay off.

    ~Rachel
  11. by   BSNtobe2009
    Quote from emtrachel
    Do you have a local EMS station near you? If so, you might see if someone there would work with you for a few minutes or if there would be a good time to stop by. Often they have a two-headed training stethoscope. Sometimes, just having someone different work with you might make a huge difference. Plus, BP's in a bumpy ambulance are tricky anyways and you might get some great tips from a seasoned person. If you do this, take your stethoscope with you, sometimes if I take a BP with someone's stethoscope who having trouble hearing with it, I can give them a better idea if there is a problem with the scope or the earpieces themselves.

    As another poster referred to, the earpieces can make a huge difference. Some people have to have hard tips, other have to have soft tips.

    Good luck~
    This is a GREAT idea. They are not always out on calls, and I'm sure some of them would be more than happy to help a student out.
  12. by   midcom
    Thank you all for the advice & replies.
    To answer a few questions- yes, I am putting the earpieces in the correct way. And I didn't feel at all insulted by the question. I always thought they were worn the other way around until just recently.
    I have both a Littman & a DRG (Doctors Research Group) stethoscope. The DRG had been recommended to me by a nurse friend who said she had better luck with it & that the nurses at her hospital were changing to them. I have equal problems with both. I'm using soft tips on both but I think the Littman also came with hard ones. I'll give them a try & see if it's better.
    I did like the idea of asking someone from a EMS for suggestions. I'm a bit hesitant to ask but it may come to that.
    I've decided to practice as much as possible this weekend & then ask one of my instructors to work with me where it's quiet. One of our assignments was to get the vital signs of everyone in the class & it was so noisy & people just didn't sit still. Heck, some talked through the whole thing. No wonder I couldn't hear. However, now, it has gotten to me so badly that I think I have become my own worse enemy & make it even harder. I just need to relax & it will come.
    Thanks again!
    Dixie
  13. by   grace_device
    I had a really hard time getting used to manual BPs as well, and even now it's not something I'm great at since I usually use the monitor or doppler for BPs.

    I found it helpful to have a baseline to go from... have someone else take the BP first (or use an electronic cuff), then you have an idea where you'll first hear the beat. That way, if the systolic was 120, you can pay extra close attention between 130 and 110, and you might have a better time learning to identify the first sound.

    Also, as others have said, make sure you palpate the pulse first so you are definitely going to hear it when you place your stethoscope there. I usually hold the patient's arm with my fingers under the elbow (holding it straight) and my thumb holding the head of the stethoscope in place.

    A fellow student can be a lifesaver... In first year, I checked one of my classmate's BP about ten times a day until I felt like I knew what I was doing... she was really patient, and kept her arm nice and still
  14. by   Dieselmota
    I had the same problem until I switched out the earpieces. I need earpieces with bigger holes.

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