First clinical in the morning.. so frustrated

  1. I start clinicals in the morning.. and I am so frustrated.

    We get there at 6:45 am and are paired up with a CNA. We start by getting vitals for all their patients.. problem.. I don't know how to do it. We spent about 15 minutes in lab yesterday learning. I have read all the chapters and watched all the videos and done all the modules on evolve.. but as far as actually doing it.. no clue.

    Blood pressures are killing me. I can't hear the first beat. Why? No idea. I have been practicing on my friends at work and on my boyfriend, but I don't seem to be getting anywhere. Even when I think I might have it right, there is no way to tell, because I don't know what I was supposed to get (know what I mean).

    Now I feel like I am going to look like an idiot during clinicals trying to take a bp on a real person. What if I can't do it?

    arg.. I'm stressed.
  2. Visit traumaQN profile page

    About traumaQN

    Joined: Jul '06; Posts: 84; Likes: 22

    12 Comments

  3. by   BeccaznRN
    Relax! You'll have a wonderful resource (the CNA) to walk you through if you get hung up on something. What I would suggest is letting the CNA know that your skills for taking vitals are still a little rusty - then say that you would like to take the vitals and have the CNA follow you with his/her own set to see where you are. You might surprise yourself!

    Best of luck, and relax! You are in clinical to practice and to learn....take advantage.
  4. by   Daytonite
    here's a link to a virtual blood pressure cuff that you can play around with tonight for some practice.

    http://medicine.osu.edu/exam/ - from ohio state university college of medicine, an interactive guide to physical examination for 8 body systems and includes sounds. has an interactive blood pressure cuff (the link is toward the bottom of the page, "take a blood pressure") where you click on a blood pressure bulb to start the inflation of the cuff. you will then hear (so have your sound turned on) and watch the manometer and tell the program what the final blood pressure is. it re-cycles to give you lots of practice!

    hopefully, you'll have a sympathetic aide. i suggest that you ask the aide to recommend a patient who will be willing to be your guinea pig (don't use those words, please!). then, pull up a chair so you are relaxed and practice taking this patient's blood pressure. wait a minute or two between attempts. you are going to find that many patients are willing to help students out. when you start to feel a little more confident, look for more volunteers.
  5. by   traumaQN
    Thanks for the input.. off to the website now.

    I just don't want to look stupid!
  6. by   AuntieRN
    RNgrad2008...just remember none of us were born knowing how to do these skills. We all had to practice. You will get the hang of it. Just keep your head up. I agree with StlRN2b1206...your CNAs can be some of your best resources. Use them kindly and wisely. Good luck tomorrow.
  7. by   mamason
    Have you tried using a different stethascope? You mentioned you were having trouble hearing the first "thump." Not all stethascopes work the same. Your CNA can be an excellant resource. Just ask. That's why you are there. To learn. Ask your instructor to give you pointers. If you are worried about looking stupid, which I'm sure you do not, take your instructor aside and talk to her privately. Maybe she would be willing to go into the pt's room and work on it with you. Don't be afraid to ask.:wink2:
  8. by   traumaQN
    Well, I just got home.. and clinicals were nothing like I thought they were going to be.

    We got to the hospital and she put us in groups of two (luckily I ended up with a friend). Then she gave us room numbers and said to practice vitals on the patients and if they weren't perfect it didn't matter, it was just practice. So we took vitals on the first patient, came back to our instructor and she gave us a handout to fill out asking questions about the room. Like.. were the curtains open, was the tv on, what was on the bedside table, was their water, telephone, and tissue nearby.. Immediately I wished I had paid more attention.

    Then we turned that in and she gave us another patient to get their vital signs. We assessed the room first thing. Then we took vitals and went back to our instructor.. who gave us another handout to complete. These questions were more patient oriented. Like did they have any impairments (vision, hearing), skin integrity, any tubes, did they have an iv, did they have a catheter, level of mobility, etc.

    Those were the only vitals we did. We did baths after that.. and that wasn't bad. My partner and I did 5, but only 2 were complete and 1 was just helping an RN clean up a man with a messy bm so he could be x-rayed.

    So, all in all, it wasn't bad. I got to see an icky bed sore and watch an RN take out an IV. I have heard horror stories about mean staff.. but everyone was extremely nice and helpful.

    The CNA's were great and happy to see us.. there were only 3 of them for 30 patients (is that the norm?)
  9. by   Ayvah
    There are some patients who are more difficult to take manual blood pressures on than others. I've found that these steps have helped me:

    -Look at their previous blood pressures. Have the systolic bp's all been in the high hundreds? Have they barely hit 100? This will give you an idea of where you will probably hear the first sound at.

    -if they don't have a prior blood pressure, one thing you can do is tell the patient you are taking a preliminary blood pressure and will get the real one 2 minutes afterwards. Then instead of holding the stethescope to them, hold your hand on their radial pulse. Pump up the cuff so that you don't feel the pulse anymore, and then let the air out until you can feel the pulse. This will give you an idea of where the systolic blood pressure is. Wait 2 minutes or so before taking their actual bp reading (you can use this time to get temperature, resps, and pulse)

    -Watch the sphygmomanometer readout while you are taking the blood pressure. You will notice that for pressures above the systolic, the pin will move down smoothly. When it hits the systolic, it will start to bump down. The link the above poster listed has the blood pressure practice program which shows this well.

    For respirations, after taking the pulse, continue pretending you are taking the pulse and watch their breathing. Otherwise, put the stethescope to the 2nd intercostal space, left midclavicular line, and say you are listening to their heart -- you can hear their breath sounds and get the respirations that way. You can also pretend to chart and take their respirations then. For one of my patients whos resps were in the high 30s/low 40s, I was able to see them in the reflection from their door window, and count them that way.

    Another thing about respirations. When you first arrive, come in quietly, and if the patient is still sleeping, get their respirations first before waking them up!
    hope this helps and good luck
  10. by   mamason
    Glad to hear your clinical experience went well . Just take it one day at time.
  11. by   puggymae
    Is there an instructor in the nursing lab that can help you? We have stethescopes with two sets of ear pieces so that the instructor can listen too and cue you in on what you are or are not hearing.
  12. by   BeccaznRN
    Quote from RNgrad2008
    Well, I just got home.. and clinicals were nothing like I thought they were going to be.

    We got to the hospital and she put us in groups of two (luckily I ended up with a friend). Then she gave us room numbers and said to practice vitals on the patients and if they weren't perfect it didn't matter, it was just practice. So we took vitals on the first patient, came back to our instructor and she gave us a handout to fill out asking questions about the room. Like.. were the curtains open, was the tv on, what was on the bedside table, was their water, telephone, and tissue nearby.. Immediately I wished I had paid more attention.

    Then we turned that in and she gave us another patient to get their vital signs. We assessed the room first thing. Then we took vitals and went back to our instructor.. who gave us another handout to complete. These questions were more patient oriented. Like did they have any impairments (vision, hearing), skin integrity, any tubes, did they have an iv, did they have a catheter, level of mobility, etc.

    Those were the only vitals we did. We did baths after that.. and that wasn't bad. My partner and I did 5, but only 2 were complete and 1 was just helping an RN clean up a man with a messy bm so he could be x-rayed.

    So, all in all, it wasn't bad. I got to see an icky bed sore and watch an RN take out an IV. I have heard horror stories about mean staff.. but everyone was extremely nice and helpful.

    The CNA's were great and happy to see us.. there were only 3 of them for 30 patients (is that the norm?)
    Glad to hear that! It sounds like you have a great instructor for your first clinical experience.

    By the way, I'm not sure if it's the norm, but I routinely had 10 patients while working as a patient care tech. Ten patients was the maximum a tech could have, and the RNs were pretty good about helping the techs out when we were assigned that many.
  13. by   truern
    I think it's GREAT that she's teaching you to be observant!!

    New students tend to have "tunnel vision" and not take in the whole picture. You should always give a glance at the patient's O2 (are they wearing their nasal cannula? what is the setting on the flowmeter? etc)..see what IVs are running (what fluid? what rate?) Check the IV site for any complications...make sure it's securely taped. Make sure the bed is in the low position with the required # of siderails up. Where is that pesky callbell? Can the patient reach it? What position is the patient in?? Are they interacting with you appropriately? Etc etc etc
  14. by   firstyearstudent
    This might sound obvious, but make sure you are wearing your steth correctly. The ear-pieces should be angled into your ear making a straight line that flows out from your canals.

close