Question about Blood Pressure

Audreyfay · Jul 13, 2003

You will learn. I sometimes still have a difficult time hearing! I always make sure I have applied the cuff appropriately, with the arrows pointing toward the artery. I also palpate for the artery in the antecubital area (inner elbow) and place my stethoscope over that spot. It would be nice if you could practice on some young guy with huge veins first. Some of the smaller thinner people have a more difficult b/p to find. Sometimes one arm is easier to hear than the other. The best thing to do is to practice. Hope this helps. :)

ItsyBitsySpider, BSN, RN · Jul 13, 2003

Practice and more practice Heather..also..when holding the stethescope over the artery just use your thumb, this helps eliminate the extra noise heard from using more than 1 finger. Finding this out helped me alot but you will see that after you do it over and over it will get much easier.

bedpan · Jul 13, 2003

Also, from just watching others in my class as they practiced I noticed that almost all of them had a tendency to let up on the pressure with their thumb on the scope as they were letting off the pressure on the cuff and neared the bottom - This was throwing their diastolic off

jacolaur · Jul 13, 2003

A couple more tips for you:

Make sure the eartubes are pointing forward...and make sure the tips fit your ear canal... too big will obstruct sounds and too small will dimmminish the heart sounds, also make sure you apply enough pressure for a good seal with the chest piece however again not so hard as to obstruct....it's a feel you will pick up with patience and practice...and it is ok to say to the patient, I need to recheck your pressure again ...never ever guess hope this helps some...

Mandylpn · Jul 13, 2003

Heather: I can relate! I had the hardest time in nursing lab, my "patient" ended up being my instructor, and she made me stay until I got it right, no kidding! Sometimes you hear your own heart beating in your ears, she said you just have to "practice", that's all I can say. I had more trouble counting her pulse! :confused:

CarolinaGrl · Jul 13, 2003

Taking BPs evoked more anxiety from me than trying to start an IV until about a month ago or so. And I graduate in just 4 more weeks! I always second guessed what I heard and was really worried that I would not get it right. But in my practicum, the practice has made me trust myself. It also gets a bit easier when you get more comfortable with just putting the cuff on and off and holding the bulb and your stethoscope etc. I have to second everyone else's suggestion - practice, practice, practice.

Tiki_Torch · Jul 13, 2003

I agree, practice.. practice.. practice... It's the only way.

Be sure you have the correct size cuff, that you are looking eye level with the mercury, and that the mercury column is at zero before you begin to inflate the cuff. The suggestions about earpieces pointiing toward your face and being the rigth size are important too. The more times you physically take blood pressures helps you get a good feel for the actual pumping and stethoscope holding, etc. Once you are good at that part, you can begin to spend more time listening very carefully.

Once you become proficient doing manual blood pressures, you'll realize that you have the gift of being able to access incredibly important information especially during a potential crisis situation. The blood pressure is a quick and incredibly valuable tool to assess patients with. Changes in systolic and diastolic pressures as well as things like widening pulse pressure can be some of the most valuable information you can have to use your critical thinking skills to recognize a patient is headed for trouble before he/she is actually in deep trouble. It's great to know you want to learn this skill well... it shows you have good nursing intuition already (in my humble opinion).

As far as hearing the sounds... that's the most difficult part for most people. The only way to get past this is to practice on as many people as you can. Friends, family, other students, sunday school classmates, whoever will let you!

I'd suggest you ask your instructors if they know of any health fairs you could attend to help take blood pressures. In nursing school we held our own health fair on campus to help raise travel money to our NSNA convention. It was a great way to get to take blood pressures on healthy, young people. Your instructors may be able to find a way for you to participate in a hospital or other community based health fair too. Being students, an instructor or another person would be available at the fair to double-check any blood pressure result you got that you felt uncomfortable with... or had problems obtaining.

As Jacolaur mentioned: Never, ever guess!!!!! This is so important!!!!! NEVER, EVER GUESS.

Our nursing instructors had a stethoscope with one tubing and two sets of binaurals and earpieces on it. For our checkoffs on B/Ps we'd do a blood pressure on someone while our instructor listened and watched the mercury at the same time. That would be a great thing to use to practice with along with another student... especially if that other student was more proficient than you are. Maybe a student from a class that will graduate before you would be willing to help you...

Didn't mean to ramble on like this. I would like to say that it's great to see you wanting to learn to do manual B/Ps well, because it tells me your nursing intuition is beginning to kick in already... you are able to instinctively understand the importance of this nursing skill and the impact it can have on your career.

You can do this. Just keep practicing and tell yourself, "I can do this... after all, millions of other people have been able to learn this before me, and they are no different than I am!"

Best wishes for a rewarding nursing career!

Heather A. · Jul 14, 2003

Everyone:

Thank you, thank you, thank you!!!!!!!

I appreciate your advice and support so much. I will continue to practice, practice, practice. I hadn't thought about the size or position of the earpiece- I will definitely check that out. Also- I am fairly certain that I have been letting off on the pressure of the scope and that has been affecting my diastolic reading. I hadn't even thought of that.

Tiki_Torch: Thank you for your kind words. You made my day.

It is very important to me to learn how to perform this skill (and many others) correctly. I don't want to just be going through the motions, I want to make sure I have it right. It could potentially be such a huge error to give an inaccurate reading. When you think about it, that's a scary thing.

Thanks again everybody. If you think of anything else, please let me know. Until then, I'll be practicing......

Heather

meownsmile, BSN, RN · Jul 14, 2003

Also,, to add to the suggestions above,, always try to hyperextend the elbow as much as possible. If you dont, you occasionally get a small air pocket between the steth bell and the skin and you wont hear well.

IowaKaren · Jul 14, 2003

Hi Heather, I had trouble with using my first stethescope and hearing ANYTHING very well. I had boughten a fairly expensive one with eartubes that were angeled and had such a time hearing out of them, thinking it was just me, not the pricey stethescope. A nurse helped me once during my first clinicals and she had a cheap stethescope which didn't angel at all, just straight into the ears and wow, I could hear everything. I broke down and ordered a cheap, cheap one on-line and it has been my best investment. Evidently, my ear canals won't work with the angeled 'scopes. Keep practicing and volunteering at B/P clinics, the Nursing School loves it when you do volunteer work and the practice is well worth it!

Carolanne · Jul 14, 2003

I have trouble with the automatic BP machines for some reason. I don't know what I do wrong. Maybe I'm not letting all the air out before I apply it to a pt's arm, but last semester I applied the cuff, started the machine, and the cuff flew off his arm and was full of air, jumping up and down on the bed! This did not make me look overly confident!! I told my instructor about it, and she said I'll tell you what you did wrong later -- she was busy doing something else -- and by the time later came, I was too tired and embarrased to ask her again. What would cause this??