HELP. Blood Pressure and Vitals

HouTx, BSN, MSN, EdD · Sep 14, 2016

Obtaining a manual BP reading is rapidly becoming a "lost art" as technology is becoming more commonly used. First of all, make sure your equipment is working appropriately. Cuff size is important... if it's too big or too small, it will affect results. There needs to be sufficient overlap for the cuff velcro to stay fastened, otherwise, it will pop off when inflation reaches a critical point. Use a good quality stethoscope and double check your placement. It needs to be smack dab over the brachial artery.

Take a look at your "patient's" previous readings to determine how high you need to pump the pressure... there's no sense in maiming or causing pain with extremely high pressures if the highest previous systolic was 100. Pump until pressure is reading ~ 20 above the patient's usual systolic. Then gradually (slowly) release pressure and listen carefully for the taps as pulsatile flow resumes. Note the pressure when you hear the first tap... that's the systolic. Keep listening and watching the sphygmo. Note the point at which you stop hearing distinct taps... that's the diastolic.

Practice, practice, practice. When I was learning to take VS, I had a great deal of difficulty obtaining accurate readings. A wonderful clinical instructor told me to tap my toes in time with the patient's pulse/resp, or whatever I was measuring. Sure enough, that helped me zero in and focus.... I still do it to this day. The more you do, the better & more confident you'll become. Realistically, manual BP readings are generally not a hugely critical deal -- the overall trend is more important in terms of the patient's assessment because it provides insight into circulatory status.

You've got this. You're going to be fine.

oceanblue52 · Sep 15, 2016

Placing the stethoscope in the correct area is key. Find a person with really good veins and prwctice this. Also make sure you are letting out air at the right rate. This takes some practice but once you accurately nail a few readings you will have this down. Rose Queen has said everything else I wanted to say so check out her post and just keep practicing! It is tricky but you will get it, you will feel so satisfied when you get it! :)

zradwin · Sep 15, 2016

Thank you, I really needed this today. I've been so nervous that this would be the make it or break it for Nursing school for me. I appreciate the advice and I will definitely try tapping my toes to the patient's pulse. I'll let you know how it goes. :)

wannabeny · Sep 15, 2016

What specifically are you having trouble with? If you don't have a BP cuff to practice at home, I would highly recommend getting one.

A 2 step BP reading with a manual cuff might help:

1- place your BP cuff on the arm; making sure it isn't too tight.

2- find the brachial pulse with your fingers; if you're having trouble have the person straighten their arm out until you do.

3- with your fingers still on the brachial pulse, inflate the cuff until you feel it disappear, then inflate the cuff 30 above that. (so if you can't feel the pulse anymore at 120, inflate to 150)

4- deflate your cuff, let the arm sit for a minute, keeping your fingers on the pulse.

5- place your stethoscope on the spot where your fingers are,and inflate the cuff up to 150 (the example number used above).

6- slowly deflate the cuff (this is what takes some practice), and you should hear the systolic. A little cheat (but one that you shouldn't use) is the needle will start to move a bit like it is beating in time with the beginning of systolic and stop "beating" when you hear the diastolic.

if it's deflating the cuff, i found that holding the bulb in my first three fingers, and the valve I controlled with my index and thumb helped control the valve a bit better.

practice, practice, practice. good luck!

BrendanO, MSN, RN · Sep 15, 2016

Depending on the type of thermometer you're using, that can be a great time to do RR. Only works for timed axillary or sublingual, not so much for the instant-reading tympanic or similar.

Practice taking BP on everyone you can. The more arms you see, the better you'll get at it! One thing that can help to find a good inflation pressure is to locate and monitor a distal pulse point (radial, usually) with your other hand and then inflate the cuff about 20 mmHg above the point where you lose that pulse.

Good luck!

emmjayy, BSN, RN · Sep 15, 2016

I'm learning manual BP's now too and I really wish we did them more often on the floor because I enjoy it so much! Make sure you line the "Artery" arrow on the cuff up with the brachial artery, and place the cuff so the bottom edge is about an inch above the artery. A little trick to help with figuring out how much to inflate the cuff when auscultating the brachial artery is to find the radial pulse, inflate the cuff, and make a note of when you feel the radial pulse return while deflating the cuff. Then, place your steth over the brachial artery, pump the pressure up to about 30 mmHg above the point you noted where the radial pulse returned, deflate the cuff slooooowly, and listen really carefully for your first Korotkoff sound at around that point as well :)

eta: I just saw that someone else recommended this trick, I really need to read threads before replying haha!

avotoasted · Sep 16, 2016

Everyone else has really good tips about taking manual BPs - I definitely would recommend the two-step also, at least until you've got it down. Practice as much as you can - friends, family, the works. :up:

Super, super no-brainer suggestion I would make is to multitask your vitals. Apply the pulse ox, slip on the BP cuff, and press start. While that's going, go ahead and check temp and RR. It'll save you a lot of time when you get up to taking 4+ patients!

violet87, BSN, RN · Sep 16, 2016

I just took my vitals skills test last week and I was soo nervous because I couldn't hear the sounds very well.

Two things helped me a great deal:

Buying a good stethoscope (not the $20 school bookstore one), and making sure the bell was not spun around for low pitch sounds :roflmao: (rookie mistake)

Good luck!!