Help with bp!

[taylor_KU]

Hello. I'm in my first week of my junior year...ugh. And well I really suck @ taking bp. I don't know what I'm supposed to be hearing the first "thump" I hear is def. systolic but I have issues with the bottom dia. #...is there a place where I can hear the sounds...everything is so faint and muffled I'm really struggling...

[jmgrn65, RN]

are u palpating the pulse in the ac before you place your stethoscope ( this ensures that you are able to hear well)? listen for the first thump and the last one. you will need to let the air out slowly so it doesn't go to fast until you are good at it. Hope this helps.

[EricJRN, MSN, RN]

If you have stethoscope with two sides (bell and diaphragm), try clicking it over to the bell side (the small piece) and trying that side for the BP. Everyone's a little different, but the bell works better for some.

[NJNursing, ASN, RN]

First, do you have a really good stethescope? I have found that some of the cheaper ones don't give as good sound quality and you get a lot of tubing noise.

Secondly, make sure you're right in the crook of the elbow, over the artery which I have found is slightly lateral (which looks medial when the hand is facing upwards).

Thirdly, make sure that you have earpieces that are a snug fit so that it blocks out a lot of outside noise.

When you hear the first "thump", yes that's systolic. You'll continue to hear it pulse and you measure diastolic when you no longer hear that thumping noise. Try to listen for as long as it holds out, but don't listen for something that isn't there. When it's gone, it's gone. Also let out the air very slowly (while you're still learning). Also, I find that the needle on my spygmamometer (sp?) will actully slightly pulse, so I will see it and hear it. Try practicing on willing family members throughout the summer.

[Daytonite, BSN, RN]

It also helps to hyperextend the elbow and forearm as much as the patient can tolerate. This assures that you will sandwich the artery between your stethoscope and the bone to increase your ability to hear the bruit.

[emtb2rn, BSN, RN, EMT-B]

Daytonite's right on with hyperextending the arm. Practicing on friends and family really helps to learn bp, same with lung sounds. Also, listen for the "thumps" as you inflate the cuff. You'll be able to hear them fade as you pass the systolic and cut off circulation.

[VickyRN, MSN, DNP, RN]

Excellent tips :) Positioning the client's arm with palm up exposes the brachial artery. Remember to deflate the cuff slowly and steadily at 2 to 3 mm Hg per second. Deflating the cuff too rapidly results in a false low systolic reading. Deflating the cuff too slowly results in a false high diastolic reading.

Also remember these "basics" for accurate BP reading:

Position client's arm so it is level with the heart, palm up. If the arm is below heart level, there will be a false high reading. If the arm is above heart level, the reading will be falsely low.

Don't allow client to cross legs (will falsely elevate reading).

Make sure you are choosing the correct size for cuff:

Bladder should fit almost completely around the client's arm; cuff width two-thirds length of client's upper arm. A cuff that is too wide will result in a false low reading. A cuff that is too narrow will result in a false high reading.

Place bottom edge of cuff 1 inch above client's antecubital region, with center of the cuff directly over the brachial artery. Wrap the cuff snugly, allowing space to place the stethoscope over the brachial artery.