How to handle clients who get upset when performing VS

[Becca Thomas, SN]

Hi my name is Becca Thomas and I am currently doing clinicals in the first quarter of my nursing program. I was wondering if anyone has some advice on how to deal with clients that end up getting upset or excited when you are doing vital signs (such as when you pump of the blood pressure cuff and it squeezes their arm.) and an incident happens that is out of your control? Let's say you explained the procedure and the client was fine and it happened unexpectedly. How do you reassure the client that everything is ok?

Thank you for your help.

[cmw6v8]

I would just educate them before doing it: "I need to take your blood pressure, you might feel a little tightness in your arm for just a few seconds but it will go away quickly." I'm not sure what you mean about "getting out of control." Do you mean they get angry, or state that they are in a lot of pain? If you could provide a more specific example of an experience you had trouble with that might help.

[semester1kid]

I had an elderly female pt who was intolerent to the hospital's automatic BP cuff. Because of a prior mastectomy, we could only use one arm. For whatever reason, no one thought of this before me, but I simply suggested using a manual cuff and only inflating the cuff 10 over her prior systolic...it worked like a charm. If that didn't work, the next step would've been to use her thigh...

[DLS_PMHNP, MSN, RN, NP]

Just remember: If a pt gets upset and refuses to let you take their B/P, it is their right to refuse.

If you insist on taking it after that, well.. you don't want to go there.

Just a friendly reminder.

Best,

Diane, RN

[dudette10, MSN, RN]

Just remember: If a pt gets upset and refuses to let you take their B/P, it is their right to refuse.

If you insist on taking it after that, well.. you don't want to go there.

Just a friendly reminder.

Best,

Diane, RN

Question: Would you try to find out why, attempt to correct the problem that caused their refusal if possible, then ask their permission again?

Using semester1kid's example:

"I don't want my BP taken!"

"Mrs. B, could you tell me why you don't want your BP taken?"

"It hurts my arm! It squeezes too much!"

"Yes, sometimes automatic cuffs can squeeze a little too hard. Can I try with my manual cuff? They usually don't hurt as much. If it still hurts, I'll just put in the notes that you don't want your BP taken. Do you mind if I try with this cuff?"

[ChristineN, BSN, RN]

I would make sure you aren't pumping the cuff up too high either. A 90lb little old lady probably does not need the BP cuff pumped up to 220.

[Becca Thomas, SN]

I was doing vital signs for the med cart nurse during my clinicals and it was my first time doing things independently, without going in a pair with another nursing student. The med cart nurse gave me a list of clients that got daily vital signs. I was doing the blood pressures manually and I was doing the 2 step version; where you feel the pulse while pumping up, deflate when you stop feeling the pulse and then re-inflate 30 above the number it stopped and listen. The lady was completely willing to let me take her blood pressure when I asked her and I did explain everything I was doing as I went along. She was calm and relaxed during the first time inflating but the second time I inflated she got angry and started grabbing at things and pulling and throwing the cuff and stethoscope. I felt so bad that I caused her to become uncomfortable and it was so unexpected that it startled me too! I talked to the nurse later and she told me that the client is known for being aggressive and hitting. I learned from this that I should ALWAYS ask about any clients I don't know so that I can be prepared to handle the situation the right way. Thank you all so much for posting and giving me all those helpful tips! I appreciate it so much.

[KristeyK]

From the sound of it, you did fine. Your RN should have given you a heads up about this pt's prior behavior.