I've got a question about BP

KellNY, RN · Mar 24, 2007

No problem--we all have a handful of things that don't click right away-or even after some practice.

Just a heads up, some people don't tolerate the cuff very well, and it is uncomfortable--especially if you have a hypertensive pt who you need to pump up to 250, 300, etc. They might start verbally complaining or fidgeting their hands/arms/body, sigh loudly, etc. I usually tell them something like a basic "Try to hold still" to "Now this might be uncomfortable, but in order to get an accurate reading, I need to squeeze the cuff kind of tight on your arm. This will only take a moment, and it's very important that you stay as still and quiet as possible so that I can get a precise measurement as quickly and comfortably for you as possible. We don't want a false reading". Just to remind them that you're on their side and looking out for their best interests--not just trying to torture them.

Some people hand over their arm, sit up straight and keep quiet as a church mouse, and some will start as soon as you begin to pump with "Ow. I don't like this! Do you need to make it so tight? It's squeezing my arm! Look-the veins in my hand are popping out. Did Dr. Soandso say if he's going to refill my medication? Everytime I come in here, you people do this to me--my arm is gonna be all red now I bet! *sigh*". :rolleyes: And everything in between.

lol, anyway! I highly suggest buying (if you haven't already) a cheap manual cuff and practice on EVERYONE-family, boyfriend, classmates, who I bet would offer their arm if you'll do the same for them.

LilPeanut, MSN, RN, NP · Mar 24, 2007

In school they taught us to find the palp first to know exactly how high to pump the cuff.

You put the cuff on, feel the radial pulse with your finger, then pump up the cuff. When the pulse disappears, you add 10-20 to that and that's how far you pump it up :)

KellNY, RN · Mar 24, 2007

In school they taught us to find the palp first to know exactly how high to pump the cuff.
You put the cuff on, feel the radial pulse with your finger, then pump up the cuff. When the pulse disappears, you add 10-20 to that and that's how far you pump it up

Seems a bit redundant to me. And maybe I'm misunderstanding you, but...how do you know how high to first pump the cuff when you palpate? Because if you know how high to pump it that time...why not just do it while auscultating and get it done in half the time with half the discomfort?

LilPeanut, MSN, RN, NP · Mar 24, 2007

It is redundant, that's why most people don't do it, but it is technically the proper way to find the systolic, according to my instructors.

And you are just feeling the pulse the whole time you inflate the cuff, so you can feel the pulse fade/stop, so you know when to stop.

http://www.steeles.com/catalog/takingBP.html Here's a page that explains it

maryloufu · Mar 24, 2007

You know what OP? God bless you for asking questions and getting it all straight in your head- I know of students who are either too afraid to ask or don't care- and that is scary- I don't need my co nurse to make up a number for me- and those automatic ones are wrong as much as they are right. So keep asking questions- you are going to be a good nurse.

KellNY, RN · Mar 24, 2007

Amen and good point mary!

When i taught medical assisting, I can't tell you how many students would just say "Yep. It's 126/82" I'd go check and get a way diff number, so we'd use the steth with 2 sets of ear buds (OP, have you tried that so you can compare notes with classmates and instructor?) and asked what she got. I'd get a stammering "Uh, I, um...like 128 over 78?" when really it was 104/62 or 142/88, etc.

Very scary, because I also can't tell you (and I'm sure any experienced member can concur here!) how many routine vitals picked up a very abnormal BP for the 1st time.

shoegalRN, RN · Mar 24, 2007

You know what OP? God bless you for asking questions and getting it all straight in your head- I know of students who are either too afraid to ask or don't care- and that is scary- I don't need my co nurse to make up a number for me- and those automatic ones are wrong as much as they are right. So keep asking questions- you are going to be a good nurse.

Thank you MaryLou! I'm usually the one asking questions about 1000 times in clinical lab. I did have my instructor listen to my lab partner's BP with me to make sure I was reading it correctly, but she went through it so fast, I just got lost. Since that lab, I had be practicing on just about anyone I could get me hands on and I always heard the sound, but was confusing systolic with diastolic and was not calculating correctly. Also, someone else mention to palpate the radius pulse until it goes away and add 10-20 more to it when puffing the cuff and that's exactly what my instructor told us to do also. So, the number 130 I mentioned before came from my lab partner. For some reason, I was using 130 on everyone I practiced on.

What I'm gonna do it try puffing it up to 160 or so and also try the radius pulse thing and add 10-20 more to it and see what I come out with each time.

I'm really grateful for this site, so informational!

hellonurse36 · Mar 25, 2007

Here is a simple explanation (sounds like you have it all figured out now, but thought I'd add my 2 cents).

To help you understand what is the systolic vs diastolic it helps to know how a BP cuff works and understand WHAT you are hearing and WHY you are hearing it. As you inflate the cuff you are exerting pressure against the artery, the number the needle points to indicates the pressure being applied. When you inflate the BP cuff beyond the pt's systolic (highest pressure in arteries - occurs during systole or when the heart is contracting) it occludes blood flow and you do not hear a pulse. You slowly let the air out and once the pressure of the cuff EQUALS the systolic pressure, blood flow is no longer occluded and it rushes past your stethoscope, hence you hear the sound. The number on the gauge at this point is your systolic or top number. As you continue to let air out of the cuff, eventually the pressure in the cuff will be lower than the pressure in the artery during diastole (when the heart is at rest) and you won't be able to hear the blood flowing by....this is your diastolic or bottom number.

I think most nursing students have problems learning how to take a manual pressure. Keep practising - it's the only way you really get confident.

Terri

kukukajoo, LPN · Mar 25, 2007

Nurse2B- 160 will be too high for some- on my grandmother it would be very painful. Try to do it the way you were taught and people on here have suggested as that is the proper procedure- feel for the radial pulse, then begin pumping the cuff. Once the radial pulse stops, pump up another 15 mm hg. At that point you release it and listen closely for the pulse to to begin again (systole) and then when it stops, that is the diastole.

Don't worry, you will get it I promise. Also, somewhere on here is a link to a site that is a virtual BP site- I used it a lot to understand and it helped me. I also practiced on everyone who came over my house until they were sick of me!

natrgrrl · Mar 25, 2007

It sounds like you know what you are doing now but I found one website to help. I'm sure there are many others.

http://www.phschool.com/science/biology_place/labbench/lab10/measpr3.html

shoegalRN, RN · Mar 25, 2007

I would like to thank everyone who have responded. It has really clarified things for me and have helped me a great deal. I really do apperciate the links, they are really helpful!

TazziRN, RN · Mar 25, 2007

It is redundant, that's why most people don't do it, but it is technically the proper way to find the systolic, according to my instructors.
And you are just feeling the pulse the whole time you inflate the cuff, so you can feel the pulse fade/stop, so you know when to stop.
http://www.steeles.com/catalog/takingBP.html Here's a page that explains it

I've been an RN for nearly 19 years and was a CNA for 4-5 years before that. This is the first time I have ever heard of this as the proper way to take a BP.