Manual BP Assessment on Elderly

[nursechristineb]

New nurse here. I am orientating on a Long Term Care unit. The first day on this unit, the seasoned nurse asked me to get bp's on residents that have parameters for cardio/pulmonary medications. This is done manually on this unit. It was taking me a few minutes each to get readings from many patients, because they were wearing sweaters, and their pulses are very irregular and faint.

After finally getting my first patient's reading done, the nurse who is orientating me, said, you only have about a minute per patient to get each reading, so you can get your med pass done.

My question is HOW am I going to accomplish that? If I leave the resident's arm sleeves in place, I can't hear the pulses through the clothing. And if I put my stethoscope under the sleeve, the noise from the clothing prevents me from hearing a pulse.

Also, the bp gage sit's atop a wobbly stand on large wheels, that is a challenge for me to see without turning my head; when I turn my head the ear pieces of my stethoscope come out.

Moving quickly is the order of the moment for this 1st med pass.

Later in the morning, I watched my seasoned nurse take a bp atop of a resident's sweater, using my stethoscope over the sweater. I can not comprehend how she can accurately assess this way.

What can I do about this. Helpful hints and insights are appreciated.

[nynursey_]

Is there some reason you couldn't take the resident's arm out of their sweater? Skin to skin contact, particularly for a new nurse, is the most accurate way to assess for the sounds that correspond with systolic and diastolic blood pressure numbers. As for the seasoned nurse, it could be that she's accustomed to taking pressures this way and has fine-tuned her listening skills to detect the readings. Some nurses can do this very easily: I, on the other hand, cannot. As a result, I have my patients slip their arms out for me, grab their BP and be on my way.

[morte, LPN, LVN]

I have a moderate hearing loss, both ears and I can get many blood pressures with only my "lesser" ear, thru clothing. I would advise you get your hearing tested, ASAP.

[nursechristineb]

Yes, for most of the residents, I removed their sleeves. This takes time; time I am concerned I don't have; even then, most of the bp sounds are faint and irregular, which takes more time to hear.

[nursechristineb]

I am going to make an appointment today to have my hearing assessed. Thank you.

[morte, LPN, LVN]

thank you for taking that post the way I meant it, some folk become defensive....

I am going to make an appointment today to have my hearing assessed. Thank you.

[CapeCodMermaid, RN]

My advice is far different...why are there still parameters on long term residents???? If they have been stable why are you taking their BP before you medicate? Speak to the MD or the pharmacy consultant. Those residents don't need a BP every day.

[AngelicDarkness]

My advice is far different...why are there still parameters on long term residents???? If they have been stable why are you taking their BP before you medicate? Speak to the MD or the pharmacy consultant. Those residents don't need a BP every day.

Not all bps in ltc are stable.

[chrisrn24]

My advice is far different...why are there still parameters on long term residents???? If they have been stable why are you taking their BP before you medicate? Speak to the MD or the pharmacy consultant. Those residents don't need a BP every day.

We have residents who need parameters! Frequently go lower and higher in one shift.

But then again I have residents not on parameters so it clearly depends.

[CapeCodMermaid, RN]

I said IF they have been stable....

[akulahawkRN, ADN, RN, EMT-P]

Other things that assist in hearing BP sounds are things like extending the elbow until it's as straight as possible. This brings the artery near the surface. Palpate the location of the artery before you start taking the BP so that you know exactly where to put the stethoscope head. Make sure you're using a decent quality stethoscope. Those can help keep extraneous noise out. If you absolutely can't hear the BP sounds, you can still palpate the blood pressure and that's usually legal... not best, but at least usually legal. The thing with a palpated BP is that the actual BP is NEVER lower than what you feel... it's always equal or higher. Therefore if you palpate a 100/P and you have a parameter of hold if BP

[scashrn]

i agree with a previous poster.....you may need a better steth. I remember when i was starting out..i could clearly hear better with a Littman steth then the cheap one i had. They cost alittle but its a good investment. Also, maybe if you have time before the readings, pop into the rooms and let the residents know you are coming back in a few to take their BP's. If they are able...they can already have their arms out and ready for you!