Need help with manual blood pressure readings

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Hello!

I am a nursing student and am having trouble with blood pressure readings in the clinical setting. At home when I take them, I can practice on myself and friend and they are accurate and I can hear them clearly. Once I get to the clinical setting, I can not hear any sound at all. It is very confusing to me as I take my time to try and figure out exactly what I am doing wrong. I have a great stethoscope, so that isn't the problem, it is a master cardio littman. My earpieces fit correctly, and I don't have any hearing problems. I am following all of the steps I do at home, and I still can't hear a thing. I am not sure if it is anxiety or if I am possibly doing something else wrong.

Thank you in advance and any tips or tricks would be useful!

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5 minutes ago, joytotheworld21 said:

My earpieces fit correctly,

But do you have them pointed in the right direction? I'm only asking because this is so often the issue. In a quiet environment you can still hear even if they aren't but it's much harder in the noisy hospital environment.

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Specializes in Pediatrics Retired.

Just say it's anxiety. That way you don't have to worry about "why" and can concentrate on moving forward in clinicals. I'll bet you'll be able to hear just fine next time.

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3 minutes ago, Wuzzie said:

But do you have them pointed in the right direction? I'm only asking because this is so often the issue. In a quiet environment you can still hear even if they aren't but it's much harder in the noisy hospital environment.

yes they are, that is another why I am confused I am not hearing anything

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Specializes in Med-surg, school nursing..

Remember that you and peers are young, healthy individuals. Meaning your pulse is likely easily felt and heard. I would try practicing on some of the older family members you have, as sometimes their pulses can be more thready.

Make sure your blood pressure cuff is up high enough and that it is the right size, your patients may have large arms, making a regular sized bp cuff harder to get up above that AC like it needs to be.

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Blood pressure readings don't sound the same on each person.

Some are bounding in your ears, some you can barely hear.

Agree, ensure your cuff is the correct size for the arm size, and that your stethoscope fits your ears correctly, and is positioned correctly (in your ears and on the arm).

Just take loads of blood pressure readings, and you will become more familiar with the differences and will find the similarities.

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Specializes in ICU/community health/school nursing.
16 minutes ago, dianah said:

Just take loads of blood pressure readings, and you will become more familiar with the differences and will find the similarities.

^Best advice ever.^

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It can be hard, some people are much easier to hear than others you just gotta keep doing it. I am currently an EMT who starts nursing school in August. It is still hard for me to hear some people especially in the back of an ambulance where there are all kinds of noises especially when driving. Do as much as you can to make it easier. I always ask if they have a history of high or low BP because if you are use to taking it on healthy people you are sometimes blown away by the BPs you get off of sick people. Do your best to keep everything as still as possible while taking the BP and at least for me in the ambulance I try to minimize the amount of things I am touching if that makes sense because the noises can be picked up. The best thing you can do is keep practicing. Also, maybe obvious, but make sure you find the strongest pulse point on their arm.. Good luck!

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Specializes in Pediatrics.

Some people have blood pressures that you can more feel than hear. On those folks, I can feel the vibration/pulsation in my ears or see the needle on the meter jump with each pulsation. I have no hearing problems either; some folks are just too soft to be properly heard, but if they have a functional pulse it will be palpable in some way.

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On 3/14/2019 at 1:27 PM, ShadowNurse said:

Some people have blood pressures that you can more feel than hear. On those folks, I can feel the vibration/pulsation in my ears or see the needle on the meter jump with each pulsation.

I am still a student & not a nurse yet, but I agree with this!! If I am having trouble hearing a pulse, sometimes it's easier to watch the needle jump on the meter than actually hear it!

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Specializes in ER OR LTC Code Blue Trauma Dog.

Guess you could always do a BP by doppler. ?

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I'm in nursing school too and I work as a tech where we do a lot of manual BPs on people, and a lot of our patients are in some form of kidney failure/fluid overload (edematous), subdural or subarachnoid hemorrhages in which they bleed out--thus all of these reasons for weak pulses making it hard to hear manual blood pressures.

There are different things I do in this situation. ( I first try moving the diaphragm around until I hear a pulse prior to inflating the cuff--that usually indicates you've got the right artery (in addition to your knowledge of where it is of course), I add as much pressure with the diaphragm (this works a lot) but if it doesn't I'll try the other arm. If it still doesn't work, I'll do the manual in the forearm and put the diaphragm of the stethoscope over the radial artery--in most cases this works. If not, you can also do a manual on the leg--I can honestly say I've done it successfully (although not ideal). If all fails, you can use a doppler, but that only helps getting the systolic BP.

I'm sure for your situation a lot of it is nerves. It's extremely stressful being watched by an instructor-but in addition, nursing school doesn't cover these topics too much or even these alternative ways to get the manual BP.

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