Need help taking blood pressure

[liladybug526]

I need some advice on taking blood pressure. I am having a very hard time hearing the systolic number. I am not sure what I am listening for. I would love to know if anyone else had this problem and how they overcame it, any advice would be greatly appreciated.

[melmarie23, MSN, RN]

In every hospital I have been in thus far, we have electronic cuffs (usually a dinamap). However, in the community setting? Its just your steth and a cuff. You NEED to know how to do a good reading. Or what about in an emergency? Or if you work in a Dr.'s office? Or what if you are employed at a hospital that rural and doesn't have the money for the newest technology?

I've done them on short, tall, fat, thin, young, and old and it just really does take some practice. But you'll learn, I promise.

And sure, the "bobbing" can be used as a guide, but its never a replacement. You should be listening and yes, you will be able to auscultate the sounds. You just have to have your steth placed correctly.

[medicgirl]

You need to have a good stethescope. There is no way around it. I have to shell out the dough before I could hear the thump.

[KookingEggs]

I had the same problem! LOL I realized after many attempts, that I was only able to hear it when I placed the chest piece beneath the cuff right on top of the brachial artery haha (I got this idea because my mom purchased a stethascope/sphygmomanometer and they were fused together as such) . But we're not supposed to do that XD - THOUGH I made very accurate readings! (Or so I was told.. and I was so sad when I found out I couldn't do it that way haha)

I don't know, it took me a lot of practice before I could hear the systolic with the chest piece outside the cuff. LOTS of practice. What also helped was looking at the dial! Because sometimes you can tell about when the sounds are supposed to occur... so I guess by knowing when to expect sounds helped me distinguish them. haha.

Best of luck with all your endeavors :) keep trying! YOU CAN DO IT!

[CuriousMe]

I had the same problem! LOL I realized after many attempts, that I was only able to hear it when I placed the chest piece beneath the cuff right on top of the brachial artery haha (I got this idea because my mom purchased a stethascope/sphygmomanometer and they were fused together as such) . But we're not supposed to do that XD - THOUGH I made very accurate readings! (Or so I was told.. and I was so sad when I found out I couldn't do it that way haha)

I don't know, it took me a lot of practice before I could hear the systolic with the chest piece outside the cuff. LOTS of practice. What also helped was looking at the dial! Because sometimes you can tell about when the sounds are supposed to occur... so I guess by knowing when to expect sounds helped me distinguish them. haha.

Best of luck with all your endeavors :) keep trying! YOU CAN DO IT!

You're not allowed to put the steth on the brachial artery UNDER the cuff (chances are high you'd get artifact--noise from the cuff rubbing the steth)....but you should be putting it on the brachial artery just under the cuff.

[mcirishdreams]

there is an online virtual blood pressure cuff that you can play around with and take practice blood pressures. make sure your computer's sound is turned on:

• http://medicine.osu.edu/exam/ - to access the blood pressure cuff, scroll down to "objective iv" and click the link that says "take a blood pressure". when the player comes up, you can re-cycle the player over and over to hear and input blood pressure readings that it quizzes you on.
  

i cant begin to tell you how much i am grateful for all your posts. i went to the website and will share it will all my fellow students to help them practise as well.

but its true you have to have a good stethoscope, no double tubing you can hear the rubbing if you are moving, as one person said and place it in the antecubital fossa away ( far away) from the bp cuff because you can hear the rubbing of the cuff not the korotoff sounds and keep the hands very still and not move, you really have to concentrate and not move at all! when we were performing this skill in class it was very nerve wracking because it wasnt silent and any little movement, by patient or nurse, can alter what you are hearing. but its true you can have the needle jump make you a little more aware of the sound, and if performing it first using that and then do it again aware of where the jumps were you can try to listen a little harder at those points, but as others said be careful using that as a crutch.

but thanks this is awesome to have this website, i especially like hearing the breathe sounds that are also located on this site. thanks again daytonite:yeah: you are making us better nursing students one post at a time!!!

[Nepenthe Sea]

FWIW, do learn how to read a manual BP the correct way. It's true that you hardly ever use those in the hospital setting, but last semester the CI made one of my classmates read a guy's BP with the cuff - on his leg! It's rare, but it does happen. I just pray that if I ever have to do it, I will remember the right way. Plus, I like to occasionally take a BP at home on a family member, just to keep an eye on their health. I never seem to have one of those "nurse-on-a-stick" things around the house when I need it, oddly enough!

[Laker2011]

the needle is not a replacement for the sound! If it were your grandparent you would want it to be accurate! Practice practice and Littman stethescopes are the best

[diane227, LPN, RN]

Just an FYI for those of you who may have listened to your Ipod too loud. I grew up on loud music and now I don't hear very well. I just bought myself a stethoscope with amplified sound. There are a couple of models out there but I can hear anything now. They range in price from $300-$500. The top end one has a recording device that allows you to listen to the sounds later.

Also, remember don't rely too much on those automatic blood pressure machines. If you have a patient with a very high or low blood pressure, those machines won't be accurate. And, if you question a blood pressure, always remember to check the pressure in both arms.

[~Mi Vida Loca~RN, ASN, RN]

These sounds are pointless (well, not pointless, but you don't need them to interpret the the BP when using the manual cuff). By the way, you'll almost never use a manual cuff in the hospital setting. AT ANY RATE, here is the "cheater's" way of doing it, which a couple of instructors have shown me: put the BP cuff on like usual, inflate the cuff to about 180 or so... slowly release the valve so that the needle slowly drops. It should drop smoothly. As soon as you see it bounce/bob up and down/etc, then that is your SYSTOLIC (top) number. As it is falling and bouncing up and down at the same time, you'll notice when it STOPs bouncing. That is your DIASTOLIC (bottom) number. After that the needle will fall smoothly once again until it has reached 0. While you're doing this, pretend to be listening for the sounds with your stethescope, but really, all you need to do is look at the measurement meter and go off of that. Good luck to you! Oh... also, for testing purposes, just know what the sounds mean. That was on our test a few times.

That won't always work. In fact I have found it to be quite inaccurate. A few people used that method in returns and found themselves coming back for their Second learning opportunity when they didn't pass. Also, I have done clinicals at a nursing home and now at a hospital setting on the medical floor and we ONLY do a manual pressure, I have never even seen a machine cuff on the floor, this is an excellent hospital with the latest technology, but they have found that the machine cuffs just aren't that accurate, they also pump to hard on the patient and can cause skin irritation.

I do believe they are used on a few floors where pressures are taken every 15 mins, but on our floor they are not used. The aides to the vitals or the student nurses, or the nurses if the aides are backed up and the nurse needs the BP for a med.

You know what is a trip, someone that has the Auscilatory sp? gap, or someone in A Fib, I have a pt in A fib and his heart is just crazy to listen to and his pressure is just as crazy, it's very good for practicing though.

It can be a bit tricky and nerve wracking at first but you really do get the hang of it. Practice on taking them on elderly people if you can. They are usually harder to hear so give you better practice.