Need to vent about manual BP

[OrthoFNP]

Ok. So, I am in first semester of school and we just started clinicals. My instructors have encouraged us to buddy up with other students while caring for our patients. This is great. This helps us to learn and to be exposed to several different clinical situations. I have enjoyed this very much, but the other day I got a little frustrated. I had a fellow student in the room with me when I was getting vitals on my patient. My patient has HTN and his BP had been running very high. The "machine" gave me a BP reading of 170/127 or so. So, I reported this to my nurse as I knew it was high, and she instructed me to go in and do a manual reading on him. So, my fellow student and I went to the patient's room to take a manual reading. I know how to do BP, but just wanted to have her check behind me since this was a pretty important situation. I was getting readings of 180/120 or so consistently and she was getting readings of 160/120 right behind me like within 10 secs. This happened three times! She was looking at me like I did not know what I was dong bc she was NOT getting a systolic reading at 180. I was getting annoyed with her bc I was. So, I told her that since I was not sure and we were getting two different numbers and I did not want to record incorrect vitals during such a crucial time, I was going to grab a nurse. She was like, "It is not that big of a deal." This made me a little angry. I told her I did not want to report it wrong and she acted like the fact that we had such a large discrepancy was absolutely no big deal. So, we got a nurse to check and she got a reading of 200/120, which was closer to the reading I got and she informed us that BP can fluctuate. I knew this. I believe it did go up to 200/120 in the 5 minutes it took us to get the nurse. I DO NOT believe that it went from 168 to 180 then back to 162 and then back up to 180 consistently in 5 seconds time. I am cnvinced the other student was NOT reading it correctly. guess her attitude that it was no big deal and the way she acted as if I was the one who was wrong in a condescending manner really mad me mad. So, my question is this...Can a BP fluctuate that much (30 or so points) in literally 5 seconds then go back down to and then right back up in that short of a time frame???

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

It doesn't matter if it can fluctuate that much (although it can - if you wonder, go look at an ICU patient with an arterial line measuring direct BP and watch the variation). It would be unusual for it to go up/down/up/down though.

What is important that you are not hearing from the first replies is that you will not get accurate BPs when you take them within 10 secs of a first reading.

I agree with the poster that said you should worry about your own practice and not your fellow students'. If you are concerned that your own readings aren't accurate, get an instructor or your patient's nurse to check your measurements, not another student whose skills you cannot assess.

I agree, we were taught that it was very important to wait in between to get accurate pressures and also for the patient it is to much to keep taking the BP over and over again. We were also taught to never keep pumping, so if you don't hear it you so often see so many people just start repumping again , we were told this would also give an inaccurate reading. I feel bad for the patient in this scenario.

[OrthoFNP]

Guys, I appreciate all of your "advice" however some of you are passing judgment. AND it seems as if you think you as first semester students know more than I do. I do not appreciate asking a question to a friendly discussion board and being treated this way. My question was an honest inquiry. My patient was ASLEEP and snoring. You try and read a manual bp when a man, 400 pound man is snoring logs and then tell me how accurate and comfortable you feel with your reading then. I am sorry I was being cautious as I was dealing with someone's life. I am pretty sure he would rather have me check his pressure twice then die of a heart attack or stroke bc of under reported pressure. It was that crucial people. He was in need of additional meds per the doc once his pressure reached a certain level. The levels I was reading. I was concerned bc my fellow student, had this been her patient, would not have reported a discrepancy and his overinflated BP would have been left untreated!!! This is a MAJOR concern in my book. You guys who "feel sorry" for the patient are the ones who need to hone in on some critical thinking skills not me! I would have saved his life while you guys would have let him have a heart attack in his sleep it sounds. Don't pass judgment on me.

[OrthoFNP]

Sorry if that came across as rude. It just seems some people are so quick to jump on others on here! I think it is rude and I really don't appreciate it! I know it is not proper to take pressure after pressure after pressure. Please don't insult my intelligence, but doing what is right for the patient is where critical thinking comes into play people. Think about it...

[rmkelly]

If I seemed condescending, rude, or especially judgemental, I am wholeheartedly sorry. Having said that, and comfort aside, repetitive pressures do cause fluctuation. Also, I asked the question if you were both using the same arm.I have been a nurse for 37 years, I still need to be asked questions and to ask questions; it is how we keep our practice current and sharp.

[OrthoFNP]

rmkelly, I was not talking about you! I appreciate your input as a nurse of 37 years!!!!! BIG time! It is the responses from students telling me they feel sorry for my patient and such, I don't really appreciate at all! I was not hurting him. I was trying to help him! I am new at this as are they. My friend that was checking behind me was a CNA. So, she should have known how to accurately read BP right??? I figured she was good as gold for a second opinion. Since this is my first clinical rotation and literally my first ever patient, I better be smart and have a second opinion. Problem was the second opinion did not seem reliable and this made me feel uneasy about my own abilities. When in fact, my reading was closer to what the nurse got. All I wanted to know was whether or not it is even logical that a BP could fluctuate 20 points in that short a time span. I asked it thinking the people on here were here to support each other not get on soap boxes and tell me how horrible of a student nurse I am bc I did this wrong and that wrong and then throwing in the feeling sorry for my patient! Come on!!! I mean if the could see what I have seen thus far, they never would have made that ignorant statement. I saw a nurse put an IV in a woman who was in so much pain she was screaming due to the way her arm needed to be manipulated for the needle to be inserted, the IV was crucial. There are just going to be situations where we are going to have to place our patients in a littel discomfort in order to do what is best for their health and safety. Right?! I also saw a number of amputees without limbs. It is those patients who we should feel "sorry" for. Not the ones who have a BP reading twice in 5 minutes. Geez people. Stop trying to mak others on this message board feel like incompetent idiots!!! We all are at some point with anything new we do! Especially nursing. Get over it. I was willing to admit I was unaware. Don't jump me for it. I mean really!

[ghillbert, MSN, NP]

A few words of "advice" from a nurse of 13 years ICU experience (if that's enough?).

Your attitude will get you in trouble. If you post on an internet forum, we only get the information that you post to base our judgement on. And yes, it's judgement because you are asking for advice. Many people view posts from the last time they were here, or by last 24hrs, so they pop up even if we're not students (or we go to that forum to try and give some help).

We are using our well-honed critical thinking skills to give you input, and you're arguing about it. If you don't want to accept input, that's fine - don't ask for it. Being defensive and argumentative will get you nowhere though - I know I won't bother answering any more of your questions.

[Serlait]

You're right to want to get the most correct measurement possible, and I commend you on your thinking that it is important, but, please consider the patient. It's not always comfortable to have pressures taken repeatedly, especially when you're not feeling well already. You're lucky the patient didn't complain and I gotta tell you, that if our instructor had caught us doing that, she'd have chewed our ears(or perhaps a lower part of our anatomy) off. It is not appropriate to take BP's just seconds apart. Your results will not be reliable with pressures taken at that interval. In future, trust yourself and go report to the nurse after the first one. Your patient will appreciate it!!

[OrthoFNP]

I was and am thankful for the info I received from the nurses. And told rmkelly such. I am not sure why you are now jumping on me. Hmmm...I was a little miffed at the comment about how some one said they felt sorry for the patient. Never ever once did I say I was ever doing the pressure right. Re-read the posts nor did I ever say I knew more than anyone who has been a nurse for 13 years. Your response of "if that is enough" was a little weird and not even on subject... I am well aware of my level of expertise which is uhhh...NONE. I am well aware that I don't know squat! I am not sure how that constitutes a bad attitude. I am willingly telling everyone on here I feel uneasy about my skills. I am admitting I need improvement and I grabbed a CNA as well as a nurse to help me accurately report his BP so that we could make sure he was taken care of. Now, you are jumping me and telling me I have a bad attitude bc I was standing up for myself when another poster claimed they felt sorry for the patient. Ok. Sorry to have upset you, but I am left confused and speechless that you took my post the way you did since I never implied I was upset with your response, nor did I ever imply I knew more than you. I simply stated that I know not to check pressure over and over again in a short time frame. I do think some responses came across as a little condescending, but I have willingly admitted in each and every response how clueless I am! I am sorry that I offended you. That was not my intention. My intention was to get a valid response to my post.

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

Guys, I appreciate all of your "advice" however some of you are passing judgment. AND it seems as if you think you as first semester students know more than I do. I do not appreciate asking a question to a friendly discussion board and being treated this way. My question was an honest inquiry. My patient was ASLEEP and snoring. You try and read a manual bp when a man, 400 pound man is snoring logs and then tell me how accurate and comfortable you feel with your reading then. I am sorry I was being cautious as I was dealing with someone's life. I am pretty sure he would rather have me check his pressure twice then die of a heart attack or stroke bc of under reported pressure. It was that crucial people. He was in need of additional meds per the doc once his pressure reached a certain level. The levels I was reading. I was concerned bc my fellow student, had this been her patient, would not have reported a discrepancy and his overinflated BP would have been left untreated!!! This is a MAJOR concern in my book. You guys who "feel sorry" for the patient are the ones who need to hone in on some critical thinking skills not me! I would have saved his life while you guys would have let him have a heart attack in his sleep it sounds. Don't pass judgment on me.

WOW it never ceases to amaze me how people act when they don't hear exactly what they want to hear. You stated that you all took his pressure MANY times only SECONDS a part. That is not good and will not get you an accurate reading so you were not doing this man any justice. You need an ACCURATE reading and go about it how you both did will not get you that. People have a hard time reading my pressure and I have had class mates take it 3 times with maybe 10 seconds in between and it was extremely uncomfortable and my arm hurt afterwords and I had broken capillaries all over my arm from the constant inflating of it. So yes I do feel bad for this patient having it done. When I read the first post it seemed like that patient care came second to a p***ing match between you and your fellow student.

Regardless, if you post stuff on a public board asking for opinions you have to be prepared that not all the opinions you get are going to be what you want to hear. I was not rude in my reply, I read the post and gave my opinion on it.

[OrthoFNP]

Serlait,

Thanks! I appreciate your post! I know it was not appropriate to take BP over and over again in such a short time frame. This is why we are students right?! To learn how to accurately practice nursing. This is my first experience in the medical field and I am here to learn as we all are. Thanks for the tip. I agree nursing is about the comfort as well as safety of our patients. I will continue to take that into consideration.

[ghillbert, MSN, NP]

I'm not "jumping" on you. I was simply replying to your post.

Good luck.

[OrthoFNP]

Apparently ya'll just keep getting fired up. I am not even reading any more of the posts. I will say it again. I was wrong. I took the pressure wrong. I am sorry I took the pressure wrong. I should not have done it that way. I should have waited. I should have taken into consideration the comfort of my patient. I get that. I do. I never said I didn't. I never said what I did was right. The bottom line is...I just wanted to know if pressure could fluctuate. I knew I would be told I was wrong. I get that. I knew it when I posted the question. All I wanted to know was if pressure can fluctaute. This thread has really made me feel like a big pile of poop. When all I wanted to know was if the pressure fluctuated that much or if myself or my fellow student were reading the pressure inaccurately. I got the answer to why it would have fluctuated and I appreciate that portion of each and every response. I was a little hurt at the portions were I was told I have a bad attitude and where everyone jumped me and told me how sorry they felt for the poor patient. I did what I thought was in his best interest at the time. Contraty to poular belief I am not a mean person out to harm anyone especially not my patient. You guys have taught me quite a bit. I am just really disappointed at how quickly I was crucified. I get it. I am an idiot with a bad attitude and this will be the absolute last time I post any questions on this board. I hope you guys learn a lot and good luck with school and nursing! :)