Need to vent about manual BP

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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???

Specializes in Emergency Dept. Trauma. Pediatrics.
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! :)

First of all I am not fired up, second of all I have not said you were a mean person out to harm your patient or that you are an idiot or anything like that. If you read the post of YOURS that I quoted in my previous reply it was very rude and condescending and did not admit to any wrong doing but instead "trashed" those that gave you a little constructive criticism. You even went on about how some "first semester" students think they know more then you. Well yes I may be a first semester student but apparently I did know better when it came to this. We live and learn absolutely and part of learning is being able to take constructive criticism IMO. Their is no reason for you to never post any questions on this forum again, this forum has invaluable information on it and is a great place for questions you just have to be prepared for all kinds of replies.

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Specializes in Orthopedics.

I am sorry you feel that way.

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Specializes in Orthopedics.
:D I am done.
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Specializes in L&D/Maternity nursing.
Yes, BP can fluctuate. Taking it repetitively would cause variation and a difference in technique could cause variation. AND, I wonder did you use the same arm? I wish I could remember the publication, but I read a great article on the 5 blood pressure sounds years ago. It was a terrific article that truly improved my practice.

yeah this was my first question. I have a patient at the food pantry (I'm in my community/public health rotation) that his systolic from his r to his l arm varies by 20-30. Did you and your partner take the BP on the same arm?

Like everyone else said, BP varies. To get a diagnosis of HTN you have to have 3 separate readings as high...on 3 separate occasions, not back to back like you two were doing. I wouldnt get too stressed about it...I mean at least you two are consistantly reading it high.

Though for arguments sake, your readings more closely reflect the machines, than did hers. I would have charted that number.

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Specializes in IMCU.

At least you guys are trying to learn a manual BP. All but 2 people in my class thought this was a useless skill because they "have never seen" anyone take a BP manually.

Hubris much?

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Specializes in Case Mgmt, Anesthesia, ICU, ER, Dialysis.

I haven't seen anyone here suggest manually palpating a systolic pressure, either. When there was a question as to what the SBP was, we always palpated, back in the days of q 30 minute manual BP readings on dialysis patients. :)

The automatic machine read a BP from the MAP as the reference point. Our manually auscultated pressures read off Korotkoff sounds - often quite subjective.

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Right, I understand how BP should be read. The only reason why we did a reading consecutively within 30 secs was in order to compare readings to report the most accurate reading to the nurse.

It's actually not really clear from your posts that you do. Repeated measurements within such a short time frame will give you an inaccurate result. Repeating BP to get it right is a good thing, but only waiting 10 seconds between measurements? That is not how BP should be read.

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.

You've only gotten good "advice" from everyone here. You asked an honest question and got honest answers. How exactly did you want to be treated? And maybe some of us first semester students do know more than you do. Programs are set up differently and people learn at different speeds.

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...

Think about this- it is essential to get the most accurate BP for your patient. So do you try to get that measurement quickly and in doing so get a more inaccurate reading, or do you slow down, take maybe a minute or two longer, and get an accurate measurement? Proper critical thinking would have been to realize that taking a minute or so longer to get the correct measurement is what is right for the patient. Critical thinking should also tell you that incorrectly measuring BP is a lot different than starting an IV that causes a patient pain.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Yes, B/Ps can fluctuate with each reading when they are being constantly taken like you guys were doing. You are leaving out the fact that the patient's anxiety can also be a factor in this. Many things contribute to the blood pressure measurement.

Do not get angry at your classmate. 20 point difference in a systolic blood pressure reading by 2 people is not worth quibbling about, believe me. Maybe your classmate has a hearing problem. What is more important is what you do with the information you obtain (your intervention) because ultimately it is our responsibility to follow through and problem solve.

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fa2ns, its too bad you felt the need to leave. hopefully you are still reading the replies. what you are getting here is only a taste of what will happen when you start practicing as a nurse. you will do things that probably aren't the best for your patient because you are learning or because you didn't know. it happens. but if you are able to learn from that experience and listen to those that are experienced in nursing, you will become a great nurse. running away from people who are actually trying to help you that great nurse is not a good thing.

i hope later you can come back and read the posts without getting defensive, there was a lot of good advice here. and i can tell you that they are only trying to help you and your future patients.

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