please help... blood pressure

guest64485 · Jul 11, 2009

Along with the great ideas already mentioned, one thing you could do is tell the patient you will do a preliminary blood pressure on them first. Put the cuff on, and instead of listening, find their radial pulse on the wrist, and pump up the sphygmomanometer until you can't feel it anymore, then release slowly until you can feel the pulse. This is approximately the systolic blood pressure and then you will know where you should start to hear the blood pressure when you auscultate. One other thing that I do, is to place the stethoscope very slightly inside the cuff when the cuff obscures the area I want my stethoscope to be in - I don't know if you feel like it has to be outside the cuff completely 100% of the time, but if 1/3 of the stethoscope is under the cuff that's no big deal. Sometimes you will get differences in what you can hear between the arms too. And also realize, some people are just that way - very very hard to hear for all of us! But definitely try the palpation method; I have used it when I couldn't hear, and its helped a lot. You record it as 110/palp, for example.

BigRussKCMO · Jul 11, 2009

Go to a nursing home on a off day and ask them if you can do bp checks once a month on the elderly. That's how I learned. Old folks love that stuff plus its a new face to talk too

boggle, ASN, RN · Jul 11, 2009

Placing part of the stethoscope is considered a no-no nowadays. The added pressure/compression over the brachial artery can give you an invalid reading.

Oh, how I struggled to understand BP technique. It took lots and lots of practicing and thankfully some mentoring by a kind, experienced nurse. Once I "got it" all was well.

One thing that kept stumping me when I was first learning was to be sure I had my stethoscope "turned" to the right head. My stethoscope had the type of head that you could rotate to head with bell or diaphragm. How many times did I have it turned to the other head and couldn't hear a thing!!!!

Go back to you Nursing fundamentals/skills book to review technique, and keep checking the American Heart Associations recommendations for technique as the years go by. (It's easy to pick up bad habits once out of school, but incorrect readings can lead to incorrect treatment of the pt.) Make sure you have the correct cuff size. Avoid taking BP over clothing if at all possible. Have pt uncross their legs. Remember to have the arm at rest and supported with with cuff at heart level. Don't let the patient hold up their own arm. When you tuck their arm under your own to support, the patient usually is still helping a bit and that can cause an incorrect high reading. Checking for that approximate systolic is a good idea if you don't know the patient's baseline. To take the BP, put stethoscope over brachial, inflate fast, deflate slowly (about 2mm /sec) and you'll have it! If you miss a sound or need to retake the BP (and we all do from time to time!!), then deflate the cuff fully and let the arm rest for at least 30 seconds before inflating.

You can do it.:)

chrissweety19 · Jul 11, 2009

thank you thank you thank you!!!i appreciate all the feedback and advice..i hope it keeps coming because i could use all the help i can get!!! this may sound stupid but sometimes the problem may be that i cant see the number on the machine....maybe im going to fast but i always try to go slowly....don't know if thats part of the problem.