Please help I cant hear vitals

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Ok so i have been a medical assistant/lpn:mad: for a couple of months now. I work for the most anal primary care group. when i take a blood pressure sometimes i can get 120/80 and some how when the dr checks it again on ther "md recheck" they can sometimes come out with a reading of 150/90! how can that be? Can a persons blood pressure change so drastically within a 5-10 time span? if not then what am i doing wrong. I use the right size cuff. I place it right where the artery sign is over artery and i sometimes get way off readings and sometimes cant hear anything at all. is that also normal.. and my biggest concern is taking a blood pressure on a overweight person waying over 300lbs...taking their blood pressure with a thigh cuff, first of all i can get the cuff over ther arm cuz th cuff is so wide and their arms are so large and short. one of the other medical assistants said its normal to but scethescop under cuff but i cant hear a thing. I do not want to give false readings and i want to be a pro at taking blood pressures. can someone help?

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What method are you using to take BPs? Do you pump it up to 180 and release from there? Or do you do it another way? It sounds like you are missing the sounds because of an auscultatory gap. You can avoid it and get more accurate readings by doing the palpation method -- palpate the brachial artery and inflate the cuff until the pulse disappears. Then reinflate the cuff 30 mm Hg over the point you felt the pulse disappear and take the blood pressure like normal.

Also, keep in mind the stethoscope you are using can make all the difference in the world.

It took me about a year to get comfortable with doing manual BPs, especially on those "hard-to-hear" people.

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Specializes in Critical Care; Cardiac; Professional Development.

Are you using a quality stethoscope? I highly recommend a Littman II or something of equal quality. A lot of my classmates bought cheaper stethoscopes and are regreting it now.

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yes i am using a littman II :mad:

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I am not the OP, but personally I find it difficult to palpate the brachial except in the thinnest of people. Is anyone able to feel the brachial on an obese or even normal-weight patient?

Funny thing, the last few times I've been to a doctor (two different doctors), they just put their steth right in the middle of my antecubital space. In school we've been taught that the brachial would actually be a little further over medially.

ETA: It's my understanding that the steth is NOT supposed to go under the cuff at all. Just a student here, though, don't know nuthin'. :)

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i agree ive watched drs and nurses do the job and they all seem to do it different. when i get a reading i am writing down what i am hearing and yet feeling comfortable and then the dr will recheck my reading sometimes and it can change from 120/80 to 150/100 or something. i dont understand sometimes

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Are you getting the cuff on firmly enough? It's not supposed to be too tight, of course, but excessive looseness will definitely not work. I have found that not getting it tight enough gives me a low reading. My PDQ-RN says that things that will cause a falsely low reading are: Bladder or cuff too wide, deflating cuff too quickly (low systolic and high diastolic), inaccurate inflation level (whatever that means), and arm above heart.

One thing that was suggested to me to get the cuff on was to take the patient's arm under your arm. Then you have the arm still and straight out, easier to get the placement. Like I said, just a student here, but these are the tips I've received when I've had problems.

ETA: Is there some way you could get some different ear tips for your steth? A better fit could create a better seal.

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Perhaps you could watch one of these doctors do a BP on a patient? Maybe THEY are the ones doing it wrong or using another method. If they are doing any of the things that Kringe38 listed, it could definitely result in a pressure discrepancy. Doctors make mistakes, too (they usually just don't admit them). :) Just a thought.

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What method are you using to take BPs? Do you pump it up to 180 and release from there? Or do you do it another way? It sounds like you are missing the sounds because of an auscultatory gap. You can avoid it and get more accurate readings by doing the palpation method -- palpate the brachial artery and inflate the cuff until the pulse disappears. Then reinflate the cuff 30 mm Hg over the point you felt the pulse disappear and take the blood pressure like normal.

Also, keep in mind the stethoscope you are using can make all the difference in the world.

It took me about a year to get comfortable with doing manual BPs, especially on those "hard-to-hear" people.

That's exactly what we're taught - except they call it 'getting the systolic estimate':D. The only difference is when we're doing the palpation first, it's normally with the radial artery down in the wrist...even though the cuff is still applied above the elbow as it normally would be.

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Specializes in CICU.
I am not the OP, but personally I find it difficult to palpate the brachial except in the thinnest of people. Is anyone able to feel the brachial on an obese or even normal-weight patient?

I find it helps when the arm in question is held out completely straight. On myself, I cannot feel my brachial pulse at all when my elbow is bent, but have no problem when the arm is stick straight.

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i am a nursing student in Malaysia. Sometimes i also fail to assess the blood pressure,especially weak patient. There are several problem we may face when taking blood pressure. It may be the quality of the stethoscope itself, the way we check the blood pressure, the condition of the patient or oneself. Some patient BP sound is hard to detect due to body weakness.So, it is better that we use the automatic BP set to check the weak patient. The patient BP from 120/80 change to 150/100 because the patient may be anxious especially you rechecked their blood pressure,he/she may be in fear that what is wrong with their blood pressure so increase in blood pressure. Another reason is, my senior told me that if we keep pumping the cuff in the same patient, it may cause their BP to increase.And, may be the patient has a history of hypertension,and the medication that they taking has loose their effect as the time passed,so BP suddenly become high,especially when patient is on Nifedipine, the Nifedipine can only last in patient body for 8hours,if exceeds that time, the BP will shoot up,the condition get worse if they miss a dose of Nifedipine.I had an experience that checking BP using automatic set was different using manual set, the patient only had stage 1 hypertension, but the automatic BP set showed the patient BP was 177/110,then i use manual BP set to recheck,it then showed 128/80. It really take times to practice in listening the BP sound using manual BP set.　Practice make perfect. Perhaps my idea is helpful.

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I find it helps when the arm in question is held out completely straight. On myself, I cannot feel my brachial pulse at all when my elbow is bent, but have no problem when the arm is stick straight.

Sometimes I cup the client's elbow in my hand with their arm fully extended out and up to at least heart level..all while sort of pinning their hand/wrist under my arm for additional support. Also, have the client pump a fist or rotate their thumb can make it easier as well. But don't make them do too much as you don't want to affect the BP results by increasing their heart rate - however, I think those little tricks should work ok

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