I am in NAC classes right now.it is really important to me that i get it all down, and pass. super nervous about the state test also. afraid i will miss one little step in something. i have been able to do pretty much all of the labs pretty ok , except for the dang blood pressure. for some reason i have problems finding the brachial pulse, and listening for it after i pump up the cuff. pretty easy stuff, but for some reason i am having a hard time. any helpful tips?
KCbaby57 52 Posts Aug 3, 2011 you have to press harder than other pulse sites and sort of under the bicep muscle to find the brachial pulse, just keep trying. also it sounds silly but make sure you have your stethoscope's ear pieces on the right way...i was wearing mine backwards for like a month and was always frustrated that i couldn't hear anything. they are supposed to go in the uncomfortable way...
Thujone 1 Article; 317 Posts Has 1 years experience. Aug 3, 2011 Have the person you are taking BP reading on pop their forearm out, it will tighten the skin, therefore making it easier to find the brachial artery, but like KCbaby57 said, sometimes the brachial artery is just a bit higher up and on the inner side of the bicep.
WKredz5 80 Posts Aug 3, 2011 Why not just get one of these? http://www.google.com/imgres?q=sphygmometer&um=1&hl=en&client=firefox-a&hs=Zor&sa=N&rls=org.mozilla:en-US:official&biw=1366&bih=634&tbm=isch&tbnid=RHx-cNn0J_nFAM:&imgrefurl=http://www.busytrade.com/sellingleads-search/digital-sphygmomanometer.html&docid=WrjwK-xnGRVe4M&w=100&h=100&ei=Nv04ToCJF6OlsQLO4ZEs&zoom=1&iact=rc&dur=280&page=6&tbnh=80&tbnw=80&start=100&ndsp=19&ved=1t:429,r:14,s:100&tx=52&ty=66Sorry for the small pic.
tech1000 210 Posts Has 2 years experience. Aug 3, 2011 Make sure the stethescope is on right (I've had a hard time hearing the BP with it on the right way, so I had asked a nurse to do it and she put hers on backwards! I was shocked she even got a BP. Also, I've seen nurses put the stethescope on the wrong side of the arm for the brachial artery, so make sure you're actually putting it in the right spot.
Dorali, BSN, LPN, RN 1 Article; 471 Posts Specializes in 6 yrs LTC, 1 yr MedSurg, Wound Care. Has 12 years experience. Aug 3, 2011 It's straight up from the pinky finger, if that helps any. Didn't see any mention of that yet.
boogalina, ADN, ASN, BSN, MSN, LPN 240 Posts Specializes in Acute Rehab, IMCU, ED, med-surg. Has 10 years experience. Aug 4, 2011 You might want to purchase an inexpensive BP cuff (I got one at a pharmacy for about $15) and then practice, practice. This will help your confidence on this skill. Good luck! You can do it!
ParkerBC,MSN,RN, PhD, RN 886 Posts Specializes in Medical Surgical/Addiction/Mental Health. Aug 4, 2011 Here is a decent link to YouTube...there are several to look at. By the way....don't go up to 300mm/Hg...
Sheenabush 4 Posts Specializes in Took care of my grandma with Hospice. Aug 4, 2011 Thanks! helped a lot today! i could actually find it better. yea i wear it the uncomfortable way. with the ear things going in toward the ear. and yea i have my own stethoscope, i will probably need to go get the cuff now. i thought they were expensive so i havent got one yet but i will look at a local drug store/pharmacy to see if they have a cheap one. everyone coming over to my house will be my victim! lol & i can usually feel it when i use a little pressure, but i am afraid i will press TOO hard on the residents. i found that the little things pulses also, but cant rely just on that for the testing. thanks for the youtube also! watching the videos help quite a bit
akulahawkRN, ADN, RN, EMT-P 3,494 Posts Specializes in Emergency Department. Has 8 years experience. Aug 4, 2011 Taking a BP isn't that hard... once you know what to feel and listen for. Make sure the cuff is properly sized for the patient and applied snugly - tight enough that it won't fall off if the patient points his or her arm straight down at the floor. Keep the elbow as straight as possible and the nice big biceps artery will be palpable just inside the biceps tendon, above the elbow joint. Once you know where that artery is on that patient, put the steth head (diaphragm side) right over that spot and don't change anything... inflate the cuff while listening and you should start hearing the sounds. Keep inflating until about 20mmHg after you stop hearing the sounds and note the point when you start hearing the sounds again as you deflate the cuff slowly. That's your SBP. Keep deflating until you no longer hear the sounds. That's your DBP. There will be people that are almost impossible to get a good BP on. The good news is that after doing BP's a few hundred times on different patients, you'll know the sounds you're listening for and you'll be able to pick them out despite normal background noise. Watching for needle bounce is a secondary means of verifying that you're hearing sounds at the right time, but this is not a precise method of taking a BP. Our eyes aren't sensitive enough to do oscillometric BP measurements like auto cuffs can. In time, this will all become second-nature to you and you'll just do it without putting much thought into the skill and you'll get to be fairly speedy and efficient about the whole process.Something else I should add... sometimes the sound you hear is not so much a sound as it is a pressure against your eardrums. Most of the time though, the sounds will be quite discrete and unmistakeable.
Sheenabush 4 Posts Specializes in Took care of my grandma with Hospice. Aug 4, 2011 i have been able to hear it maybe once or twice, really well. others it is impossible for me to hear for some reason. but i am thinking if i just keep at it, it will get easier. like you said, after doing it a lot, it will probably be much easier, once i get used to the sounds and everything. and yea, iknow not to rely just on the thing moving. because my luck, for the test, it will be completely wrong. so that is why i am trying to get the bp down. but for some reason this is the only thing i am having a problem with, and it seems like it is the easiest part!
CarolinaGirl1112 94 Posts Aug 5, 2011 I can tell you what helped me in class. Have the patient/guinea pig stick their arm out palm up and completely straighten it so that their elbow locks. Then, using a finger or just your eyes, trace a straight line from their pinkie finger to the inner aspect of their elbow. You should be able to find the pulse a lot easier this way, but it's really important that the elbow is locked as it does make a difference if it's bent a little.Oh, and I'm not sure if it makes a difference, but one of our instructors pointed out that in our skills book it says that we have to feel for the brachial artery, not actually find it. Just something to keep in mind.Best of luck to you!
