question for the Peds experts

suzanne4, RN · Jan 29, 2006

i got a job as a Floating LPN but have to work as a Medical Assisstant till i pass the nclex. i am scheduled mainly at the Peds office in a very busy community health center.
now, i quickly found out that taking a B/P on a 3 yr old is not the easiest thing in the world to hear. WHAT ARE THE TRICKS TO HEAR IT BETTER? i use a Littmann Classic II SE...should i get myself a cardiology stethoscope?
BTW, i also take the nclex on wednesday...i average about 70%-75% on my nclex question/study books...i hope i do it!

Automatic BP cuffs are the easiest. The kids also like to watch the numbers.

TheCommuter, BSN, RN · Jan 29, 2006

When I did my clinical rotations in a busy pediatric doctor's office, I always used an automatic blood pressure manometer for the small children. I have never attempted to do it manually.

Any by no means am I a peds expert.

rjflyn, ASN, RN · Jan 29, 2006

Well I work mostly ER and we generally dont take BP's on pts that young. That is unless there is a specific reason to take one. Otherwise like Sue said automated cuffs. In PICU it was automatic cuffs or an arterial line.

Rj

TheCommuter, BSN, RN · Jan 29, 2006

Well I work mostly ER and we generally dont take BP's on pts that young. That is unless there is a specific reason to take one. Otherwise like Sue said automated cuffs. In PICU it was automatic cuffs or an arterial line.

At the clinic where I did a portion of my clinical rotations, their rule was to avoid obtaining BPs on patients 2 years old and younger.

Vman · Jan 29, 2006

one of the nurses i work with brought in an automatic one time and she was told we cannot use them, they have to be done manually.

we only do BP's on children that come in for a PE or Surgical Clearance and are over 3 years old.

unless there are any tricks, do u think a cardio stethoscope will help? i do like working with the children so spending a few bucks on a good stethoscope will not bother me as long as it may help.

pedsallergynurse · Jan 29, 2006

Having worked peds in th hospital and a busy primary care office for years I have experience with bp. We take bp on all well checks 3 and above. No automatic cuffs in my office too expensive. I have found explaining you are going to give their arm a little hug while listening with your stethoscope to "hear if your arm likes the hug" will usually work. Also let them look at the numbers on the dial and pump the bulb a couple times. If all else fails just palpatate the systolic - better than nothing.

oh2beinxtc · Jan 31, 2006

I have been an LPN for 16 years,upon working in peds I have found that keeping a few stickers or disney bandaids,brightly covered bandaids in my pocket and let them know I have it.After the successful BP let them choose one.Also instead of telling them you are checking their BP,tell them you are checking to see how big their muscles are,also you can ask them if they like getting hugs from mom and dad,when they say yes,tell them that you are going to give their arm a hug.....

Vman · Feb 1, 2006

yep, we tell them the same and have a good stock of stickers for them....but can u hear the B/P on the little ones(3-5yrs old)? i have a really hard time hearing it sometimes, and occasionally have another nurse double-check the reading i got.

should i invest in a cardio littman?

PedsNursetobe · May 20, 2006

Kids respond much better if they know what you're doing before you do it. I generally talk to them about it before I do it--building a bit of a rapport. Telling them that it's like a hug for your arm is a good way to go. I also tell them that it's a very silly way to be sure their heart is nice and healthy. You can also show them that it's no big deal by doing it on a parent first. Some kids are just not agreeable to it, no matter how you try! You have to sometimes decide if the battle ( and getting them upset before the doc sees them) is really worth it. In an emergency, obviously you do what you can. I've never been a fan of the automatic BP machines but the can be helpful,too. It's been a while since this was posted, what did you find that worked?

Missy in Michigan

Vman · May 20, 2006

thanks for all the replies....but the issue at hand IS NOT getting the cuff on the child and cooperation for taking the BP....but to HEAR the BP as it is not very audible on 3 year old chidren.

another issue.......doing a PPD on 1 year olds!!....LOL. what is the best way to keep that arm still to get a good wheal without the parents getting upset with you????

PedsNursetobe · May 21, 2006

You're right, Vman--auscultating a BP on a 3 year old is tough! I'm not sure I have any advice on that other than making sure you've got the appropriate sized cuff and that the child is sitting " Like a they are a frozen popsicle".

PPD's are tough on kids!! I work in an allergy clinic where I perform anywhere from 2-30 intradermals per patient! As with anything, it's more difficult with children.Before I even start, I explain the process to the parent. I tell them that the test has to be in a very exact location and if you don't get the wheal, you'll have to do it again. This will require that you hold the childs arm very firmly ( NOT in a way that will hurt the child). That way if they do move, you still have a pretty steady spot to use. I also have a different technique for intradermals that I learned from one of the nurses in allergy and it allows me to do a one handed intradermal. Works MUCH better--if you're interested, I can tell you more! I hope this helps!

Missy in Michigan