Question on taking Blood Pressure and Respirations

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I was wondering how long you should count a patient's respiratory rate. I believe I was taught 30 seconds then multiply by two. However, if the patient is not experiencing respiratory distress, is it OK to count it for 15 seconds then multiply by four like we do the pulse? I work in an urgent care clinic which is fast paced. I've known some nurses to glance down at the patient for only a few seconds and estimate their respiratory rate. I really doubt any of them count the patient's respirations for 30 seconds like I do.

My other question is regarding blood pressures. I don't know if anyone else has the same problems I do, but sometimes I just don't feel like I'm hearing blood pressures well. I even bought a new stethoscope not too long ago. I at first blamed the equipment we had in our clinic which is heavily used (we don't use automatic cuffs). I don't have the problem all the time, but I find that some patients have blood pressures which are somewhat hard to hear. I personally don't feel that I have a hearing problem, but I think I'm having problems determining when I'm really hearing the first beat (it can be easy to miss). Other times while listening to BP, the sound becomes so muffled that I'm not sure what to write down at the diastolic pressure. I usually support the arm at the level of the heart and roll up sleeves as needed. I also at times will tell the patient not to speak while I'm taking BP (when they do I find this so annoying). I pump up most patients to the 160 mark and slowly release until I hear something. If I'm not sure of the BP on one arm, I tend to take it on the other too, and sometimes I get a difference of around 10-12 mmHg which makes me feel like I'm way off. If anyone can offer any suggestions or advice, I'd appreciate it. Thank You!

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Hi Rhonda,

Try finding the radial artery and place the diaphram of the stethoscope right over that spot. Inflate the cuff to 30mmHg above the point at which the radial pulse can no longer be palpated. There will be some people you will have a difficult time finding the BP on. If you are unable to get a BP, ask someone else to try.

Also eliminating excess noise (such as blaring TV), and also asking the pt not to speak while you are taking the BP are also good measures. I haven't figured it out either why people want to talk when you'e got the stethoscope in your ears :smackingf

Your probably right about others not counting Resps for 30 sec, but you are actually correct by taking at least 30 sec to count them. 60 secs if Resps are irregular.

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Hi,

30 seconds is fine for an adult. You should do a full 60 seconds on infants. With the infants, I have the parent hold the child so the childs back is to me, then I can listen to lung sounds and feel the resp rate without upsetting the child.

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Specializes in ICU, telemetry, LTAC.

The key for me to get resps counted in the volunteer clinic that I worked in, was the old thermometer. It's an ivac, but it used to take a minute or so to read. No one wanted to use it but me. While the pt's quiet, I look at 'em, smile, look at watch, and when done, resps are correct.

I dunno if the providers even looked at the resps in the VS section, but hey, I was a student, and it got done.

Another method: if you're using manual bp cuff, you're probably taking a radial pulse. Simple: just hold the arm after or before you are done and look at resps while they still think they gotta be relatively still.

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Specializes in Neuro, Critical Care.

I find that finding the radial pulse when taking a manual BP is harder than finding the brachial. I first find the brachial pulse then inflate the cuff till I cannot feel the pulse anymore, I deflate, wait a few seconds and inflate again 30 over what the value was...make sure to put your steth over the brachial artery...if you are off it makes it harder to hear...Also make sure your earpieces are in good and tight...oh and make sure the tvs are off and the pts are quiet...I hate it when some pts cant turn off the sound to the tv for a few mins while I do BP!:) Sometimes when I do resps I listen for them too, while listening for lung sounds...usually for 30 seconds unless I think they may be irregular! good luck:)

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

I was taught to count respirations for 30 seconds. I try to do it for a full minute, however.

I was also taught many years ago to take a blood pressure in the left arm. There is a difference in blood pressure between the left and right arm. I believe that the left arm is the higher pressure. I was taught and learned: To first palpate for the brachial pulse in order to know where to put the bell of my stethoscope. To inflate the cuff slowly and smoothly while listening for the bruit. To stop inflating the cuff about 20 more points beyond the point at which I stop hearing the bruit and then begin to release the air in the cuff. By that method you have a pretty good idea of the patients blood pressure before you've even finished doing it.

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I find that finding the radial pulse when taking a manual BP is harder than finding the brachial. I first find the brachial pulse then inflate the cuff till I cannot feel the pulse anymore, I deflate, wait a few seconds and inflate again 30 over what the value was...make sure to put your steth over the brachial artery...if you are off it makes it harder to hear...Also make sure your earpieces are in good and tight...oh and make sure the tvs are off and the pts are quiet...I hate it when some pts cant turn off the sound to the tv for a few mins while I do BP!:) Sometimes when I do resps I listen for them too, while listening for lung sounds...usually for 30 seconds unless I think they may be irregular! good luck:)

Actually I did mean the Brachial artery in my post but mistakenly typed radial.

I should have reread my post more carefully.

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Specializes in Family.

One thing I do when taking a hard to hear bp is hold the pt's arm against my side with my elbow to ensure that the arm is straight as can be. I am having a brain-fart right now and can't remember the proper word, but the elbow needs to be as flat as possible. The slightest bend in the AC space can cause a BP to be less easy to hear.

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Specializes in Neuro, Critical Care.
Actually I did mean the Brachial artery in my post but mistakenly typed radial.

I should have reread my post more carefully.

well, the other day in clinical I had an obese pt. there for gastric bypass and the standard cuff on the wall wouldn't fit her...I searched the floor from top to bottom looking for a larger cuff...when I couldn't find one I asked the nurse what to do and her response was to take the blood pressure on the forearm and palpate the radial pulse...I found this extremely hard and had never heard of anyone doing it that way? The cuff was positioned between her wrist and her elbow. I knew you could take it on the thigh but I had never heard on the forearm...anyone else ever do it this way? just wondering:)

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Specializes in Family.
well, the other day in clinical I had an obese pt. there for gastric bypass and the standard cuff on the wall wouldn't fit her...I searched the floor from top to bottom looking for a larger cuff...when I couldn't find one I asked the nurse what to do and her response was to take the blood pressure on the forearm and palpate the radial pulse...I found this extremely hard and had never heard of anyone doing it that way? The cuff was positioned between her wrist and her elbow. I knew you could take it on the thigh but I had never heard on the forearm...anyone else ever do it this way? just wondering:)

I've done that before, but it does skew the numbers. I just searched online and looked in my textbook, but I can't find it. What I read basically said that the BP would need to be taken that way each time after establishing a baseline due to the difference between taking a BP there and taking it in the upper arm.

ETA: I actually use my stethoscope when doing this, just place it over the radial pulse point.

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well, the other day in clinical I had an obese pt. there for gastric bypass and the standard cuff on the wall wouldn't fit her...I searched the floor from top to bottom looking for a larger cuff...when I couldn't find one I asked the nurse what to do and her response was to take the blood pressure on the forearm and palpate the radial pulse...I found this extremely hard and had never heard of anyone doing it that way? The cuff was positioned between her wrist and her elbow. I knew you could take it on the thigh but I had never heard on the forearm...anyone else ever do it this way? just wondering:)

Any time you palpate a BP just remeber you will get the systolic but not the diastolic pressure. Document as 146/palp or 146 palpated depending on agency policy.

If they're taking care of post-op RNY pts though they really need to have the appropriate bariatric sized equipment around! That surgery has to many complications to be messing around with the possibilty of inaccurate BPs, IMHO.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

For me depends on situation really. I love the manual way of doing things so I take pulses by palp only and I count radial usually by 30 seconds as I take a resp at the same time! (the reasoning behind that is that if a patient knows you are counting resps, it changes...try it on yourself or family/friend..if they know..it becomes a conscious activity!).

If I feel or hear or think something is amiss...I go radial with apical ausc for one full minute...takes practice!

BP...I always ask what someones norm is...and go 100 past that when getting it. I always let my patient know I am going to squeeze harder when it is getting tight and to let out a nice breath! I then hold till after that breath and then start. If it isn't working well or I feel something is wrong..I don't DON'T take another right then and there, I wait 3-5 minutes, chit chat, and do it again on the other arm (if able to use other arm...always remember, masectomy sites, dialysis sites...do not use that side!).

IF for some reason I can't seem to get a good bp, noise or what not...I do it by palp! A lost art! Pump up....let go slowly, feel the radial for the first, second, third beat on that number...you have the systolic at least! Better than nothing! (learned that from paramedics where most BP's or Pulses sound like a disel engine..LOL!).

One time in code I did listen for two minutes on apical as we positioned the patient and awaited the cart...I allowed for other sounds since the patient was being moved...I didn 't do bp because...heck I don't go into auto...I know no pulse means no bp!~ LOL!!!!!!

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