Blood Pressure Fail

I had a head to toe assessment test today, and passed everything except for blood pressure. We do the two step method, palpate the radial pulse while pumping and then wait for that pulse to disappear. Well I could have sworn her pulse went away at 140 mm Hg. I thought that was odd because she was so skinny. I asked her if she had high blood pressure and she said, "Maybe today!" So then I took her other vitals and then listened to her Korotkoff sounds and I could have sworn I heard the first one at around 138, so that's what I went with. The instructor said it was 110/70, and I was getting 140/70. When she demonstrated, she inflated the cuff very quickly, and deflated it very quickly. I could only hear two sounds the entire time. But I guess that's beside the point, how on earth was I so wildly off? I should mention I'm in block 1 and we've been doing clinicals for 4 weeks now. I've taken BP about 20 times in my entire life. And well, the instructor is right whether or not I agree with her.

Thanks

It is only your first failed skill. Careful about your instructors. They can be nasty. While you fail today, you may succeed tomorrow. Instructors only see the here and now. Before one comes on here and says 'we don't have time'. You are being paid. They are so wrong.

I failed my blood pressure skill and the instructor illustrated my failure to the entire class. The whole class watched as I tried to get the correct blood pressure. She had no sympathy. She went and told my clinical instructor (we had multiple in our skills lab) that I wasn't getting the skill. How ridiculous, I am now a nurse. And a sought out one. Just a tacky instructor.

What did you do to improve your skill? I obviously can't get any of the instructors to help me. I swear I heard Korotkoff sounds at 140 multiple times but the student said she was 110 and the teacher said she was 110. I have to fix this, I can't just guess. I have been taking blood pressure on patients in clinicals and the CNA's said it was fine, so I thought I was fine. I must be doing 'something' wrong!

Thanks

Go on YouTube! Find some tutorials and practice.

If I understand your post, it sounds as though your Instructor did not allow a full minute between readings for the arteries to recover. (According the the American Heart Assn) Not doing so will give false reading, so your readings will differ. Clinic nurses do this all the time (re-pumping too soon or too quickly) and so does the automatic cuff which is why our docs don't use them if they don't have to. Secondly, when a cuff is pumped up, no one should be talking as that too can affect the reading and pumping it too quickly and releasing too quickly will cause your numbers to be off.

I don't mean the speed at which to squeeze the bulb, rather, not waiting in between attempts to do a pressure check. Example: You place the cuff get things in place and begin to pump. You slowly release, at the rate of 2 marks (on the cuff) per beat, that's how slow you should be releasing to listen. If you still don't hear it, release the bladder of the cuff completely. Wait one full minute, then try again. Hope this helps. If you are not doing it this way, you are doing it wrong. The

American Heart Assn. will back me up.

Practice Guidelines: New AHA Recommendations for Blood Pressure Measurement - American Family Physician

Go to this link:

Scroll down to the actual technique and you will see what I am trying to say. You may wish to print it off for your instructor. Give it to her in private though.