skills check off tomorrow--blood pressure..help!

Bayley · Jun 5, 2008

It sounds like you're doing everything you can so I don't know what advice I can really give. It really is just practicing alot. When I was learning it I practiced on everyone I knew as well as on my self. You have a decent stethoscope so I don't really think that is the problem but you should make sure the ear tips fit well and block out as much outside noise as possible. Make sure you're actually finding the brachial pulse first and put the stethoscope diaphram directly over it. Also make sure you're not moving or bumping the BP cuff tubing or stethoscope tubing as that will casue some interference. Asides from that just let the pressure out slowly like you've been doing and sometimes it helps to remind any other people around you to try and be as quiet as possible. Good luck tomorrow and try to relax as much as you can, you'll get it!

kitsune01, BSN, RN · Jun 5, 2008

I had my checkoff on tuesday. I've done enough BPs before that I felt somewhat confident, but I had one partner that I had the hardest time finding the brachial pulse on, (it was really deep), and it took me forever to get it the steth positioned so that I could hear well enough to get a diastolic bp. The instructor suggested that I try pressing harder. I think this might be especially important for littmans with that weird tuneable membrane thing.

Did your steth come with extra eartips? You may want to try a different size of eartips to see if it helps. I had to put the smaller eartips on my new littman, although I didn't remember having that problem with the cheap steth I had before. One of the dual scopes we were using for checkoff had these large hard eartips and I couldn't hear anything out of it because they wouldn't fit in my ears properly.

Good luck tomorrow :)

FriendlyGhostRN · Jun 6, 2008

I know it is REEEEAAAALLLLYYY hard for ya'll to help me over the web, BUT..
tomorrow is our skills check off for blood pressure. I have the hardest time hearing that very last sound so that I will know the diastolic blood pressure. I go as slow as I possibly can, but often I don't hear anything so I don't know when to stop. To my knowledge, I don't have any hearing problems, but I don't know what to do in order to get this skill down. I have a Littman Lightweight stethoscope and regular ADC BP cuff, if that means anything.
Do ya'll have any tips for getting the manual blood pressure check skill down pat?? I have been practicing and practicing and practicing. Maybe I should get my hearing checked??
I am so nervous about tomorrow. sigh.

It sounds like you're doing everything right to me. That last "sound" is actually the absence of any sound!! So once sound goes away, you've got your diastolic BP. Just note the mmHg that the last sound was heard at.....and remember to relax. I just had my test out on vital signs last Wednesday and it was much easier than I made it out to be. These test outs are way stressful...tomorrow I have it on bed making, bathing, and mobility...but next week's is a doozie!! We've got to do it for NG Tubes and Urinary foley catheters....so I'm just taking things one day at a time. Anyways, back on track! haha...You'll do just fine. Just keep on practicing until you've got it down and you feel confident with it. I do agree that you need to make sure you find the brachial pulse first to hear the best sound possible...GOOD LUCK, you'll do just fine. :)

Jules A, MSN · Jun 6, 2008

It does get easier, I promise!

kitsune01, BSN, RN · Jun 6, 2008

It sounds like you're doing everything right to me. That last "sound" is actually the absence of any sound!! So once sound goes away, you've got your diastolic BP.

The problem is that if you are having trouble hearing through your stethoscope, or you don't have it positioned right over the artery, then it can be hard to hear the last korotkoff sound (where it gets muffled), and if you can't hear it very well, then it's hard to tell when it goes away. That makes getting an accurate diastolic harder.

FriendlyGhostRN · Jun 6, 2008

The problem is that if you are having trouble hearing through your stethoscope, or you don't have it positioned right over the artery, then it can be hard to hear the last korotkoff sound (where it gets muffled), and if you can't hear it very well, then it's hard to tell when it goes away. That makes getting an accurate diastolic harder.

Which is exactly why I said that it is very important (basically agreed with earlier posts) to find the pulse first to get the best sound possible. :)

Jamie2887 · Jun 6, 2008

I have a really embarrassing story to add, Last summer before starting nursing school, I was reading up on how to take a BP right after I bought my fancy dancy littman, I was practicing on my Bf's mother who is an RN, and she wasn't really paying attention, after pumping up twice and hearing nothing, she said "honey, you have to turn it around the other way," I had the earpieices in backwards! haha. BUT i still couldn't hear really well with them in right, so I got my hearing checked, and I actually had quite alot of wax build up, got a good cleaning by an ENT, and could hear great!

FriendlyGhostRN · Jun 6, 2008

I have a really embarrassing story to add, Last summer before starting nursing school, I was reading up on how to take a BP right after I bought my fancy dancy littman, I was practicing on my Bf's mother who is an RN, and she wasn't really paying attention, after pumping up twice and hearing nothing, she said "honey, you have to turn it around the other way," I had the earpieices in backwards! haha. BUT i still couldn't hear really well with them in right, so I got my hearing checked, and I actually had quite alot of wax build up, got a good cleaning by an ENT, and could hear great!

Haha! That's so funny...but probably really common...because when we started the vital signs lab, the first thing we went over with the instructors was putting the earpieces in correctly (they told us some stories similar to yours)....thank goodness we did this....because I probably wouldn't have figured that one out on my own...hehe. :) :chuckle

diamondmeadows, BSN, RN · Jun 6, 2008

Did your steth come with extra eartips? You may want to try a different size of eartips to see if it helps. I had to put the smaller eartips on my new littman, although I didn't remember having that problem with the cheap steth I had before. One of the dual scopes we were using for checkoff had these large hard eartips and I couldn't hear anything out of it because they wouldn't fit in my ears properly.

I second this. I have to use soft eartips; I can't hear anything through those hard plastic ones. I've noticed that a lot of steths come with a set of both. You might give it a try.

Good luck, and try not to stress too much. Once you get it, you've just got it, and it's a piece of cake. I'm sure you'll do great!

sugarsweet21612 · Jun 6, 2008

Haha! That's so funny...but probably really common...because when we started the vital signs lab, the first thing we went over with the instructors was putting the earpieces in correctly (they told us some stories similar to yours)....thank goodness we did this....because I probably wouldn't have figured that one out on my own...hehe. :) :chuckle

a nurse that i was shadowing during clinical actually put hers in backwards once and proceeded to "listen" to lung sounds. of course i didn't correct her... :smackingf

FriendlyGhostRN · Jun 6, 2008

a nurse that i was shadowing during clinical actually put hers in backwards once and proceeded to "listen" to lung sounds. of course i didn't correct her... :smackingf

Hahah! Oh that is just too funny!!