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So embarrassed today and nervous (re vital signs)

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by Kringe38 Kringe38 (New Member) New Member

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I'm just not having any luck learning to take someone's BP. I'm not too smooth with counting pulse and respirations, either. Does this mean I am doomed or can I still learn?

We're having vital sign check-offs Thursday afternoon. I can't feel anyone's brachial pulse. We're supposed to be able to feel it first before doing the actual BP. Well, I can't feel it. Then while I'm trying to actually take the BP I'm not sure I'm hearing the top number - do hear the bottom number. Scared to death of inflating too far.

Today I was practicing on a classmate with the instructor listening with one of those dual steths, whatever you call them, and it turned out I was letting the air out too slowly and the classmate's arm turned all red and tingly. I felt so bad! So my technique at this point is pathetic!

I also have a hard time feeling even just the radial pulse. Then when I try to start counting, I find I'm counting the seconds and losing time with the pulse. So stupid!

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JulesRN10 specializes in Pediatrics/Adult Float Pool.

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first, don't beat yourself up! i always make things so much harder than they really are, so i totally know where you're coming from...and as an "older" adult student returning for a 2nd career, i felt huge pressure to perform perfectly no matter what...so...as far as the brachial pulse, i find that when i am checking, i am always looking too far to the outside/center of the ac, perhaps you're doing the same? try farther inward, toward the body. find guinnea pigs everywhere you go. count their respers. count their pulse in everywhere you can feel. perfect practice makes perfect, so don't worry about how fast you get it, just practice on getting it...the speed will come with time. i look at my watch and see where i'm starting, then i look away, so i don't get "distracted" by the second hand...a glance tells me about how much farther i have to go. as for the bp, again, practice. maybe you need a different stethescope so you can hear better. i have found that makes another huge difference. see if a store in your area can let you try some different ones out, or classmates even. and again, don't be afraid to just take your time...of course, you don't want your "patient's" arm to fall off, but just practice inflating a few times. practice listening for the first heart tones a while, and then the second ones. practice deflating the cuff...when you feel comfortable with each, put it all together. i know it sounds daunting in just a couple of days, but good friends and family understand their part in your nursing school--it's to be of total and utter support no matter the cost, and being the pig is one of them! ha! good luck, you can do this!

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locolorenzo22 is a BSN, RN and specializes in Ortho, Neuro, Detox, Tele.

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i always just put the arrow and the lines on the inside of the arm while the subject has their arm palm up...inflate while feeling the RADIAL pulse, when that pulse disappears inflate another 30 points. While letting air out slowly, look at the needle. when it starts to jump, be aware that the beat will be coming..also the heart sound will disappear before the needle stops jumping. good luck.

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4,814 Visitors; 188 Posts

I have a Littmann Lightweight SE II. It's not the fanciest one. Maybe I need an amplified one, IDK. :bluecry1:

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You can still learn. A lot of these skills don't come easy to a lot of people. You have to practice.

Brachial pulses are a pain, you need a bit more pressure than you do for a radial but not so much that you are going to cut off the circulation and therefore not feel anything. I always just remember just above the inner aspect of your elbow on the side closest to your body. Its in the same place on practically everybody, it's usually just a matter of finding the right amount of pressure to locate it. Try to use the tips of more than one finger so you're widening your search. Another thing that sucks is when people tense up and all you can feel is a tendon. I always get people to relax their muscles to make my search for a pulse a lot easier. Kind of the opposite on the brachial but if one way doesn't work, try the other.

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Blueorchid is a ASN, RN and specializes in Trauma ICU.

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I was a hero the first few weeks of my first semester because I could find brachial pulses on my classmates. The biggest tip I can give is that you don't need "just two" fingers to feel them. A wider surface area is going to give you better success at feeling something in one particular area so why not use four fingers?

The guinea pig idea is crucial. My Health Assessment professor said when your family and friends start running away from you when they hear the "a" word (that's assessment now) then you're really in nursing school. :)

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i have no idea why you are having a hard time counting the RR and HR. That's as basic as it's going to get. For the BP, it will help you to look at the nanometer and watch it click - that's a trick a lot of people use.

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MattiesMama specializes in Community Health.

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i have no idea why you are having a hard time counting the RR and HR. That's as basic as it's going to get.
the OP has stated that she is already embarrased, this type of comment is probobly not helpful :down:

For the BP, it will help you to look at the nanometer and watch it click - that's a trick a lot of people use.
It's also an innacurate way of measuring blood pressure.

Anywho...

The Littman II SE is a VERY good scope, esp. for taking pressures because of the way the bell is contoured, try reading the owners manual or going to their website, there are some "tricks" to get it to work right...

You have already gotten some good advice for B/P...another tip, have the pt. make their arm as straight as possible and hyperextend a little if they can when you are feeling for it, use 2 fingers (or more) and apply moderate pressure. If you are still having trouble, have the pt. lower their arm for a bit to increase blood flow, and you might have an easier time finding it (just make sure the arm is at heart level when actually TAKING the B/P!)

For radial and respirations-my trick is this: I use a stopwatch that is connected to my stethescope to time it (you can buy them at most nursing stores) so that I don't have to watch the second hand and get distracted, and I usually have the patient position their arm over their chest while I count their radial and then I just stay like that and count respirations by the feeling of their chest moving up and down while breathing. It gets it all done in one shot and a bonus is, the pt. usually doesn't even realize that you are counting their respirations so they are more likely to breath at their normal rate.

Don't worry, it is hard for a LOT of people in the beginning. It took me a whole semester just to master the "art" of vital signs!

Edited by MattiesMama
:)

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It may just be nerves that are causing you to "not hear". Magically, when I am nervous I can't hear or concentrate. Practice, practice on friends and family. Try not to stress and worry. I know it is hard with instructors looking over your shoulder. Once you relax and practice you will be a pro. :D

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4,607 Visitors; 267 Posts

You can worry about perfecting your skill later on. The issue at hand right now is to pass your check-off. Use the nanometer - it almost never fails. And truthfully, you probably won't touch a mechanical BP cuff ever again.

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Hey!! First, thank you so much for this thread!! And please don't feel embarrassed!! My classmates and I are ALL struggling with this! I've been practicing like crazy - part 1 of our mastery is to take vital signs on 50 people and I promise you, by person #10 you start hearing better and better.

At first I couldn't hear the BP sounds AT ALL. I thought I had hearing problems! Even my instructor told our class "I thought I had to drop out of nursing school because I couldn't hear blood pressure sounds." So you are definitely NOT ALONE and don't let all the people who tell you that it's easy discourage you.

My helpful hints. Make sure your earplugs are very properly sealed. My instructor told us to turn the plugs outward (imagine making a "nose") and form it into the shape of a V. Of course, take it in the quietest room possible. Some people have strong pulses, some do not. I know that you are supposed to press "semi-hard" to really feel the pulse, however, pressing TOO hard can occlude the pulse. I find it easier to press just hard enough so I can feel it.

I agree with the poster who said that looking at the secondhand watch is a bit distracting, so I look away too. I stare at my arm so that the watch is in my peripheral vision.

Another tip is to be sure that you are pressing very firmly on the diaphragm of your stethoscpe. I have a Littman Light and if we press too "lightly", then we are activating the bell! So have a firm grip with two or three fingers before you begin the pumping.

I have a quick pulse rate question that's very beginner-ish. :D On some people's pulse, it feels like it is beating two times very quickly. Hard to describe, but it sounds kind of like "bump-bump". That counts as 2 beats, correct?

Best of luck...you'll get it with practice! If I can do it, you definitely can! (I heard NOTHING the first time I put on a stethoscope)

Also...I am a first semester clinical nursing student so if I accidently gave any false/faulty info, please correct me!

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shescoolie specializes in Telemetry, Med-Surg.

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Hey OP don't feel embarrassed. Just practice practice practice. I just took my VS clinical test Tuesday and was one of only 2 people out of 10 who passed that VS portion. I was fumbling MISERABLY with the electronic thermometer trying to take an axillary temp and couldnt get a reading because the probe was in my partner's shirt! :banghead: lol :bugeyes: :chuckle

I also FINALLY figured out how to find the brachial pulse on just about anyone. The pulse can be felt in the little grove where the bicep and tricep muscles lay next to each other JUST above the crease in the elbow. Works like a charm every time. Just keep practing and try to find patterns or similarities on how you should palpate where and how deep and youll soon find that it's almost the same for everybody you practice on.

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