So embarrassed today and nervous (re vital signs)

BabyLady, BSN, RN · Sep 12, 2009

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!

Tips...I remember shaking in my boots when I did my first vital sign return demo.

Practice..is key...practice on people at home.

1. The key to finding the brachial pulse, I have found, is it's easier when the arm is outstretched and you'll find it most commonly on the INSIDE fold of the elbow...most people, and infants, I can find it the easiest here.

2. The key to hitting the top number is to reduce the cuff pressure SLOWLY...if you drop it too fast, you'll miss the number..if you don't have your stethescope right over or near where you heard the pulse, you'll miss it too.

3. Watch the dial on the cuff..it actually "pulses" a couple of times before you actually hear it...so that is when you know it's close.

4. Buy a good stethescope! Classic II is probably the cheapest you can get away with..one thing I have learned is it's hard to hear things with cheap stethescopes...the best prices are at Allheart...I haven't found any place that beats them...if anyone else has another source..post it!

Good luck....what they are grading you on is can you follow the steps in the correct order...

Kringe38 · Sep 12, 2009

It probobly is the extra weight then...you have more subcutaneous tissue over your artery so that will tend to muffle the noise. My stepmom had gastric bypass done but she told me when she was heavy the nurses always had a really hard time getting her B/P. Do you have an extra-large cuff? If not I would suggest getting one, cuff size can make a big difference.
The fact that your B/P is hard to read might actually work to your advantage in the end, because if you can read it on yourself, you should have no problem with a "normal" patient. My B/P isn't hard to read but it is all over the place because my medications, so I have like 4 patients in my own body that I can practice on

I haven't got an extra large cuff at home but the instructor had my classmate use one on me. Does cuff size make a difference in the ease of hearing it? It's my understanding that a too-tight cuff would make the reading come out higher than it really is.

MattiesMama · Sep 12, 2009

I haven't got an extra large cuff at home but the instructor had my classmate use one on me. Does cuff size make a difference in the ease of hearing it? It's my understanding that a too-tight cuff would make the reading come out higher than it really is.

You know, I'm really not sure but from my way of thinking...if a cuff is too tight to begin with, hypothetically it could already be occluding your blood flow even when it's NOT inflated, so inflating and then releasing it might not even make that much of a difference...whereas if you have a cuff that fits properly, the blood flow starts off normal and then is occluded by the pressure of the cuff-the point of "release" when the blood is allowed to flow freely again is going to be a bigger "event" psysiologically...does that make any sense?

How does it feel when you are taking your own B/P? Your systolic should be VERY noticeable when you do it on yourself, if you are doing it correctly...you will feel that blood pumping through your arm.

ETA-i just looked it up...cuff too tight=falsely high B/P and harder to read

Kringe38 · Sep 12, 2009

So...theoretically she should have been able to hear it with the larger cuff, which is what she was using. In the classroom, the students who supposedly couldn't hear it on me were using a smaller, "regular" size cuff because that's all there was. Hmm. I've been trying to look this up but can't find much. I will try it on myself but all I have to practice with is a regular size cuff. I wanted to order a larger cuff AND a regular cuff but did not see one when I ordered mine from Amazon. I've only tried it on myself once and of course the cuff is too small, plus I couldn't get it on tight enough with just one hand. :zzzzz

How tight is it supposed to be? That is something that I don't feel the instructors have addressed. I'm also going to ask when I get my "remedial" help.

morningland · Sep 12, 2009

(Sorry if this is repeating what other people have already said but as a new nursing student myself, I am too busy to read all the responses)

For starters, don't be to hard on yourself. I think we ALL get nervous and feel like we can't handle the skills but that is why we practicepracticepractice, right? Some people will just naturally have a weak pulse, so it may be hard to feel. Also, meater people will also make it a little harder to feel a pulse and sometimes people have a strong brachial (sp) but a weak Radial and vice versa. If you know where to feel then thats the important thing I think and if you can't feel a pulse then they just have a weak pulse and thats that, it doesn't mean you yourself are weak.

We are actually getting checked on Baseline assesments this week... BEFORE vitals, which seems kinda backwards. Anyways, you will learn that you classifiy the strength of a persons pulse (+1 being weak, +2 being normal and +3 being strong), so a pulse that is hard to feel a +1 in my book.

Also, about over inflating, we are learning to first palipate the radial pulse before actually taking the BP. Find the radial and pump up the cuff until you can not feel the pulse anymore, then deflate and add 30 to the number where you could not feel the pulse, this is going to the the general area will you hear your first heart beat.

As far as counting the seconds... just don't look at your watch when you are counting resps and BPM because this will naturally cause you to synch your counting with your watch. Just find an easy point to start on your watch (3, 6, 9, 12) and occasaionally glance at it here and there to see where you are at. I did the same thing until I was taught this little trick.

The way I see it is this, we are learning a whole to set of life information here and these are some intense skills we are learning. It is only natural to feel awkward with ANY skill you are first practicing. The only thing that REALLY matters is how dedicated you are to practice and get really good at these skills through much effort. If your school offeres open lab time where you can come in on your own time and practice, do it because the little bit of time I spent practicing in open lab has really helped me to feel more confident in the skills.

Remeber, these words are coming from a guy who at this point is feeling overwhelmed and unsure of himself so just know you are not alone. Peace

p.s. If you are having a hard time feeling a brachial, I find that it REALLY helps to raise the arm up a little bit and you have also be pressing to hard or soft of the artery, so adjust the firmness and you will probaly feel it!!!!

Charlie0413 · Sep 13, 2009

We just signed off on vitals today. My instructor said that on alot of people you cannot palpate the brachial. It helps me to put the stethoscope on the side closest to the person. That is where the artery is most often located. When counting pulse try to note constantly look at the clock instead figure out where you are going to stop counting and just glance at the clock periodically.