Taking Bp's - Help!!

I've been out of nursing for many years and as stupid as this sounds, I'm having a hard time taking BP's!! I have a great stethoscope, a new BP cuff, but the sounds are barely audible. I can hear breath and heart sounds okay. It's really embarrassing as I don't understand why this happening. Maybe it's just practice I need again, but I'm going to be working with the elderly who often are more difficult to hear anyway. Now that this "simple" task is causing issues for me I'm concerned it's giving me some anxiety and making things worse. Any ideas to help? I feel like I'm doing something wrong (placement maybe) although I found ideas and follow them. I feel so stupid about this!! If in doubt, I end up using the automatic BP machines. Also, how on earth do people hear to take BPs in the ER or loud situations?? Sorry if this is a dumb question, but any help would be appreciated!!

HI!!

Im a nursing student and we just went over BP's in school so I have some pointers but if anything is incorrect here plse forgive me:)

As I have just learned there are sooo many factors that contribute to getting the right BP..

1. size of the cuff is very important, if your cuff is too small or too big for the pt it will give you a false reading and or make some of the sounds hard to hear (thats generally a too big cuff). If you are working with the elderly that could be the problem if they are very small.

2.When taking a manual BP are you finding that (goodness ive already forgotten the term) point where you cannot feel the brachial pulse? after applying the cuff we were taught that you find the brachial pulse and slowly pump up the BP cuff. At the point when you can no longer feel the brachial pulse (say 140) add 30 (always 30) and that is the number you will pump it up to when actually taking the BP...could it be that you are not pumping it up enough? for example from above, you stopped feeling the brachial pulse at 140, add 30=170, deflate the cuff and wait for 5 mins, then pump the cuff up to 170 and slowly start letting the air out, about 2-3 mm/sec, when you hear that first sound that is your top number and when you hear the last sound its your bottom number.

3. Also placement of the arm is important..the arm needs to be level with the heart.

4.Placement of the cuff matters too..here ya go from my text book, "With the cuff deflated center it about 2.5 cm (1 inch) above the brachial artery and wrap it evenly"

5. also make sure the pt has both feet flat on the floor, legs uncrossed:)

whew well theres my review for my next test, hope this helped you!

I've been out of nursing for many years and as stupid as this sounds, I'm having a hard time taking BP's!! I have a great stethoscope, a new BP cuff, but the sounds are barely audible. I can hear breath and heart sounds okay. It's really embarrassing as I don't understand why this happening. Maybe it's just practice I need again, but I'm going to be working with the elderly who often are more difficult to hear anyway. Now that this "simple" task is causing issues for me I'm concerned it's giving me some anxiety and making things worse. Any ideas to help? I feel like I'm doing something wrong (placement maybe) although I found ideas and follow them. I feel so stupid about this!! If in doubt, I end up using the automatic BP machines. Also, how on earth do people hear to take BPs in the ER or loud situations?? Sorry if this is a dumb question, but any help would be appreciated!!

I am a pre nursing student and just finished my first skills class and had trouble at times too. I was told a few things such as go to the little finger side of the joint and if at all possible ensure my pt. was as hydrated as possible. Nerves and the embarrassment you are feeling could very well be interfering so take a deep breath and relax and Practice. Best of luck!

Also, how on earth do people hear to take BPs in the ER or loud situations?? Sorry if this is a dumb question, but any help would be appreciated!!

We don't! lol In the back of an ambulance, it's not uncommon for a BP to be called in as 120/palp, meaning we took the BP, felt for a pulse instead of listening for noises, and we only can record systolic. We always try to get a full manual one before leaving the scene though. -Andrea

also, wiggle those earplugs around a bit....

do yours fit?? do they occlude all other sounds?

get them down practically in the ear canal..... that's why i don't loan by steth to anyone.

also, turn the volume down on all t.v.'s in the room.............

the earplug wiggling fixes the audio for me....

Reminds of the time I was at work taking B/Ps and all of a sudden freaked out for about 30 seconds cause I thought I couldn't remember how to do it.

Couple things I've learned along the way. When you palpate the brachial artery, don't just feel for the pulse, try to gauge how much pressure you are putting on the artery to feel the pulse (if you put too much you block it and you can't hear it, and if not enough, well, you can't hear it) so use that pressure marker as a baseline when you place your stethescope.

Also, the earpiece part seems kind of obvious, but I swear I took about twenty B/Ps in lab and could not get them, despite teachers telling me, maybe you should check your earpieces, and I was like, no, I always put them like this, then I decided to fiddle with them and you would not believe the difference it makes! For me, pointing them out at a pretty big angle makes a big difference.

And, I'm sure you probably know this but I have forgotten so many times, it's worth mentioning, make sure you rub your finger across the diaphragm to make sure it's turned in the right direction.

Legally speaking, one of the things through which the competency of a professional is gauged by is the quality and quantity of the tools that he or she has with regard to professional utelization.

Thus, with regard to taking blood pressures, listening to breath sounds, listening to heart sounds, listening to abdominal sounds, and other auscultations, an electronic stethoscope would be most appropriate because of it's greater ability to detect and differentiate ausculated sounds.

Further, objectivity is most important in determining vital signs. Thus, wrist and arm automatic blood pressure measurements should be utelized initially to rule out blood pressure anomalies. If suspected and/or present, and/or other clinical manifestations of high or low blood pressure are present, automatic blood pressure readings should be confirmed with the electronic stethoscope.

Instruments can fail and the nurse can erroneously make a determination of a blood pressure reading. However, by utelizing quality equipment in a logical order as appropriate to the clinical situation the nurse can reasonably meet all professional standards with regard to taking blood pressure readings and other vital signs.