Those experienced in taking blood pressure, I'M DESPERATE!!

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I'm having a huge problem with measuring blood pressure!

I've got the systolic down pat, but it's the diastolic I'm having trouble with. My instructor was using a teaching stethoscope (the stethoscopes with 2 ear sets) to hear what I'm hearing whilst taking another student's BP and she seems to be finished with it and have the diastolic reading long before I'm even finished hearing things. I swear, I hear faint beats go all the way down to zero.

Is the diastolic measurement LITERALLY the very last thing you hear when taking a blood pressure, or is there something specific you're listening for?

I have an A in this course and I have everything else down pat other than taking blood pressure and I start clinicals tomorrow, then I'll be finished. But my instructor told me I wouldn't be able to go to clinicals if I didn't have the BP thing figured out, then I fail the entire course! And so near the end!!

Do you think if I bought the teaching stethoscope and went to a local doctor's office, hospital, nursing home, etc.. and asked someone experienced to help me, they would? Because idk anyone personally who could help, as my instructor doesn't seem to want to!

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Specializes in LTC and Acute.

I personally was till the last beat is gone or at the very least to where it is faint and I have to strain to hear it. It also depends on the nurse. I have been taught to wait till the VERY LAST beat is gone, but working in a hospital I have had other people tell me that it's when the last clear loud beat is heard. It's best to ask the teacher what they are doing differently and follow his/her advice.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

I have found (comparing to a mechanical NBP) that the VERY LAST LOUDEST beat seemed to correlate.

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The lady that had taught me how to do BP, said that sometimes people can hear something all the way to the end, but the lower number is when you actually hear a change in the way it sounds.

I agree with hburatti85 though, ask your teacher how they are doing it. Don't worry if you look stupid, everyone gets confused on something or another. :]

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Specializes in Public Health, TB.

Make sure you are not using your thumb to hold the stethoscope in place, your own pulse can be transmitted through the end piece. Go with the last clear sound you hear. Depending on the patient's age and health, you may hear a pulse even without the cuff on, i.e. pediatrics, a renal failure patient with an old fistula, or you may even be picking up aortic stenosis, or an aneurysm.

Good Luck!

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I watch the needle. There is a hesitation or hop when the needle hits the systolic number and the sounds become audible. Then the needle kind of "ticks" and you hear the blood flow with the heart beat. When it hits diastolic, the needle will hesitate or slow down and the sounds abate. After that the needle falls steadily. There are also some good examples if you search "taking blood pressure" on YouTube. Hope this helps!

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So is the systolic the very first clear sound you hear, or the very first sound you hear no matter how faint?

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I often hear a heart beat when practicing on fellow students go up to 180 when I know usually have a BP of 120/60. I can also hear the heart beat down in the 20's, so you're not alone.

I don't listen for what they tell us to in the text books, instead I listen for a change in the sound. It's hard to explain in words, but instead of a 'thmb-thmb' sound, it's closer to a 'thsk-thsk' sound.

I think it's individual for the nurse, as my friend is much like me - but another friend is textbook in how she hears her BP's. It's literally the first and last thing she hears.

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Specializes in Med/Surg.
I watch the needle. There is a hesitation or hop when the needle hits the systolic number and the sounds become audible. Then the needle kind of "ticks" and you hear the blood flow with the heart beat. When it hits diastolic, the needle will hesitate or slow down and the sounds abate. After that the needle falls steadily. There are also some good examples if you search "taking blood pressure" on YouTube. Hope this helps!

I suggest not using this approach because the diastolic sound may become inaudible, but the needle still ticks down. It can also happen with the systolic reading. You should go by the SOUND primarily instead of the needle movement or you may get an erroneous reading.

I think you would benefit by listening to as many blood pressures as possible so you can become familiar with it. If someone is available, ask them to double check your reading either on the opposite arm OR wait one minute if using the same arm. That's another alternative to using the teaching stethescope. :)

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I watch the needle. There is a hesitation or hop when the needle hits the systolic number and the sounds become audible. Then the needle kind of "ticks" and you hear the blood flow with the heart beat. When it hits diastolic, the needle will hesitate or slow down and the sounds abate. After that the needle falls steadily. There are also some good examples if you search "taking blood pressure" on YouTube. Hope this helps!

I suggest not using this approach because the diastolic sound may become inaudible, but the needle still ticks down. It can also happen with the systolic reading. You should go by the SOUND primarily instead of the needle movement or you may get an erroneous reading.

I think you would benefit by listening to as many blood pressures as possible so you can become familiar with it. If someone is available, ask them to double check your reading either on the opposite arm OR wait one minute if using the same arm. That's another alternative to using the teaching stethescope. :)

Sorry if I wasn't clear. I agree, DO NOT rely on just the needle, the sounds are of primary importance and they can end before the needle movement becomes smooth. However if you are hearing sounds until the the cuff is empty, then needle movement may help learn to you distinguish the changes in the sounds you are listening for. (Or it may not) This is a link to a gsite that has audio recordings of the Korotkoff sounds. http://132.241.10.14/bp/bp.swf. good luck and keep practicing, it will get easier.

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Specializes in Med/Surg.
Sorry if I wasn't clear. I agree, DO NOT rely on just the needle, the sounds are of primary importance and they can end before the needle movement becomes smooth. However if you are hearing sounds until the the cuff is empty, then needle movement may help learn to you distinguish the changes in the sounds you are listening for. (Or it may not) This is a link to a gsite that has audio recordings of the Korotkoff sounds. http://132.241.10.14/bp/bp.swf. good luck and keep practicing, it will get easier.

If I came off as snippy (only word I could think of), then I apologize. You are definitely right with this tip! It may help the OP focus in the right area to become familiar with what to listen to. And listening to sounds on the web; our instructors did the same for us. Some of my classmates had the same issue, so they lived in our skills lab practicing as much as they could with an instructor and even pulled random students as pseudo-patients!! It's hard for some people, but it definitely gets better with more practice.

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someone has already said it, you need to get your thumb off the stethoscope.

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