Tips on taking vitals on the elderly


Hey everyone,

I'm new here and also new to nursing school! Does anyone know any tips on taking manual BP and vitals on the elderly? Specifically I've been having a lot of trouble hearing korotkoff sounds, finding radial and brachial pulses for my assigned patient - 86yo male w/ end-stage parkinson's. His radial and brachial pulses are weak and thready. And I just simply do not hear anything on sounds for blood pressure (I have a cardio III). I've been practicing on a lot of people successfully, but are limited on practicing on the elderly.

I have no issue taking temperature, RR, apical rate for this specific patient.

Any tips and/or tricks are greatly appreciated!!.. I'm at a loss of what to do in clinical.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

If you have access to a Doppler device, try taking the blood pressure with that. Sometimes Korotkoff's sounds in frail elderly people are VERY difficult, if not impossible to hear. I've also taken b/p's with a child's cuff on the wrist, or even behind the knee with a thigh cuff if I couldn't find anything on the arm or if the patient could not have b/p taken on the UEs for some reason.

You may also want to ask your instructor to use a double stethoscope so she can listen while you attempt to take your patient's b/p. Maybe she can make out the sounds and coach you. Or you can try an automatic cuff if the goal is to get his b/p and not just to teach you how to measure it.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

You might want to question WHY you're getting vitals on an elder. We are getting away from routine, weekly vitals on many of our residents.

Thanks for responses.

We haven't learned how to take a bp on any other limb yet so I'm stuck trying it manually. We are not allowed an automatic reading because our instructors want us to learn it manually first.

We are taking vitals because we learned it in class and need to apply it in a clinical and/or real life setting. Taking vitals is mostly for the student's learning, as we are not documenting our findings in any real chart (yet)

vintagemother, ADN, CNA, LVN, RN

Specializes in Med-Surg, Psych, Geri, LTC, Tele.

Are you using a high quality stethoscope? Not the ones the school gives you, but a good one like a littman? I also second what the OPs said about having your clinical instructor listen with you.

I practiced taking bps on the leg with my kids. It's relatively simple if you have a decent stethescope.

Yep, have a cardio III. The thing is.. we did use a dual stethoscope and i definitely did not hear anything. But she said she heard it loud and clear and said to just write down 120 over 80. I talked to my other classmates and the same story... Student doesn't hear anything but (same) instructor hears it clearly. Something tells me that she just did that so we don't bother the nursing home patients too long, as well as not worry them.

Sometimes I've found that the radial pulse is not always where it should be. Feel around!