In doubt of taking blood pressure of an old obese patient

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    The patient was lying in bed when i took the patient's bp she wasn't feeling dizzy or any sign and symptoms of someone who's having a high bp... I inflated the cuff to 180 and heard the thumping sound right away... I think im doing something wrong since it's not her usual bp... This happened to me before and when someone took the bp it was in the normal range... Should i take the loudest thump and make it her systolic bp? HELP!!!
    Last edit by VickyRN on Aug 29, '12
  2. 8 Comments so far...

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    My patient is obese and in her 80's.The patient was lying in bed when i took the patient's bp she wasn't feeling dizzy or any sign and symptoms of someone who's having a high bp... I inflated the cuff to 180 and heard the thumping sound right away... I think im doing something wrong since it's not her usual bp... This happened to me before and when someone took the bp it was in the normal range... Should i take the loudest thump and make it her systolic bp? HELP!!!
    Last edit by VickyRN on Aug 29, '12
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    I would review how to take a manual blood pressure. Here is a link: Measuring Blood Pressure - YouTube

    It's also possible that the cuff on the machine was too small, which can give a falsely high reading.
    hgrimmett and Ginger80 like this.
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    The first sound you hear is the systolic... also is the cuff too small? Too small of a cuff will give a false high reading. I would also try getting a radial pressure to start out with if unsure. Just put the cuff on the patient, find their radial pulse and pump the cuff (slowly) until you can't feel the radial pulse anymore. That will give you an idea of where you should hear their systolic. I wouldn't necessarily discredit your ability to take a manual BP just because another person got a "normal" value. Perhaps they didn't pump the cuff high enough and didn't hear the very first sound. Could there be any reason why the patients blood pressure shot up?
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    Well probably the cuff is small and it was hard putting it in her arms .... And she wasn't able to drink her bp meds
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    Not all pts will be symptomatic with HTN, I would've inflated the cuff more to ensure I hear the first beat. Also, as other posters have said, review how to take a manual bp and inflate until you lose the radial pulse. Then after a minute or so, reinflate the cuff 30mmHg higher than where you lost the pulse and go from there.
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    I am in a cynical mood today.....after you make sure the cuff is the right size, don't worry what others got. report what you got.
    others may be avoiding the extra work of reporting an abnormal finding.
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    Your facility does have cuffs sized for obese patients, right? Use one, and put it on properly. Your other alternative is to have someone show you how to take a blood pressure at the radial artery properly, putting the cuff below the elbow.
    sharpeimom likes this.
  10. 0
    Thanks guys!


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