I've got a question about BP

  1. Hello All,

    I am a nursing student and I have a question about BP. I am confused as to when the diastole start. I will pump it up to 130 or so (depending on radius pulse) and then let it out slowly. I can hear it just fine, but don't know when I should start counting for diastole. I know the systole count is when you no longer hear the pulse, but do I start counting diastole right before the systole? Or do I start counting as soon as I hear the pulse? I'm confused and I'm scared if I don't get this together, I will record the wrong BP on a patient and that could result in death in some cases. PLEASE HELP!!!
    •  
  2. 23 Comments

  3. by   AirforceRN
    Unless I've been doing this wrong....(which is possible I guess)
    The FIRST beat you hear on the way down (say around 120) is your systolic...the "top" number, the LAST beat you hear (say around 80) is your diastolic...so your bp is systolic/diastolic or about 120/80. I hope this helps
  4. by   tnbutterfly
    Quote from AirforceRN2b
    Unless I've been doing this wrong....(which is possible I guess)
    The FIRST beat you hear on the way down (say around 120) is your systolic...the "top" number, the LAST beat you hear (say around 80) is your diastolic...so your bp is systolic/diastolic or about 120/80. I hope this helps
    You are correct, AirforceRN2b.
  5. by   shoegalRN
    Ok, I mis-worded it. So, when do I start counting for systole? Is it when I hear the first beat? Or do I count the last beat right before diastole? BTW I'm a first semester nursing student, no previous nursing experience.
    Last edit by shoegalRN on Mar 24, '07 : Reason: grammer
  6. by   discobunni
    systolic - first beat
    diastolic - last beat
  7. by   tnbutterfly
    You pump up the cuff, then slowly let the air out while listening. There shouldn't be any pulse at first. If there is, you need to pump it up higher. The first sound you hear is the systolic BP. Keep listening, and when there is no further sound, that is the diastolic BP....the last beat you hear.
  8. by   llg
    Also, be sure you have pumped it up high enough to begin with. As tnbutterfly said, if you hear beats right away, then you did not pump it up high enough. You wrote that you pump it up to around 130. Many, many adults have systolic pressures higher than 130. You should be pumping it up at least 10 or 20 points higher than you expect the reading to be -- or even a bit higher to be sure.
  9. by   shoegalRN
    Ok, got it. Now another question. Let's say after you hear the first systolic beat do you count that number it falls on after the first beat as the systolic number? For example, after you pump it up to 140 or so and you hear the beat and it starts out on 120, then goes down a notch and then another notch, then finally silence, do you count the 120 as the systolic beat since it was the first beat?

    I guess I'm confused because of the other beats until diastole.

    So, if I'm understanding this correctly, the very first beat after letting out the air slowly is the systolic number? So, I shouldnt worry about the other beats after the first beat until diastolic? If that makes sense?

    Thanks to all who have helped! I really need it!
    Last edit by shoegalRN on Mar 24, '07 : Reason: grammer
  10. by   TazziRN
    And make sure you have the right sized cuff, or your reading will be incorrect.
  11. by   tnbutterfly
    Quote from nurse2be09
    So, if I'm understanding this correctly, the very first beat after letting out the air slowly is the systolic number? So, I shouldnt worry about the other beats after the first beat until diastolic? If that makes sense?

    Thanks to all who have helped! I really need it!
    That's correct. The first sound you hear is the systolic number. Don't worry about the other sounds. Sometimes, on an older person the beats will be irregular. You need to listen carefully for the very last beat. And that last sound is the diastolic number.
  12. by   KellNY
    Yep-1st beat is systolic, last is diastolic. Doesn't matter if there are 2 or 20 beats in between.

    And 130 on an adult (unless you are familiar with that particular pt and know he/she runs low) is not adequate. I go up to 160 or so if they have no hx of hypertension....higher if it's not uncomfortable for them. No matter how high you decide to go-if you hear your 1st beat (systolic) right away or very shortly after releasing pressure--close the valve an pump it up another 20 or more, because it's likely higher than you've assumed (or hoped, lol).

    If you only go up to 130 on your patients, no one will ever demonstrate a high reading as it would be impossible. Think of it like this--taking a temp with a thermometer that only goes up to 99.0. You'd never record a fever, whether your pt is 99.0 or is really 104.5. Very inaccurate, and potentially VERY dangerous.

    Does that make sense?
  13. by   shoegalRN
    Quote from KellNY
    Yep-1st beat is systolic, last is diastolic. Doesn't matter if there are 2 or 20 beats in between.

    And 130 on an adult (unless you are familiar with that particular pt and know he/she runs low) is not adequate. I go up to 160 or so if they have no hx of hypertension....higher if it's not uncomfortable for them. No matter how high you decide to go-if you hear your 1st beat (systolic) right away or very shortly after releasing pressure--close the valve an pump it up another 20 or more, because it's likely higher than you've assumed (or hoped, lol).

    If you only go up to 130 on your patients, no one will ever demonstrate a high reading as it would be impossible. Think of it like this--taking a temp with a thermometer that only goes up to 99.0. You'd never record a fever, whether your pt is 99.0 or is really 104.5. Very inaccurate, and potentially VERY dangerous.

    Does that make sense?

    Yes, Kelly, that makes perfect sense! I think my problem has been not pumping it up higher, but since I know that now, I will keep that in mind. That may have been my problem all along.

    Thanks so much for your reply!
  14. by   KellNY
    No problem--we all have a handful of things that don't click right away-or even after some practice.

    Just a heads up, some people don't tolerate the cuff very well, and it is uncomfortable--especially if you have a hypertensive pt who you need to pump up to 250, 300, etc. They might start verbally complaining or fidgeting their hands/arms/body, sigh loudly, etc. I usually tell them something like a basic "Try to hold still" to "Now this might be uncomfortable, but in order to get an accurate reading, I need to squeeze the cuff kind of tight on your arm. This will only take a moment, and it's very important that you stay as still and quiet as possible so that I can get a precise measurement as quickly and comfortably for you as possible. We don't want a false reading". Just to remind them that you're on their side and looking out for their best interests--not just trying to torture them.

    Some people hand over their arm, sit up straight and keep quiet as a church mouse, and some will start as soon as you begin to pump with "Ow. I don't like this! Do you need to make it so tight? It's squeezing my arm! Look-the veins in my hand are popping out. Did Dr. Soandso say if he's going to refill my medication? Everytime I come in here, you people do this to me--my arm is gonna be all red now I bet! *sigh*". And everything in between.

    lol, anyway! I highly suggest buying (if you haven't already) a cheap manual cuff and practice on EVERYONE-family, boyfriend, classmates, who I bet would offer their arm if you'll do the same for them.

close