Blood Pressures

nurseprnRN, BSN, RN · Feb 27, 2012

it does depend on the patient, or should. i routinely ran 80/50 in college, but the gals at the red cross came to know me and let me give blood anyway (their limit was systolic >100) once i figured out how to valsalva when they took my bp to elevate it at just the right time (i could read a bp dial just fine). then i told them after they took my blood that i had done that, and then they came to realize that i would not, in fact, pass out on the sidewalk of hypovolemia afterwards, and i was just a healthy late adolescent. they got a unit every 10 weeks for four years out of me.

on the other end of the spectrum, around the same time some fool young internist decided to treat my grandmother's high blood pressure, which at that point at age 82 ran around 180/100. she also smoked two packs a day of unfiltered camels and did a case of johnny walker red label all by herself every six weeks or so, and had more marbles than most people half her age. she had already outlived her old internist, and this whippersnapper thought he'd do better. so. she started on bp meds and they put her right to sleep. she needed that pressure to perfuse her brain, and her liver was probably doing a fine job of anticoagulating her. she stopped taking them within two weeks. she died several years later-- of oral cancer, sure, but no cardiovascular or renal disease. :up:

so the question becomes, how's any given patient doing with her bp, and when she goes down, does it do her well or poorly?

RNperdiem, RN · Feb 28, 2012

It depends on where you work and why the med was ordered.

Sometimes beta blockers are given to control a rapid heartrate for atrial fib rather than to control blood pressure.

If I float to the cardiac unit, the doctors are not as worried about low BP numbers. Unless the patient is symptomatic, they will tell you to go ahead and give the meds.

If I float to the neuro ICU, the concern is for maintaining good cerebral perfusion and that requires fairly high pressures if a patient has high intracranial pressures. Low blood pressure is something to be avoided in those cases.

I once held a BP med in the medical unit, and was told by the doctor to give it because the patient had portal hypertension.

Sometimes you have to ask.

Perpetual Student · Feb 28, 2012

As alluded to above, the numbers are just numbers. You need to look at the entire clinical picture and what the patient needs.

silverhalide · Mar 19, 2012

In this case, the patient is a-fib, pot. working diagnosis of CHF. She was diagnosed with hypertension, now she is hypotensive. Probably related to the CHF (a-fib) Her BP's are generally low. She is on coumadin. How fast a pulse rate is too fast for a-fib? The other day I got a reading that was jumping from 98 - 110.

silverhalide · Mar 19, 2012

Also -- a person with CHF will generally have low BP's right?

Anna Flaxis, BSN, RN · Mar 19, 2012

Are you using manual or automatic cuffs? Auto cuffs can be inaccurate by up to 10 points on people with A-Fib.

silverhalide · Mar 19, 2012

it is auto. I think I am going to bring my manual in for her. Do the autos generally read too high or too low with a-fib? I have gotten both.

prinsessa · Mar 19, 2012

I have found that patient's with A-fib can have crazy BPs with an automatic cuff (either too high or too low). Some people can only be checked with a manual cuff because the automatic is never accurate. My BP normally runs around 90/50 so I don't have much wiggle room. During labor my systolic ran into the 70s so they kept bolusing me.

MomRN0913 · Mar 19, 2012

CHF's have high BP's unless they are going into shock.....

Anna Flaxis, BSN, RN · Mar 19, 2012

The auto cuffs can read too high OR too low with A-Fib.

People with CHF can have high, low, or normal range blood pressures. Blood pressure is only one element in the entire clinical picture, and is influenced by a variety of factors.

FLmomof5 · Mar 19, 2012

My family has a history of low BPs. Before my (genetic, asymptomatic) cardiomyopathy was Dx'd, my BP was regularly 90/58. The low BPs are common for my Dad (CHF) and both my brother and sister who also have cardiomyopathy (which is why I got checked!).

My mother (retired RN) has had fits with the floor nurses who try to hold my Dad's cardiac meds because of his low BP! Sad but true, one floor nurse wanted to hold his meds b/c his HR was 58. My mom looked at her and said, "Which part of PACED did you not understand?"! Dad is paced at 58.....

I usually ask the pt what their BP normally runs.