can/t determine blood pressure..

Nurses General Nursing

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good day everybody.. yesterday i was taking the blood pressure of this patient.. but i was confused on what really his blood pressure is.. i performed a preliminary palpatory determination of systolic pressure and when i pump the cuff i no longer felt the brachial pulse at 150mmhg.

but here is the problem.. when i ausculated the clients blood pressure.. as i release the valve at 190mmhg, as the pressure falls at 170mmhg i heard a low toned "puff"sound.. then again at 160mmhg then there will be a gap or a silence between 160mmhg to 140mmhg.. then again i heard a loud "tapping" sound at 140mmhg and then the repetitive tapping sound disappears at 90mmhg..

so i recorded his blood pressure as 140/90mmhg. but i was confused about the first two tapping sounds that i heard from 170mmhg to 160mmhg. what are those tappings sounds called? am i wrong about this? is it possible that the real blood pressure of this client is 170/90mmhg? for the reason that i heard the first tapping sound at 170mmhg.

help pls. thank you in advance.

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Specializes in Surgical Intensive Care Unit.

I think that maybe the "auscultatory gap". That gives you a false low systolic pressure.

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Specializes in Ortho, Neuro, Detox, Tele.

The blood pressure should go from the first "regular" tap to no more sounds....The first sounds are the gap....listen close and practice.....it really does make perfect.

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The systolic should be measured at the first sound (1st Korotkoff), not the at the first regular tapping.

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For the sake of clarity, I ask we get to the bottom of this.

In my CNA training (it is what it is), we were trained to listen for the first regular tap for systolic.

This is going to drive me crazy until we have a defined answer....I need help too.

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Specializes in Critical Care, Med-Surg.

If the patient is having ectopy or missed beats, that could account for the gap.

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birdgarner said we should read it at the first tapping sound.. then Absolutely13 said in the 1st regular tapping said.. we should vote who is correct between the two of them.. hehehe

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birdgarner said we should read it at the first tapping sound.. then Absolutely13 said in the 1st regular tapping said.. we should vote who is correct between the two of them.. hehehe

I just wanted to learn the correct way. I feel foolish if the training I had was not complete and accurate. I have some excellent resources and it's being addressed. My post wasn't an insistance I was correct, but a prompt for more people to comment so I could learn more and correct anything I may be doing wrong. Sorry if I confused anyone.

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Hello everybody,

Had a number of talks with various people on this subject and had a wide variety of answers. It appears my training was correct, but oversimplified. I feel much relief. This info is for folks who had similar training to mine and need a more definitive explanation.

Auscultatory sounds

  • Phase I—The first appearance of faint, repetitive, clear tapping sounds which gradually increase in intensity for at least two consecutive beats is the systolic blood pressure
  • Phase II—A brief period may follow during which the sounds soften and acquire a swishing quality
  • Auscultatory gap—In some patients sounds may disappear altogether for a short time
  • Phase III—The return of sharper sounds, which become crisper to regain, or even exceed, the intensity of phase I sounds. The clinical significance, if any, to phases II and III has not been established
  • Phase IV—The distinct abrupt muffling of sounds, which become soft and blowing in quality
  • Phase V—The point at which all sounds finally disappear completely is the diastolic pressure
  • http://www.bmj.com/cgi/content/full/322/7293/1043

Apparently phase and korotkoff are interchangable.

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Specializes in Community Health, Med-Surg, Home Health.

I have another question about obtaining blood pressure-on patients that have had a double mastectomy. This matters more to me as an LPN- as a CNA, we were told to report to the nurse...now, it is me. Which arm (if any) is used? I remember reading somewhere that we would not take it from the most recent surgical arm, but am not sure.

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This has been my night for researching BP procedure. I've learned a lot. I would verify this, but it seems to make sense.

ALERTS

Clients who have had a mastectomy should not have a blood pressure cuff placed on the arm which is next to the mastectomy. The veins cannot support the additional pressure experienced by the cuff. In the event that a client has had a double mastectomy, a leg cuff should be used to obtain a blood pressure reading.

http://fpskdent.sasktelwebhosting.com/Workplace%20Issues/Handbook-pdf/CH2-Blood%20Pressure%20Measurement.pdf

It looks like an 18 x 36 cuff is the standard for that.

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good day everybody.. yesterday i was taking the blood pressure of this patient.. but i was confused on what really his blood pressure is.. i performed a preliminary palpatory determination of systolic pressure and when i pump the cuff i no longer felt the brachial pulse at 150mmhg.

but here is the problem.. when i ausculated the clients blood pressure.. as i release the valve at 190mmhg, as the pressure falls at 170mmhg i heard a low toned "puff"sound.. then again at 160mmhg then there will be a gap or a silence between 160mmhg to 140mmhg.. then again i heard a loud “tapping” sound at 140mmhg and then the repetitive tapping sound disappears at 90mmhg..

so i recorded his blood pressure as 140/90mmhg. but i was confused about the first two tapping sounds that i heard from 170mmhg to 160mmhg. what are those tappings sounds called? am i wrong about this? is it possible that the real blood pressure of this client is 170/90mmhg? for the reason that i heard the first tapping sound at 170mmhg.

help pls. thank you in advance.

you have to go by the first sound. i would take the blood pressure in the other arm to see if you get the same thing. if i did i would go by the first sound heard

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