What about Diastolic? Noob Nurse Question

xtxrn, ASN, RN · Sep 28, 2011

First, intuition isn't based on anything measurable. If it's measurable, you don't need intuition- if there are things going on you can measure- they seem ok, BUT you still feel something is off based on knowledge of the patient, or previous situations that had similar components, then you get into intuition.

If you keep running into diastolics in the 40s, I'd ask the doc for parameters. I don't know what type of BP meds you had to give- diuretic, beta blockers, calcium channel, etc. I'd also make sure I checked it manually ANY time I got a reading outside of the "usual" norms.

:)

AgentBeast, BSN, RN · Sep 28, 2011

Would depend on the exact BP med you were giving. Usually Mean Arterial Pressure >60 Apical Heart Rate >60 you pass the med.

Double-Helix, BSN, RN · Sep 28, 2011

It might help to research the difference between systolic and diastolic blood pressure. Systolic is the pressure in the arteries while the ventricles are contracting. Diastolic is the pressure while the ventricles are filling, or the heart is at rest. Most blood pressure medications that you are giving affect the contractions of the heart- either slowing the rate or decreasing how hard the heart contracts. Those would decrease systolic pressures (force during contraction of the ventricles) but affect the diastolic much less.

YOu need to be concerned about the diastolics when giving a medication that relaxes the smooth muscles of the arteries (like hydralizine). Med's that relax the arteries will decrease diastolic blood pressures as well.

Also consider whether the diastolic BP is the patients norm or if they are taking other meds that could be affecting it.

When you have a question like this, think about the action of the med you are giving. How does it affect the body in order to achieve results? Then consider whether or not that mechanism of action is likely to negatively affect the patient in some way.

The JuggerNurse · Sep 28, 2011

The meds were Hydralazine, Isosorbide Dinitrate and Verapamil. I keep being told to use my " Nursing Judgement" but I've only been working for a month, I don't trust my judgement just yet:o

The JuggerNurse · Sep 28, 2011

Wow thank you that's really helpful

xtxrn, ASN, RN · Sep 28, 2011

The meds were Hydralazine, Isosorbide Dinitrate and Verapamil. I keep being told to use my " Nursing Judgement" but I've only been working for a month, I don't trust my judgement just yet:o

And you're wise :)

Was it a manual BP?

The JuggerNurse · Sep 28, 2011

No it was by machine. Next time I will double check manually

Esme12, ASN, BSN, RN · Sep 28, 2011

Would depend on the exact BP med you were giving. Usually Mean Arterial Pressure >60 Apical Heart Rate >60 you pass the med.

She's a LVN in a nursing home.....so she probably needs a little more information

Equation: MAP = [(2 x diastolic)+systolic] / 3

Diastole counts twice as much as systole because 2/3 of the cardiac cycle is spent in diastole. An MAP of about 60 is necessary to perfuse coronary arteries, brain, kidneys.

Usual range: 70-110

http://www.globalrph.com/map.htm

I agree with Ashley....

http://www.biosbcc.net/doohan/sample/htm/COandMAPhtm.htm

The JuggerNurse · Sep 28, 2011

Thanks for the links

Anna Flaxis, BSN, RN · Sep 28, 2011

Okay, quick post because I have to run out the door:

Even with a diastolic of 49, I would still give those meds.

Because the systolic is in the higher range, that means that when the heart is contracting, there is a lot of resistance in the vasculature that the heart is pushing against. This is not a good thing. By relaxing the blood vessels, the heart won't have to work so hard.

nurseprnRN, BSN, RN · Sep 28, 2011

actually, the heart pumps against the pressure that sits in just outside the aortic valve in the the aorta, diastole-- it's the contraction of the ventricles that makes the systolic (higher) pressure. all the left ventricle has to do is overcome the diastolic pressure to open the aortic valve and make some cardiac output. if the diastolic pressure is high, it's more work for the poor old ventricle to do that. that's one reason why vasodilating drugs decrease cardiac workload.:redbeathe (the other reason has to do with the frank starling law-- it's cool, look it up, tells you why people in chf get vasodilators and diuretics )