How to read blood pressure?

[Femine91]

Hello nurses and the like. I am a student (so please dont yell at me lol) learning how to accurately measure someone's blood pressure. I have a question that might sound ridiculous but I can assure you I have stumbled upon it in actual practice (practicing with other students of course not actual patients) that might interfere with my accuracy in recording someones BP

When hearing someone's blood pressure, in the meter, i VISUALLY see the "pulse" the gauge starts pulsing, say..at 140. HOWEVER, at this point i dont hear a thing, all i see is the pulse.

Then, at about 132, not only do i see the pulse, I also HEAR the thump. My question is this

IS the BP at 140 where I can see the gauge pulse, OR at 132 when I can actually hear the heartbeat?

Also can someone explain how or why the gauge begins to pulse without a sound?

Thanks

[OrganizedChaos, LVN]

Do not go by what you *see* but by what you *hear*. That is a bad habit to get into.

[nolanurse88]

First sound you hear is systolic, last sound is diastolic

[CrunchRN, ADN, RN]

Only when you hear it. Pulsing is meaningless.

[sailornurse]

Are you first palpating the radial artery while inflating the cuff to see where the pulse disappears? Before you auscultate? This is so you know how high to inflate the cuff, usually 20-30mm mercury above the point where the radial pulse disappears. Also, the correct way to listen for the BP is with the bell of the stethoscope, though you will rarely see it done that way, since many stethoscopes do not have a bell. Since you are a student, have you learned what the auscultatory gap is?

[Double-Helix, BSN, RN]

There may be a point where the pressure wave from the heart beat is strong enough to bounce the needle. But the Korotkoff sounds are heard when blood actually starts flowing through the vessel. That being said, the visible bounce and audible sound should occur within about 10mmHg, and the bounce is a good indication that you should start listening closely for the Korotkoff sounds.

[Purple_roses]

This isn't a silly question :) I struggled with BPs in my first semester and I felt so stupid for it. The systolic is what you hear. Never go by what you see alone. What helped me was to inflate the cuff on a friend or relative and look away as I deflated and listened so that I could be familiar with what I was hearing. Then it was easier to definitively determine if I had truly heard the systolic.