Low BP pt Need Tips for when I am by myself!!

allnurses Guide · Apr 21, 2010

Can you take the palpable BP to get an accurate systolic BP??

leonurse · Apr 21, 2010

I would like to know, as well.

madwife2002, BSN, RN · Apr 21, 2010

First of all I would suggest you find out why the pt has a low bp because it may be something as simple as they are making mistakes with their bp meds if on them. Also consider dehydration especially if they are old and hardly ever drink anything. 90/60 I wouldn't get too stressed about some people do function on a lower side of normal range that may be quite normal for them.

So my main advice is see if you can establish why they have a low BP then the solution may be simple-also you need a baseline of their 'normal' range before any suggestions come your way about how to deal with it.

ilovenursing2009 · Apr 21, 2010

First of all I would suggest you find out why the pt has a low bp because it may be something as simple as they are making mistakes with their bp meds if on them. Also consider dehydration especially if they are old and hardly ever drink anything. 90/60 I wouldn't get too stressed about some people do function on a lower side of normal range that may be quite normal for them.
So my main advice is see if you can establish why they have a low BP then the solution may be simple-also you need a baseline of their 'normal' range before any suggestions come your way about how to deal with it.

Thanks! The pt always runs low. She is not on any meds that would make her that low. She has CIDP, but i have not been able to find any research about CIDP and low BP. So since she her normal is on the low side; I am not sure how to get an accurate measure with what is going on.

**canoehead, BSN, RN** · Apr 21, 2010

Use palpation as well as listening, and do both arms, make sure you are getting the same reading on each side.

mcknis · Apr 21, 2010

I first would want to make sure you are comfortable with doing a manual BP. If you are not, perhaps try checking BPs on other co-workers and have fellow staff double check. Palpation should never be justified, unless the individual is familiar with this technique, and it should never be trusted at the correct reading. Although difficult when patients have low BPs, the manual blood pressure is the only preferred/accurate way to assess a patients hemodynamic status in the home. Rely on other symptoms (lightheadedness, dizziness, diaphoresis, skin color and temp, mucous membranes, conjunctiva of the eyes, etc.), in addition to the other vital signs you have on the patient. Turn off distractors (if any) such as the TV, radio, cell phones, pt talking, etc.

Good luck!

brownbook · Apr 21, 2010

I have an auto cuff for personal use, I've found it to be very accurate? All the suggestions are great, and maybe the auto cuff's aren't as accurate with a low BP? But I trust my auto cuff at home, and trust my auto cuffs at work more than my ears, unless I get a really odd reading, then I might "use my ears." Maybe buy a new auto cuff in addition to the other suggestions.

bunsterj · Apr 21, 2010

Do you access to a portable Doppler device? I would think home health would. Anyhow, you can check the systolic BP with that.

melsman1904 · Apr 21, 2010

Anyone have any tips for taking a manual BP on a pt that has low BP (around 80/50 to 90/60). I can never hear the dang thing and I am getting frustrated. I can see the needle somewhat bounce, but little to no sound. I have never had a pt that I could hear nothing on! (I have an auto-cuff but I doubt it is very reliable....today it told me I had a BP of 70/48! Don't think so!!!)

Have you looked into a different stethoscope? I would try using a different scope. Also, where do you store your scope when you're not using it? Hopefully not on your rear view mirror. And consider the noise level...is it quiet when you're checking?

allnurses Guide · Apr 24, 2010

Palpation should never be justified, unless the individual is familiar with this technique, and it should never be trusted at the correct reading. Although difficult when patients have low BPs, the manual blood pressure is the only preferred/accurate way to assess a patients hemodynamic status in the home.

What is your rationale as to why palpation "never justified" and "never [to] be trusted at the correct reading"????? It's a little much to make such statements without rationale.

Getting a palpable systolic to guide an inexperienced BP taker as to where to listen for the systolic pressure on auscultation is most definitely "justified". Many nursing schools teach students to do this first, then reinflate to get the auscultatory BP.

ilovenursing2009 · Apr 25, 2010

What is your rationale as to why palpation "never justified" and "never [to] be trusted at the correct reading"????? It's a little much to make such statements without rationale.
Getting a palpable systolic to guide an inexperienced BP taker as to where to listen for the systolic pressure on auscultation is most definitely "justified". Many nursing schools teach students to do this first, then reinflate to get the auscultatory BP.

In my school (I graduated a year ago) we were taught to do the two step method first using palpation and auscultation. I guess to some it seems like such an old school way of measuring BP, but your right it is still taught!!!