Low diastolic = 911?

Posted

Hello. I am an RN still in the "new grad" category (less than 1 year nursing experience) who was recently hired on as a weekend supervisor at a LTC facility. It is a great facility and so far the job had not been too bad until this past weekend, when I was asked to put aside my administrative duties to cover for a nurse that had quit. I would actually have enjoyed doing the actual nursing work, if I had known what the heck I was doing! Due to my unfamiliarity with the patients and procedures on top of still doing alot of management/administrative stuff, it took me until about 2pm on both days to get all of the "morning" meds done. That's a whole other vent though.

My question is this, is there an urgent significance to low diastolic blood pressure? I received a phone call from the ADON because I had documented a blood pressure with only the systolic because I had not been able to obtain the diastolic. The patient was non-symptomatic and the systolic was within normal range at 122. I have worked in EMS before and we quite often had difficulty obtaining a full reading due to riding in an ambulance or whatever and many times would document a BP as systolic/palp. Now I realize that it might seem I was being lazy but I had tried several times to get a good reading and ended up taking one on her leg. I didn't really think anything of it until I got the phone call and the ADON said she "fixed" the documentation so I would not be liable if anything should happen to this patient in the near future and it came to light that I did not get her further evaluation for an "unobtainable diastolic". As far as I know, low diastolic (with a normal systolic) is not urgent but can cause damage over long-term...and there's no way of knowing if her diastolic was low or I just couldn't hear it because I was taking it in her leg. (Had never done that before) U

Sorry to babble about such a silly question but I'm really not understanding this. I would appreciate if someone could enlighten me! Thank you!

jossjjojo

jossjjojo

Specializes in Cardiology. Has 28 years experience. 38 Posts

I would have charted the systolic and charted that you were unable to hear the diastolic x how many ever times your tried and the different locations that you tried. Obviously the patient had one, you just couldn't hear it. I wouldn't call 911 for a low diastolic or inaudible one. If the patient had been symptomatic such as passing out, faint. extremely weak, I still wouldn't have called 911 but would have called the doctor on call.

PedsAtHeart

PedsAtHeart, LPN

Specializes in LPN, Peds, Public Health. 375 Posts

Ok, I'm lost. Call me crazy, but how do you have a systolic and not a diastolic? Does that mean you just heard one "pulse"? I have never encountered this. If you hear a beginning, shouldnt there be an end?

Mulan

Mulan

2,228 Posts

Wow, I would be more concerned about her "fixing" the documentation.

How exactly did she "fix" it?

GM2RN

GM2RN

1,850 Posts

Wow, I would be more concerned about her "fixing" the documentation.

How exactly did she "fix" it?

My thoughts exactly.

Mulan

Mulan

2,228 Posts

Sometimes you will hear a systolic and hear it all the way down to zero, and sometimes you will hear a systolic and then hear a change and then hear it all the way down to zero. I would just document how I heard it

120/heard all the way down to zero

120/40-0

ImThatGuy, BSN, RN

2,139 Posts

Treat the patient not the monitor. Remember that from EMS?

If she's not symptomatic then just try again later. No big. Check old notes and see where the diastolic usually is and pay scrutiny to that region of numbers perhaps. At any rate, if she was mildly symptomatic you might call her doctor for an order, however, I don't think the reply of "I don't know I couldn't find the number" would've sufficed if asked by the prescribing physician. If she was shocky then definitely call the ambulance.

On another note, I was told once (never experienced this) that if you release the cuff exceptionally slowly then you'll hear a pulse all the way to the end of it. I should try that one day.

mentalhealthRN

mentalhealthRN

433 Posts

Yes you can sometimes get a SBPand have a difficult time hearing the DBP--not all that uncommon with the geriatric population. And yes I was also taught in nursing school as well as EMT training of how to do a palpated BP when unable to get a full BP. It is certainly better then none and gives you an idea of if you are looking at a SBP of at least over 90. I agree that "fixing" documentation is more wrong! You shouldn't make up a DBP!! Ummmmm illegal!!! One thing you can do is to see about having a doppler available. I know in LTC you are usually lucky to have a BP cuff and stethoscope let alone a doppler--but I have used them in the hospital when I had difficulty hearing--sometimes its hard to hear due to age but also an obese pt. I have had docs ask me to try with the doppler when I let them know of the difficulty. And they (docs) have also taken my reported (stable) SBP alone when I tell them of my difficulty with getting a DBP. The other thing I can suggest is to have another nurse try to get the full BP. I have been a nurse for almost 8 years and still do that now and then when I am not sure if what I am getting is accurate, or I just plain can't hear. Its part of team work so I have never had a nurse give it a second thought when I ask.

OB-nurse2013, BSN, RN

Specializes in Labor and Delivery. Has 3 years experience. 1,229 Posts

Treat the patient not the monitor. Remember that from EMS?

If she's not symptomatic then just try again later. No big. Check old notes and see where the diastolic usually is and pay scrutiny to that region of numbers perhaps. At any rate, if she was mildly symptomatic you might call her doctor for an order, however, I don't think the reply of "I don't know I couldn't find the number" would've sufficed if asked by the prescribing physician. If she was shocky then definitely call the ambulance.

On another note, I was told once (never experienced this) that if you release the cuff exceptionally slowly then you'll hear a pulse all the way to the end of it. I should try that one day.

Not true..I just started doing bp and practice on my husband. The first few times I did it I went really really slow and I still could hear definate sounds and had a very clear diastolic reading.

ImThatGuy, BSN, RN

2,139 Posts

Not true..I just started doing bp and practice on my husband. The first few times I did it I went really really slow and I still could hear definate sounds and had a very clear diastolic reading.

Well, like I said I've never tried it. I've only been told that. Thanks!

dthfytr

dthfytr, ADN, LPN, RN, EMT-B, EMT-I

Specializes in ER, Trauma. Has 30 years experience. 1,163 Posts

I'd first start looking for a new job. Second I'd report the ADON for falsifying charting. You were liable for nothing by not charting a systolic without a diastolic in a a-symptomatic patient. Had you sent the patient to the ER for "no diastolic" you and your ADON would have got an earful by an angry ER doc. You did everything correctly. Your ADON has broken the law in falsifying charts, I can only guess out of ignorance.

PedsAtHeart

PedsAtHeart, LPN

Specializes in LPN, Peds, Public Health. 375 Posts

Ok, I understand being able to hear all the way down to 0. Just didn't see how you could have a start but no stop.

My bp is weird... You get a start at the normal 120 or so, then it will stop at about 80, but then start back up at like 60.