PIH and blood pressure

[mom22]

Our APU unit nurses occasionally manipulate blood pressure by positioning patients on the left side for 15 minutes and taking the BP from the upper arm. The nurses believe this gives a lower reading. I think it may give lower readings in some cases, but is an inappropriate way of managing blood pressure.

I recently had a post partum PIH patient that had been having elevated but not critical BPs. When I took care of her (day 3 PP), I was getting readings of 170-180s/ 110-120's. I took her BP, the tech did, the macine did- all high. The highest reading I got was 181/124. During the shift, I gave her her scheduled BP meds, plus procardia 10 SL, and 5 mg apresoline IV x 2 (per orders). I gave report and left.

The next day, the nurse I reported off to came to lecture me on BP. She said the patients pressures were "normal " for her, the nurse, all night (140's/80's) . She told me I took the patients BP wrong and should have followed the above described proceedure. Apparantly, everyone had been doing so (3 days later?!). She also told me that my getting a high reading caused the patients blood pressure to go up.

My contention is that her 'normal' BPs overnight were more likely related to the 5 doses of BP meds I gave her in 8 hours, and that manipulating the BP is not actually helping the patient. Heck, I wouldn't let her up to shower on my shift, plus she felt bad (and she had a 28 weeker).

Does anyone else take BP like that? Is there anything legitimacy to that method.

I have 2 issues here: the blood pressure and the nurse. What do you think?

[mzjennifer]

Originally posted by mom22

Does anyone else take BP like that? Is there anything legitimacy to that method.

I have 2 issues here: the blood pressure and the nurse. What do you think?

You bring up some good points! We take blood pressures on the left lateral side in PIH'ers also - and record that BP. I would be very concerned about leaving someone with a BP of 180s/120s WITHOUT the intervention of laying in the left lateral position. You did not mention if you had her change position and recheck the BP.

From what I've read, doesn't PIH eventually resolve itself within a few weeks after delivery? I would be quite concerned about those elevated BPs post-delivery. Are there any plans to keep this pt on antihypertensives beyond the PP hospital stay? What about frequent BP checks at home?

Back to the original question....I would document the BP when she's supine, and then after she's been laying on her left side for 10-15 minutes. I would then consult with the MD about whether the anti-hypertensives should be given. I believe that they should be, considering that she will not always be on her left side, all day long, to keep the BPs in the normal range. Wouldn't want her to have a CVA from continued high BPs!

[LDRN697]

At my facility we also take B/P's in the left lateral position. I would also document the B/P in the supine position and the left lateral position and call the doc.

I think you are right on when you say her B/P's probably decreased due to the medications you gave her. You did good!

[kennedyj]

Absolutely. The left side or even right side as long as you take it on the elevated arm is a great way to take BP's escepially after getting a high reading.

However if you are getting some strange readings further investigation is needed:

look a little more closely at her baseline throughout pregnancy. Has her BP always been a little high (if so less risk for PIH- however labs should be checked the same. If the BP diastolic is consistently over 100. Consider Nifedipine (procardia) or Methyldopa (aldomet) but somewhat depends on labs and whether the BP fluctuates. If Platelets are low, AST ,LDH, or protein in the urine is high, some Magnesium therapy may be in order however it does little for the blood pressures (only decreased risk of seizures).. Procardia will usually kick in by 2-3 days. Methyldopa (aldomet) is considered the safest while pregnant.

J

[canoehead, BSN, RN]

If I get a high BP, I try positioning, rest etc and take it again and then report the intial BP and what I had to do to get it down. Of course if the ptis hospitalized we encourage her to stay in the position that gives her the lowest BP, decrease stimulation etc, and then treat for the average BP, labs, reflexes. Not based on any onetime reading.