Pre-eclamplsia: BP on left side?

[obtech2nurse]

I have always taken BP on the left side of patients with differing levels of PIH (I know there is no such thing any more, but how do you abbreviate pre-eclampsia?) An older nurse jumped all over me because I did this all night. She claims that we should NEVER take BP's with the patient on their side because it "falsely lowers it". She is dead set that she is right. We already knew this patient was severe pre-eclampic and had established that she needed to be delivered. Why encourage high BP when the fetus has better perfusion with mom on L side with "stable" BP's?

How does everyone else deal with this?

[nrice28]

What were you supposed to do? lay the patient on her back so she could pass out? I had pre-eclampsia and they always laid me on my left side. I thought trendelumburg was the only way to "falsly lower a bp". You were right. YOu were protecting the pt and her baby.

[IMNAHA]

At the very least, if everyone is taking the BP on the left arm, it would give you consistency in monitoring (taking the BP in the same arm).

[obtech2nurse]

I need to find some articles to support my position. I guess I know what I am going to do with my downtime tonight!

[mollyaqua]

I agree with you if the patient has already been admitted. If the patient is here to rule out preeclampsia, then I let her move around in bed at will. (This is assuming that she is not an obvious, severe PIHer just waiting for confirmation). If there is a chance that the physician is going to discharge the patient to home, well then, I want some evidence as to what her blood pressure is going to be when we discharge her to home. I don't want "falsely decreased" pressures if we are going to send her home to normal activities.

[nrice28]

I realized that I was wrong about the trendelumburg position! It would increase the pressure not lower the pressure!

[MamaCJRN]

The recommendation for a true reading is for the patient to be in a semi-fowlers or sitting position. The most important thing is to never have the patient lay flat on her back, at the very least she needs a hip roll under her left or right hip.

I'm not sure as I don't know the nurse you are working with but I would want the true reading so I would know if interventions (medications, positioning, quiet environment) are working for the patient.

Your hospital protocol should state how you perform BP's for these patients. Hope this was helpful.

[passionflower, BSN, MSN, RN]

I had a patient with elevated b/p's, pih LAST pregnancy but normal labs this pregnancy. All day they were taking her b/p and then administering hydralazine iv prn. I saw a note in chart when looking back on her records stating to take bp in left arm. I started doing this and no more elevated blood pressures requiring hydralazine. The next day I saw that they were again administering hydralazine and not doing left arm b/p's.

Wonder which is better for the baby - better position for perfusion or medications?

[nrice28]

Okay so I am reading my OB book b/c I have a test on Wednesday and I thought of this thread. The book says that you should measure the blood pressure in the same arm with the woman in the same position each time. If the woman is in the lateral position the lower arm should be positioned so the woman is not lying on the dependent arm. This more closely approximates the arterial pressure, whereas using the arm of the opposite side falsely reduces the measurement. Hope that helps...although I know this was a while ago. :)

[beachmom]

If the pt. is lying on her side, the upper arm will have a lower BP and the lower arm will have a higher BP. If you are taking BP's every 15 min, it would be unreasonable to have her stay in semifowler's for the whole labor so the BP's would be the most accurate. I usually put the cuff on the non-IV side. If I get a BP that's too high or too low, then I would have the pt. move to semifowlers to get an accurate BP.

[passionflower, BSN, MSN, RN]

Thank u for responding you all are very helpful