Question about BP

Trauma Columnist · Feb 21, 2006

My first thought would be are you using the correct sized cuff.

jschut, BSN, RN · Feb 21, 2006

I thought of that too, after I had posted my question, but she weighs an even 200, and we have used a regular adult size and a large adult size with the same results... (guess I should've put that info in the first time, huh?)

But even with the larger adult size, the difference is still between 25-30 points higher than with digital.

Is there another reason?

Trauma Columnist · Feb 21, 2006

I can't figure out what it is. I would advise asking the doctor.

jschut, BSN, RN · Feb 21, 2006

Thanks...I was planning on asking today, cause if this continues much longer, I want to know what's going on with her BP and which one the doc says to use.

Maybe I'm worrying too much, but where I work, we have a young lady (not much older than my dd) who had a stroke during childbirth, so I am being extra cautious now....

TazziRN, RN · Feb 21, 2006

Manual readings are almost always different than mechanical readings and are more accurate. When you went to the ER you should have insisted that a reading be taken with a manual cuff, and the ER doc should also have requested a consult with OB based on history. Mechanical readings should never be taken as absolute....if you need a truly accurate reading always get a manual one.

Larry77, RN · Feb 21, 2006

BP cuffs should cover 3/4 of the upper arm to be the "right" size.

NEVER trust an electronic BP machine. It is fine if you are looking at trends but you cannot compare directly to manual BP. Trends-if you always use the same electronic BP cuff you can look at changes which should be fairly accurate.

CoffeeRTC, BSN, RN · Feb 21, 2006

I had issues like this when pregnant. The manual ones were always more accurate. The cuff size often gets overlooked. I was sooooo big with my first pregnancy (pre E wt gain) That I always made sure they were taking it with the right size. I had to ask for the "big girl cuff" After delivering, they were taking my bp with a small cuff on the machine (the newer nurse and aid insisted that this is all they had!!) until I pointed to the manual cuff on the wall.

Along with the numbers, I'd alse be concerned with the other s/s of PIH, etc. Keep track of the BP readings you are doing at home and have her bring them to the next appt.

JustMe · Feb 22, 2006

One of our cardiologists insists we keep a mercury cuff in our ICU. The automatic cuffs read a BP by finding the mean and then calculating the systolic and diastolic. A manual cuff should have the "dial" calibrated every so often to be accurate. And you need to use the right size cuff.

I teach my students what you guys already know. BP readings catch the crest of a "wave" like waves on the ocean, but no two "waves" are alike--hense the differences in one reading to the next. Cuff readings are an imprecise measurement but the best we can do shy of direct arterial readings.

Good luck with your daughter. My daughter-in-law had post-partum preeclampsia after her first baby--BP went to 180/100 with a screaming headache. I had never heard of such a thing but apparently it is more common than we think. She's delivering again in March but I won't let her get discharged this time if her BP is up.

KuteNurse, LPN · Feb 22, 2006

Yes, cuff size is most important. Make sure she is sitting and relaxed while taking BP, do this consistently. Avoid manual BP machines, they may not be calibrated correctly. Notify her OB doc definately. Good luck and I hope you have a beautiful grandchild:)

KN

meownsmile, BSN, RN · Feb 22, 2006

I see posted some of the same concerns as i have regarding those dynamap readings. We have recently gone to machines for vitals, and i hate it.

SweetieRN · Feb 22, 2006

Scenario:
Daughter is 9 months pregnant, has had trouble with high BP throughout....I am taking BP twice daily.
Manually (using cuff and stethoscope), BP is higher...almost dangerously high.
This has been the case here at home, and at doctor's office.
Sunday, BP was 166/102 manually....we went to hospital.
Digital cuff on upper arm had BP as normal, and we were sent home.
I have a wrist cuff at home and it is also reading normal numbers. But the manual cuff still reads high.
I feel more inclined to believe what I hear instead of what I see. But I am still curious....
Why the difference? I'm glad we (she) has an OB appointment today and this is almost over with!

Being an OB nurse, I see my share of preeclamptic women. I guess my first question would be, are you using the right sized cuff? I have seen readings too high and too low with incorrect cuff sizes. Secondly, is she having headaches, diziness, or any edema? If the answer is yes, then she needs to see her doctor or head to the ER. A test of her urine for protien and PIH labs would tell a better story. Please, if there is any question - be persistant with her healthcare provider to run these tests. Good luck to her and to a safe and healthy pregnancy :) :)