Question about post CVA and blood pressure

[kimmie4476]

Ok, this may be a stupid question, but I had a patient the other day that was post CVA and had right sided weakness. The patient's family member started freaking out when the CNA started to take a blood pressure on the right arm, telling her "you can't take blood pressures or do blood draws on a patient that's had a stroke on their effected side!!!" I asked the Doctor, and she said she didn't know of any reason to not do this, (but if I found one to let her know lol), so, does anyone know any reason why we should not take a blood pressure or start IV's, blood draws on the effected side? Preferably someplace where I can do research on it? I tried googling and can't find any literature on this......

[Teacher First]

oops, patients

[ProBeeRN, BSN, RN]

I've had patients tell me that their BP isn't accurate on their effected side. As for blood draws, sometimes edema may make it more difficult to get a stick? So maybe more of a convenience issue rather than an actual contraindication. If they do have a fistula on their good side, then you gotta do it somewhere!

[mad-mary]

I believe using the affected extremity can lead to falsely elevated readings. It is best to take the BP using the unaffected side.

When admitting a new patient to the unit, I take a blood pressure in each arm. If both pressures are close then it probably would not matter which arm is used. Does anyone else have a better way?

[leslie :-D]

i would 'think' circulation would be impaired on the affected side, thus, not getting an accurate reading.

leslie

[irishwannabe]

My teacher told me that by taking a blood pressure on the affected side the CVA could rupture again. I hope this helps.

[nurseprnRN, BSN, RN]

My teacher told me that by taking a blood pressure on the affected side the CVA could rupture again. I hope this helps.

That is absolutely crazy, and I think you must have misunderstood her.

There is no reason why arterial flow should be affected on the neurologically-affected side. Effects of CVA do not include peripheral vasoconstriction or vasodilation, and even if there was something vasoactive going on it wouldn't affect ONE arm.

Many people have different pressures on different arms. BP also fluctuates by the minute or even within seconds, with fear, agitation, apprehension, and respiration, so unless you have two people taking the BP simultaneously on both arms it's meaningless to say one is higher than the other when taken sequentially.

Serial BP measurements are trends, not absolutes. Take each pt's BP on the same arm every time.

Keeping effect and affect clear:

Affect:verb (used with object)1.to act on; produce an effect or change in: Cold weather affected the crops.

2.to impress the mind or move the feelings of: The music affected him deeply.

3.(of pain, disease, etc.) to attack or lay hold of.

noun4.Psychology . feeling or emotion.

5.Psychiatry. an expressed or observed emotional response:Restricted, flat, or blunted affect may be a symptom of mental illness, especially schizophrenia.

Effect:

noun1.something that is produced by an agency or cause; result;consequence: Exposure to the sun had the effect of toughening his skin.

2.power to produce results; efficacy; force; validity; influence:His protest had no effect.

3.the state of being operative or functional; operation orexecution; accomplishment or fulfillment: to bring a plan intoeffect.

4.a mental or emotional impression produced, as by a painting ora speech.

5.meaning or sense; purpose or intention: She disapproved of theproposal and wrote to that effect.

verb (used with object)10.to produce as an effect; bring about; accomplish; make happen: The new machines finally effected the transition to computerized accounting last spring.

Think of a cartoon with someone hit by a water balloon. The effect was that he got wet; the water affected his hairdo.

In psych, a patient's affect is his presentation-- calm, flat, laughing, angry. Medications may have an effect on that.