question about reading blood pressure

Nurses General Nursing

Published

Hi all! Long time since i've been on here but glad to be back. I have a question for you about taking blood pressures. I was taught that the systolic reading is the first sound you hear after releasing the valve. However, when looking at the dial, sometimes you will see the needle bounce before any sound. I was taking a blood pressure on a patient and a PA was standing next to me and saw the first bounce and called that the systolic, even though I heard no sound (or for the several bounces after that first bounce), therefore my systolic was lower than what the PA interpreted the systolic as.

Can you tell me who's right? And what do the first few bounces mean if there's no sound? How to interpret this...Thanks in advance :-)

kkluczynski

51 Posts

Specializes in skilled nursing LTC.

Go with the first sound you hear thats the systolic...

LEM1234

14 Posts

I was always taught that it is the first sound you hear.

Specializes in ER; HBOT- lots others.

it is the first sound u here, BUT, how far off was the PA really? because in emergency situ's in the field, at times, you cannot hear anything and DO go off of sight. but in the clinical setting- its sounds.

-H-RN

Papercutz

30 Posts

This happened quite a while ago, but I remember it was quite a difference, maybe 40mm/hg. That's my concern!

allnurses Guide

ghillbert, MSN, NP

3,796 Posts

Specializes in CTICU.

It's the first sound. If in doubt, do a palpable BP - deflate the cuff while holding a radial pulse - when you feel it come back, that's the systolic.

Whispera, MSN, RN

3,458 Posts

Specializes in psych, addictions, hospice, education.

Systolic is the first heard sound--that's the standard taught in nursing school....

lamazeteacher

2,170 Posts

Specializes in OB, HH, ADMIN, IC, ED, QI.
it is the first sound you hear, BUT, how far off was the PA really? because in emergency situ's in the field, at times, you cannot hear anything and DO go off of sight. but in the clinical setting- its sounds.

-H-RN

Well, the OP proved what I have long suspected - that PAs' education isn't as good as that of nurses! Doctors wanted to make junior docs out of someone, without any nurses' interference - many of them "don't believe" in nurse practitioners (probably because they've been caught doing something wrong by one of them). So here we are with a health care provider with an attitude..... who can prescribe.

Another correction: NewRN2008, I don't know where you got the idea that if you can't hear the first sound, you watch the dial..... those bumps arer caused by the backed up blood trying to get through......You have to know that the blood has passed a restriction on the arm where the cuff is, exerting the most pressure the heart can do, to pass the obstruction.

Here's the way it's done when hearing isn't possible:

Feel the anticubital pulse before pumping air into the cuff, keeping your finger lightly on that spot (without exerting pressure, or you'll obliterate the pulse when it resumes),

Then pump the cuff up until the dial reads 170; and while releasing the valve, letting air out of the cuff note where the pointer on the dial is, when the first pulse beat is felt, and again, when the last beat is felt, then disappears. (If the patient states that he/she has uncontrolled HTN, then pump up to 200 - ouch!)

The stethascope yields more accurate readings, but not much more. :nurse:

lamazeteacher

2,170 Posts

Specializes in OB, HH, ADMIN, IC, ED, QI.
It's the first sound. If in doubt, do a palpable BP - deflate the cuff while holding a radial pulse - when you feel it come back, that's the systolic.

You really want to know when the pulse beats first, closer to the restrictive cuff, which is the anticubital pulse.

allnurses Guide

ghillbert, MSN, NP

3,796 Posts

Specializes in CTICU.

I think if there was a 40mmHg discrepancy, then a radial palp would do just fine to distinguish.

Papercutz

30 Posts

Well, the OP proved what I have long suspected - that PAs' education isn't as good as that of nurses! Doctors wanted to make junior docs out of someone, without any nurses' interference - many of them "don't believe" in nurse practitioners (probably because they've been caught doing something wrong by one of them). So here we are with a health care provider with an attitude..... who can prescribe.

Another correction: NewRN2008, I don't know where you got the idea that if you can't hear the first sound, you watch the dial..... those bumps arer caused by the backed up blood trying to get through......You have to know that the blood has passed a restriction on the arm where the cuff is, exerting the most pressure the heart can do, to pass the obstruction.

Here's the way it's done when hearing isn't possible:

Feel the anticubital pulse before pumping air into the cuff, keeping your finger lightly on that spot (without exerting pressure, or you'll obliterate the pulse when it resumes),

Then pump the cuff up until the dial reads 170; and while releasing the valve, letting air out of the cuff note where the pointer on the dial is, when the first pulse beat is felt, and again, when the last beat is felt, then disappears. (If the patient states that he/she has uncontrolled HTN, then pump up to 200 - ouch!)

The stethascope yields more accurate readings, but not much more. :nurse:

thank you very much for the info!!!

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