RN's at my job tell me "Diastolic BP is when the sound 'changes' NOT when it stops!"

[student456]

Okaaayy, I am a nursing student...

Very confused here. I was taught that when you take a blood pressure, your diastolic number is the LAST sound you hear and not when the "sound changes"....a ton of nurses at my summer job keep telling me that I am wrong with my blood pressures.

They all keep telling me that the number you record is when you hear the sound change and not your final one (because some pts have diastolic's that keep going until practically 0).

And its not only one or two nurses that have told me this...several have.

Who is right!?!?!?

[ilstu99]

You are, but I would do it their way, and discuss the differences with your instructor.

The END of the 4th/5th Korotkoff sound is the diastolic pressure. If you can hear a sound until the cuff reaches 0, then you're deflating the cuff too slowly.

http://www.medphys.ucl.ac.uk/teaching/undergrad/projects/2003/group_03/how.html

[student456]

No the ones that have told me this have explained that you do it for every patient...they just gave me that as an general example

However, interestingly it does say on the link that you provided that:

Phase 4

At this point, there is an abrupt muffling of sound. The blood flow is becoming less turbulent. Some medical practitioners choose to record this point as the diastolic pressure.

So now this is confusing...there are two ways of recording diastolic pressure???

[Dolce, RN]

Okay, I'm glad to know I'm not the only one that struggled with this in nursing school. I was hearing the exact same thing as you and my nursing instructor thought I was crazy, I think. Finally she just concluded that I must have really good hearing because I was recording the diastolic number way too low. Now, after much, much practice I can distinguish the "change" in sounds. Keep practicing. You could try following one of your coworkers after they check a BP so that you can know what to listen for. I have to check BPs manually very often because I do home health. On many patients I "hear" the even when the cuff is almost completely deflated.

[chenoaspirit, ASN, RN]

I was taught that the Diastolic is when you last hear it, not hearing a "change". I will continue to do it that way too. Ive been doing it that way for years.

[Dolce, RN]

I was taught that the Diastolic is when you last hear it, not hearing a "change". I will continue to do it that way too. Ive been doing it that way for years.

The problem with this is that I continue to hear the sound until the BP cuff is completely deflated. On almost every patient! So, I do listen for a change. Whatever works for you.

[Zee_RN, BSN, RN]

I was taught the "last" sound too. And that's what I use for the majority of the time.

However...in nursing school, we practiced on each other. And everyone hears my pressure bump "all the way down." I tend to run a comparatively low SBP. So...I guess you have to individualize it. (Or my DBP is zero!)

[SuesquatchRN, BSN, RN]

Heh. I always hear it stop, and I'm hard of hearing.

[OC_An Khe]

Since every one has different levels of hearing, wouldn't the automatic cuff give you a more consistent reading. Providing it is done correctly.

[SuesquatchRN, BSN, RN]

Since every one has different levels of hearing, wouldn't the automatic cuff give you a more consistent reading. Providing it is done correctly.

Nope. Mine are always right on target.

It's learning proper interpretation. That's where the double scope comes in.

:)

[SDS_RN, RN]

I was taught that the diastolic was the last sound and that's what I've always done and haven't heard anything different.

[TiredMD]

The problem with this is that I continue to hear the sound until the BP cuff is completely deflated. On almost every patient!

Maybe you're pushing too hard with your stethoscope.

Just like how every patient has an abdominal bruit if you push too hard.