Before posting this I tried searching google and allnurses forums but I wasn't able to find answers to my questions so I hope you guys can help! (What happened to the search function anyway, or did I go blind?)
2 questions:
1) I recently had a pt with BP of 124/48. She was fine, no concerns. However, I haven't seen a dbp that low and asked a fellow nurse when dpb would be considered too low and something to contact the doc about and she said she didn't know and to judge it by how the pt was doing.
I didn't pursue the question because we were pretty busy, the pt was fine, and I wanted to do some research later on.
I know that we should be considered if the sbp is below 80 or sometimes 90 depending on the pt - is there some kind of parameter for the dbp?
2) What was the lowest dpb you have seen and how was the pt doing?
It depends on what the patient is admitted for. If it's a neuro patient i would be concerned about an elevated systolic with a low diastolic because of widening pulse pressure. If it's cardiac I care more about the MAP. I care about both if they're post-op. If I'm super concerned I'll get orthostatics. In general, if a patient has a low top or bottom number I just care that the MAP is greater than 50-60 (depending on a few other factors). You really can't go by one value in itself without taking into consideration why they're admitted.
28 was the lowest I've seen, it was in a 1 year old.
Systolic of 0--I've had a couple pt's have tied that number and they were all EXCEPTIONALLY stable...
? Am I missing something a systolic of 0 and they were stable?......
A more important number (than just the diastolic) is the mean arterial pressure (MAP) which ideally should be above 60 to profuse organs.
2x diastolic+ systolic /3= MAP
so if the pressure is 139/38 the mean pressure is 72 .....so even with a diastolic of 38 this patient has a decent mean pressure. Of course.....always remember treat the patient not the number.
Had a patient who used to run hypotensive---around 70/30 but would be awake and alert...not as exciting as some of the other stories here.
Most exciting was my patient whose apical HR was routinely between 28-40 bpm....and he was totally with the program, asymptomatic. Earning himself a pacer once some of his other issues clear up. I remember I sent my nursing student in there to get his vitals without fair warning....she came out with a frightened look on her face and saying "Katie his HR is 36..." shocked when I was like "oh ok, he's fine". Incredible!
Lowest I've seen thus far was my own: 88/55. I was in labor w/ my daughter post sleeping pill amd labor inducement. I was hypertensive w/ all my pregnancies so when I woke up w/ a contraction despite sleeping meds and saw that bp, I couldn't believe it! My nurse had a very disconcerted/worried look on her face! ( I had BPs in the 160's/90-100's and was on strict bed rest).
Lowest diastolic (other than zero) I've seen is 24....I've forgotten the systolic, but it was around 50 or 60....called the doc and he told me it was normal for that patient. Patient did fine. Son runs 80/40 routinely (teenager, athletic).
Before posting this I tried searching google and allnurses forums but I wasn't able to find answers to my questions so I hope you guys can help! (What happened to the search function anyway, or did I go blind?)
2 questions:
1) I recently had a pt with BP of 124/48. She was fine, no concerns. However, I haven't seen a dbp that low and asked a fellow nurse when dpb would be considered too low and something to contact the doc about and she said she didn't know and to judge it by how the pt was doing.
I didn't persue the question because we were pretty busy, the pt was fine, and I wanted to do some research later on.
I know that we should be considered if the sbp is below 80 or sometimes 90 depending on the pt - is there some kind of parameter for the dbp?
2) What was the lowest dpb you have seen and how was the pt doing?
Thanks!
In hospice I got some very low B/P readings. Often times I couldn't ausculate the bottom number. The lowest over BP I have gotten was 30 systolic I just documented t as 30/0. Pt passed within 10 minutes of that reading. Have noticed the quality of the sounds change as the patient nearer to the end.
60/40 while I was in labor and had just received an epidural. I didn't even know it had dropped so low until nurses and the anesthesiologist rushed in. My bp usually runs around 90/60.
NeoPediRN
945 Posts
It depends on what the patient is admitted for. If it's a neuro patient i would be concerned about an elevated systolic with a low diastolic because of widening pulse pressure. If it's cardiac I care more about the MAP. I care about both if they're post-op. If I'm super concerned I'll get orthostatics. In general, if a patient has a low top or bottom number I just care that the MAP is greater than 50-60 (depending on a few other factors). You really can't go by one value in itself without taking into consideration why they're admitted.
28 was the lowest I've seen, it was in a 1 year old.