How to Measure Blood Pressure

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How to Measure Blood Pressure

• Vital Signs in the Ambulatory SettingAn
  Evidence-Based Approach
• Cecelia L. Crawford
• RN, MSN

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Blood Pressure An Overview
(Pickering et al., 2005 Perry Potter, 2006)
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BP Its all about the Numbers!

• Terminal Digit Preference
• Some people may show a preference for certain
  numbers in auscultated BP readings
• Zeros, even numbers, odd numbers
• Research study on BP revealed 99 of auscultated
  SBP/DBP readings ended in zero
• Be aware you might like certain numbers more
  than others!

(Roubsanthisuk, W., Wongsurin, U., Saravich, S.,
Buranakitjaroen, P., 2007)
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Blood Pressure An Overview

• Automated BP machines give fast accurate blood
  pressure measurement
• Cannot be used in patients with
• Seizures, shaking, or shivers
• Weak pulses
• Agitation
• Any situation where the arm cannot be kept still

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Blood Pressure An Overview

• Equipment for accurate BP measurement
• Functional calibrated machine
• Right-sized cuff
• Pen or pencil
• Flowsheet, chart, or medical record
• Clean hands and fingers!
• Patient in a comfortable relaxed position
• Wait 5 minutes if patient was active

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Right Cuff in the Right Place

• Cuff width 20 more than upper arm diameter
• Cuff width 2/3 of upper arm length
• Cuff bladder length encircles 80 of upper arm
• Cuff arrow aligned with brachial artery
• Inside of the elbow

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Blood Pressure Procedure

• Wash hands put on gloves, if appropriate
• Provide privacy
• Assist patient to a comfortable relaxed
  position
• Back supported, legs uncrossed

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Blood Pressure Procedure

• 4. Unplug roll machine near the patient
• 5. Ensure connecter hose will reach
• 6. Turn on machine to self-test
• 7. Select proper arm cuff size
• Small adult cuff
• Medium adult cuff
• Large adult cuff
• Pediatric cuff

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etings/p27ashp.html
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Blood Pressure Procedure

• 8. Expose upper arm completely
• Do not put cuff over clothing!
• Machine cant hear the pulse with clothing
• 9. Upper arm properly supported at ? level
• 10. Squeeze air from cuff attach connector hose
• Check for kinks
• 11. Wrap flat cuff snugly around the upper arm
• 12. Arrow mark on cuff is at inside of elbow

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Blood Pressure Procedure

• 13. Set machine for adult or pediatric BP
• 14. Press start button
• 15. No talking or hand gestures by you or the
  patient
• 16. Check digital display for BP when cuff is
  fully deflated
• 17. Repeat BPs may be taken if 2 minutes apart
• 18. Remove cuff and replace clothing

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Normal BP Measurements
(Mosbys Critical Care Nursing Reference, 2002
Perry Potter, 2006)
( BP is often not taken on children less than 3
years of age)
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Blood Pressure Problems

• What if a BP cannot be obtained?
• What if the cuff doesnt fit?
• What if a right-sized cuff isnt available?
• Consult with RN or MD for all troubleshooting
  issues

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Blood Pressure Procedure

• 19. Inform RN or MD for
• Very high or very low BP
• Difficulty taking a BP
• Unable to get a BP reading

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Blood Pressure Procedure

• 20. Discuss BP with patient or parent
• 21. Remove gloves wash hands
• 22. Clean cuff per facility protocol

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Blood Pressure Procedure

• 23. Document the Results
• Flowsheet, clinic record, or clinic chart
• 24. Communicate the Results
• RN
• MD

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Whats wrong with this picture?

• More than one thing may be wrong.
• Write down as many wrong things as you can find!

(Blood Pressure Competency Questionnaire Kaiser
Permanente Southern California RegionJune 2006)
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Whats wrong with this picture?

• Provider and patient are talking
• BP cuff applied over clothing
• Arm supported above heart level
• Patient legs are crossed
• Selected size of the cuff looks big for the
  patient

(Blood Pressure Competency Questionnaire Kaiser
Permanente Southern California RegionJune 2006)
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BP Measurement in the Clinic

• YOU can make the difference
• Welcoming presence
• Decrease any anxieties fears
• Reassure patients family
• Accurate vital signs