LEARNING GUIDE FOR Checking Blood Pressure
LEARNING GUIDE FOR Measuring Blood Pressure for Adults | |
|STEP/TASK | |
|GETTING READY |
| The client should be in a supine or sitting position with back supported for 5 minutes and legs | | | | | |
|uncrossed, feet flat on the floor and patient relaxed. The patient must not eat or smoke | | | | | |
|Prepare equipment (stethoscope and mercury or aneroid sphygmomanometer) | | | | | |
|Determine if the pulses are equal (if equal, use right arm; if unequal, use arm with the strongest | | | | | |
|pulse). Take off the sleeve of the identified arm. | | | | | |
|In patients who have recently undergone surgery involving the | | | | | |
|arm or shoulder, it is recommended that the opposite arm be used | | | | | |
|for measurement. Individuals with an arteriovenous fistula for | | | | | |
|dialysis should have the opposite arm used for blood pressure | | | | | |
|measurement Arm should be abducted supinated and at the heart | | | | | |
|level and supported. | | | | | |
|The correct size should be determined by measuring the width of | | | | | |
|the cuff bladder around the arm. The bladder should be at least | | | | | |
|40% of the circumference of the midpoint of the upper arm and | | | | | |
|the length should be 80% of the upper arm. | | | | | |
|TAKING THE BLOOD PRESSURE | | | | | |
| Place the cuff around the upper arm with the lower edge of the cuff, with its tubing connections, | | | | | |
|placed about one inch above the antecubital space across the inner aspect of the elbow. | | | | | |
|Wrappe the cuff snuggly around the inflatable inner bladder centered over the area of the brachial | | | | | |
|artery. | | | | | |
|Close the valve; inflate the cuff while palpating the radial pulse. Inflate the cuff rapidly to 70 mmHg| | | | | |
|then 10 mmHg at time till the pulse will no longer be felt (the pulse obliteration pressure). This is | | | | | |
|the approximate systolic blood pressure. Deflate the cuff. | | | | | |
|Add 20-30 mm Hg to that number to know the maximum inflation level (MIL). | | | | | |
| Place the earpieces of the stethoscope into ears, with the earpiece angles turned forward toward the | | | | | |
|nose. Palpate brachial artery. Apply the bell (or diaphragm in obese arm) of the stethoscope over the | | | | | |
|brachial artery, just below but not touching the cuff or tubing. | | | | | |
|Close the valve; inflate the cuff rapidly to the MIL previously determined. The eyes should be level | | | | | |
|with the midrange of the manometer scale on a distance of 1-3 feet. | | | | | |
| Open the valve slightly and maintain a constant rate of deflation at approximately 2mm per second, | | | | | |
|allow the cuff to deflate, listen throughout the entire range of deflation until 10mm Hg below the | | | | | |
|level of the diastolic reading. The first loud beat will be the systolic recording (Korotkov I) ,the | | | | | |
|sudden reduction of sound (Korotkov IV) , in case of wide pulse pressure or sound continue to zero, or | | | | | |
|Disappearance of the sound(Korotkov V), in all other patients, will be the diastolic recording. | | | | | |
| Fully deflate the cuff by opening the valve, remove the stethoscope earpieces from the ears. Write | | | | | |
|down the systolic and diastolic readings to the nearest 2mmHg. | | | | | |
|If sounds are not heard clearly, or if some accidental occurrence has seriously impaired the quality of| | | | | |
|the reading, deflate cuff completely, raise arm above head level for 1 minute then lower arm and repeat| | | | | |
|steps 3-8. | | | | | |
| In patients with atrial fibrillation or frequent premature beats deflation should be done more slowly | | | | | |
|and 4 blood pressure determinations should be taken and averaged. | | | | | |
| In individuals with a slow heart rate, the deflation rate should be 2mm Hg per heart beat. | | | | | |
|Standing BP should be taking in: First visit evaluation, elderly patients above 60 year, diabetic | | | | | |
|patients, patients with postural symptoms or patients on potent vasodilator or large doses of | | | | | |
|diuretics. Standing BP should be measured 2 minutes after standing. Repeat steps 3-8. | | | | | |
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