Assessing Blood pressure

Purpose
◘ To obtain base line measure of arterial blood pressure for subsequent evaluation
◘ To determine the clients homodynamic status
◘ To identify and monitor changes in blood pressure resulting from a disease process and medical therapy.

EQUEPMENT
◘ Stethoscope
◘ Blood pressure cuff of the appropriate size
◘ Sphygmomanometer

Procedure
1. Prepare and position the patient appropriately
• Make sure that the client has not smoked or ingested caffeine, with in 30 minutes prior to measurement.
• Position the patient in sitting position, unless otherwise specified. The arm should be slightly flexed with the palm of the hand facing up and the fore arm supported at heart level
• Expose the upper arm

2. Wrap the deflated cuff evenly around the upper arm.
• Apply the center of the bladder directly over the medial aspect of the arm. The bladder inside the cuff must be directly over the artery to be compressed if the reading to be accurate.
• For adult, place the lower border of the cuff approximately 2 cm above antecubital space.

3. For initial examination, perform preliminary palipatory determination of systolic pressure
• Palpate the brachial artery with the finger tips
• Close the valve on the pump by turning the knob clockwise.
• Pump up the cuff until you no longer feel the brachial pulse
• Note the pressure on sphygmomanometer at which the pulse is no longer felt
• Release the pressure completely in the cuff, and wait 1 to 2 minutes before making further measurement

4. Position the stethoscope appropriately
• Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward.
• Place the diaphragm of the stethoscope over the brachial pulse; hold the diaphragm with the thumb and index finger.

5. Auscultate the client's blood pressure
• Pump up the cuff until the sphygmomanometer registers about 30 mm Hg above the point where the brachial pulse disappeared.
• Release the valve on the cuff carefully so that the pressure decreases at the rate 2-3 mmHg per second.
• As the pressure falls, identify the manometer reading at each of the five phases
• Deflate the cuff rapidly and completely
• Repeat the above step once or twice as necessary to confirm the accuracy of the reading.

6. Remove the cuff from the client’s arm

7. For initial determination, repeat the procedure on the client's other arm, there should be a difference of no more than 5 to 10 mmHg between the arms. The arm found to have the higher pressure, should be used for subsequent examinations

8. Document and report pertinent assessment data, report any significant change in client's blood pressure to the nurse in charge. Also report these finding:

A. Systolic blood pressure (of adult) above 140 mmHg.
B. Diastolic blood pressure (of an adult) above 90 mmHg
C. Systolic blood pressure of (an adult) below 100mmHg

Study questions
1. Explain vital sings and list what it includes.
2. Identify important times to assess vital signs.
3. Mention some of the factors affecting body temperature.
4. What does pulse deficit mean?
5. Define arterial blood pressure.
6. Explain the two methods of assessing blood pressure.