Mastering Blood Pressure Measurements: Techniques & Equipment

1. Vital Signs Blood Pressure Part 2 Measuring Blood Pressure

2. Equipment Used to Measure Blood Pressure Sphygmomanometer (Blood Pressure Cuff) Stethoscope Alcohol Swabs Gloves, if blood is present

3. Blood pressure Cuff: Sizes • Pediatric Child • Normal Adult • Large Adult • If the blood pressure cuff is too loose or too tight the blood pressure reading will typically be falsely high

4. Korotkoff Sounds • Blood flow sounds that healthcare providers observe while taking blood pressure • When measuring blood pressure you will be listening for korotkoff sounds • 5 Sounds total • Systolic BP is recorded when the first Korotkoff sound is heard • Diastolic BP is recorded when the Fifth Korotkoff sound is heard

5. Blood pressure Measurement: Equipment Preparation • Wash hands prior to taking blood pressure (during skill check off you will state that you would wash your hands) • Clean ear pieces and the bell/diaphragm of the stethoscope with an alcohol wipe • Press down on the blood pressure cuff to make sure it is completely deflated

6. Blood pressure Cuff: Proper Placement • The blood pressure cuff should be placed at the level of the heart • If the cuff is placed below or above the heart a falsely high measurement will be taken • Typically the left arm is used to take blood pressure • Cuff is placed over the Brachial artery

7. Measuring Blood Pressure: Patient Set Up • Have patient sit in a chair with back supported, feet flat and legs uncrossed • Arm used for blood pressure is supported by personal trainer or a piece of furniture • Arm free of clothing when recording blood pressure

8. Measuring Blood Pressure: Patient Set Up • Wearing clothing will muffle the intensity of the Korotkoff sounds • Rolling sleeves up can place additional pressure on the artery resulting in a falsely high blood pressure reading

9. Measuring Blood Pressure: Resting Requirements • 5 minutes of quiet seated rest • Free of stimulants (nicotine, caffeine and alcohol)for at least 30 minutes • No strenuous exercise for at least 60 minutes prior

10. Measuring Blood Pressure Place blood pressure cuff over brachial artery 1 inch above the bend in the elbow Palpate the brachial artery and place the stethoscope over the brachial artery

11. Measuring Blood Pressure A A Place stethoscope in ears with binaurals (ear pieces) facing forward Palpate the radial artery

12. Measuring Blood Pressure A A A A Inflate blood pressure cuff until the radial artery pulse is no longer felt Inflate blood pressure cuff an additional 30 mmHg Deflate blood pressure cuff at rate of 2-3 mm Hg per second

13. Measuring Blood Pressure • A • A • A • A • A • A • a • Listen for Systolic Blood Pressure and Diastolic Blood Pressure measurements • First Korotkoff sound is SBP • Last Korotkoff sound is DBP • Rapidly deflate cuff to 0 after DBP is obtained • Record blood pressure measurement • Blood pressure readings are recorded in even numbers • When SBP and DBP fall into two different classifications the higher classification should be selected. • Blood Pressure is recorded 120/80 mmHG

14. Re-measuring BP • In some situations you may need to take a second blood pressure reading • Wait for 1 full minute before repeating the blood pressure measurement. • It is generally recommended that all persons older than 30 years have their blood pressure checked annually.

15. Blood Pressure Equipment Clean Up If gloves were worn remove gloves according to universal precautions and dispose of properly Wash hands Deflate blood pressure cuff and returns to storage kit Clean stethoscope with alcohol swab: bell/diaphragm and ear pieces

16. White Coat Syndrome Occurs when a patients feeling of anxiety in a medical environment results in an abnormally high blood pressure measurement As much as 20% of the population suffers from white coat syndrome

17. Emergency Situations In emergency situations blood pressure should be measured as soon as possible Give information to EMS personnel when they arrive

18. Blood Pressure Categories according to ACSM

19. Practice Classifying Blood Pressure Readings • Correct answers to blood pressure classification • A. 144/84 mmHg • B. 96/68 mmHg • C. 104/72 mmHg • D. 156/84 mmHg • E. 112/68 mmHg • F. 192/116 mmHg • G. 158/104 mmHg • H. 174/116 mmHg

20. Chart Noting • Include: • If blood pressure was resting, during exercise or post-exercise • Classification of measured blood pressure • Only physicians can officially diagnose an individual with hypertension • If additional medical attention was advised

21. Chart Noting – Practice, See last slides for examples • Resting Blood Pressure: 118/74 mmHg; classified as normal, no medical recommendation given

22. Chart Noting – Practice, See last slides for examples Exercise Blood Pressure: presented signs of elevated blood pressure including severe headache and muscle cramps, BP=180/128 mmHg; classified as hypertensive crisis, EMS was activated

23. Chart Noting – Practice, See last slides for examples • Recovery Blood Pressure: Following a 90 minute strenuous swim practice patient complains of dehydration and being light-headed, nauseous and dizzy. BP: 88/54 mmHg; classified as hypotension, medical recommendation see doctor, consume additional fluids, particularly a sports drink such as Gatorade.

24. Chart Noting – Practice, See last slides for examples • Resting Blood pressure: Past medical history indicates known hypertension treated with a Beta-blocker. Client’s doctor would like to see client if BP exceeds 160/100 mmHg, current BP=142/90 mmHg, having you regularly check and monitor their blood pressure. Do not refer to physician, recommend having blood pressure taken daily and as needed.

25. Chart Noting – Practice: In-Patient Treatment Center for Eating Disorders • Resting Blood pressure: New patient with past medical history which includes diagnosis of anorexia nervosa with evening episodes of hypotension. Patient’s doctor requires blood pressure monitored every other day, three times per day. Doctor wants notified if SBP drops below 90 or DBP drops below 50 and pedialyte should be administered, current BP=84/56 mmHg. Include what you would do with the BP results.

26. Vital Signs Blood Pressure Answers to Classifications and Chart Noting

27. Practice Classifying Blood Pressure Readings • Correct answers to blood pressure classification • A. 144/84 mmHg Stage 1 Hypertension • B. 96/68 mmHg Hypotension • C. 104/72 mmHg Normal • D. 156/84 mmHg Stage 1 Hypertension • E. 112/68 mmHg Normal • F. 192/116 mmHg Hypertensive Crisis • G. 158/104 mmHg Stage 2 Hypertension • H. 174/116 mmHg Hypertensive Crisis

28. Chart Noting – Example of correct response Your response may vary slightly • Resting Blood Pressure: 118/74 mmHg; classified as normal, no medical recommendation given • Date, Time Resting BP was measured at 118/74 mmHg and result is WNL. Client was encouraged to continue maintaining healthy lifestyle. Signature with title

29. Chart Noting – Example of correct response Your response may vary slightly • Exercise Blood Pressure: presented signs of elevated blood pressure including severe headache and muscle cramps, BP=180/128 mmHg; classified as hypertensive crisis, EMS was activated • Date, Time Client complained of severe headache and muscles cramps. Exercise BP was measured at 180/128 mmHg and classified as hypertensive crisis. EMS was activated and client was transported to the hospital. Signature with title.

30. Chart Noting – Example of correct response Your response may vary slightly • Recovery Blood Pressure: Following a 90 minute strenuous swim practice patient complains of dehydration and being light-headed, nauseous and dizzy. BP: 88/54 mmHg; classified as hypotension, medical recommendation see doctor, consume additional fluids, particularly a sports drink such as Gatorade. • Date, Time Pt had completed a 90 minute swim practice and began complaining of feeling light-headed, nauseous and dizzy. Pt also complained of being dehydrated. Post-exercise BP was recorded at 88/54 mmHg and is classified as hypotension. Pt was given the recommendation to consume additional fluids including sports drinks. Pt was advised to see his physician as soon as possible. Signature with title

31. Chart Noting – Example of correct response Your response may vary slightly • Resting Blood pressure: Past medical history indicates known hypertension treated with a Beta-blocker. Client’s doctor would like to see client if BP exceeds 160/100 mmHg, current BP=142/90 mmHg, having you regularly check and monitor their blood pressure. Do not refer to physician, recommend having blood pressure taken daily and as needed. • Date, Time Client’s PMH indicates known HTN tx c(should have line over it) and has asked for regular monitoring of their BP. Client’s resting BP was measured at 142/90 mmHg. BP falls WNL per Dr.’s orders and was not referred to physician. Encouraged client to have BP taken QD and PRN. Signature with title

32. Chart Noting – Practice: In-Patient Treatment Center for Eating Disorders Your response may vary slightly • Resting Blood pressure: New patient with past medical history which includes diagnosis of anorexia nervosa with evening episodes of hypotension. Patient’s doctor requires blood pressure monitored every other day, three times per day. Doctor wants notified if SBP drops below 90 or DBP drops below 50 and pedialyte should be administered, current BP=84/56 mmHg. Include what you would do with the BP results. • Date, Time Pts PMH includes Dx of Anorexia Nervosa c(with line over it) pm episodes of hypotension. Dr. requires BP monitoring QOD, TID. Dr. wants notified if SBP drops below 90 or DBP drops below 50. BP was recorded at 84/56 mmHg. Dr. was contacted and made aware of pts VS. Pt was given pedialyte stat. Signature with title