CNA 3.5.1 (Blood Pressure)

Procedure for blood pressure

- Wipe ear pieces and diaphragm of stethoscope with alcohol or disinfectant. - Cleanse your hands. - Roll up the patient's sleeve about 5 inches above the elbow. - Place the arm in a comfortable and supported position at heart level with the palm facing up. Make sure the rolled-up sleeve is not constricting the patient's arm. - Wrap the blood pressure cuff around the upper arm 1 to 1 ½ inches above the elbow. The center of the cuff should cover the brachial artery. - Find the palpatory systolic pressure. - Locate the radial pulse with your first two fingers. - Squeezing the bulb, inflate the cuff until the radial pulse can no longer be felt. - Inflate the cuff 20 to 30 mm Hg higher. - While watching the gauge, slowly open the valve on the bulb by turning it counterclockwise to slowly release the pressure in the cuff. - Note the reading on the gauge when the pulse is felt again at the radial site. - Deflate the cuff by further opening the valve on the bulb by turning it counterclockwise. - With your first two fingers, locate the brachial artery. The brachial artery is on the inner side of the arm at the elbow. - Place the stethoscope diaphragm over the artery and place the ear pieces in your ears. Make sure the tubing from the stethoscope and the sphygmomanometer are not tangled. - Close the valve on the bulb by turning it clockwise. - Inflate the cuff to 30 mm Hg above palpatory systolic pressure. Make sure that you can see the sphygmomanometer gauge clearly. - Slowly open the valve on the bulb by turning it counterclockwise, allowing the air to escape slowly and evenly. - When the first sound is heard through the stethoscope, note the reading on the gauge for the systolic pressure. - Continue allowing air to escape until the sound heard through the stethoscope changes to become very faint or stops. Note the reading on the gauge for the diastolic pressure. - Deflate the cuff by further opening the valve on the bulb by turning it counterclockwise. - Record the following blood pressure data on note paper: - Date - Time Blood pressure, for example BP 114/76 (with systolic over diastolic) - Remove the blood pressure cuff from the patient's arm. Squeeze any remaining air from the cuff. - Wipe ear pieces and diaphragm of stethoscope with alcohol or disinfectant. - Check the patient, observing all safety precautions. - Cleanse your hands. - Record the following blood pressure data on the patient's chart: - Date - Time - Blood pressure data, for example BP 114/76 - Your signature and title - Immediately report any abnormal blood pressure data to your supervisor.

Blood pressure

Blood pressure measures the force, or pressure, of the blood against the artery walls when the heart contracts and relaxes. Blood pressure readings reflect the condition of the heart.

Diastolic

Diastolic readings indicate the constant pressure on the artery walls when the left ventricle of the heart relaxes.

Hypotension

Hypotension is the term used for low blood pressure and is considered abnormal. There is no specific reading at which blood pressure is considered too low. However, many physicians will investigate hypotension if the blood pressure reading is less than 100 mm Hg systolic and 60 mm Hg diastolic. Hypotension can be caused by rest, sleep, or shock. Additionally, hypotension can result from depressant drugs, excessive blood loss, and fasting. Orthostatic hypotension happens when blood vessels are unable to compensate for a quick change in position, such as from sitting to standing. Both the systolic and diastolic pressures drop suddenly, causing lightheadedness, dizziness, or blurred vision. This state usually lasts only a few seconds until the blood vessels adjust and push more blood to the brain.

Digital blood pressure monitors

Medical technology has afforded health care providers with equipment that makes obtaining and monitoring vital signs easier and less time-consuming. For example, many hospitals and healthcare delivery systems use digital sphygmomanometers, also called automatic or digital blood pressure monitors. These monitors do not require the use of a stethoscope. Digital blood pressure monitors come in a variety of types, including monitors that take a reading from a cuff on the upper arm. Other monitors may take readings on the wrist or finger. Even with the availability of digital blood pressure monitors, it is still important to learn how to read a manual cuff with an analog gauge. There are instances where using a manual cuff with an analog gauge is still preferable. For example, if a digital blood pressure cuff gives an error reading more than once, or if the reading shows the patient's blood pressure to be very low or very high, it should be assessed with a manual cuff. Manual readings are more accurate because you're listening for the sound of the pulse in conjunction with reading the gauge.

Pulse pressure

Pulse pressure is the difference between systolic and diastolic pressure. Pulse pressure is an important indicator of the health and tone of the arterial walls. Blood pressure is read and recorded in units called millimeters of Mercury (mm Hg). As with other vital signs, abnormal blood pressure can signal disease.

Blood pressure

Risks of high blood pressure include an increased risk of heart disease, stroke, and other serious health issues. High blood pressure, hypertension, is commonly called "the silent killer". The human body adjusts, in a process called homeostasis, to level out vital signs or other bodily functions. Because of this, many people won't experience any symptoms until the symptoms are uncontrolled. Examples of those symptoms include headache, dizziness, blurred vision, or nausea. Therefore, early detection is important. Blood pressure categories are as follows: - Normal: Less than 120/80 mm Hg - Elevated Blood Pressure: Systolic between 120-129 mm Hg and diastolic less than 80 mm Hg - Stage 1 Hypertension: Systolic between 130-139 mm Hg or diastolic between 80-89 mm Hg - Stage 2 Hypertension: Systolic at least 140 mm Hg or diastolic at least 90 mm Hg - Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg Careful documentation of blood pressure readings should be done before a treatment regimen for hypertension of any category is implemented. This includes at least two careful readings on at least two different occasions. Out-of-office blood pressure measurements, documented at home by the patient, should also be used to confirm diagnosis.

Systolic

Systolic readings indicate when the left ventricle of the heart contracts to push blood into the arteries.

Normal blood pressure

The average normal reading for adult systolic pressure is less than 120 mm Hg. The average normal reading for adult diastolic pressure is less than 80 mm Hg. Therefore, a normal calculation for pulse pressure is about 40 mm Hg. It is important to note that many factors may affect what is considered normal blood pressure for each patient.

Sphygmomanometer

The sphygmomanometer is the instrument used to measure blood pressure. There are several types of sphygmomanometers. Older sphygmomanometers contain mercury and are rarely used today. Aneroid sphygmomanometers use air to measure blood pressure. They are calibrated to mercury manometers, so they also measure blood pressure in millimeters of mercury. When using a manual sphygmomanometer, stethoscopes are also needed to take blood pressure.

Blood pressure factors

There are factors that can influence blood pressure readings. The force of the heartbeat is one factor. Another factor is the elasticity of the arteries. Elasticity is the ability of the arteries to return to normal size after being stretched by each pulsation of blood. Another factor that can influence blood pressure is the volume of the blood in the arteries. There are also factors that can change blood pressure readings. Different positions such as lying down, sitting, and standing can change blood pressure.

Hypertension

There are several risk factors that can lead to the development of hypertension. Some of those factors include diet, exercise, heredity, stress, drug abuse and smoking. The effects of hypertension are far-reaching and can result in other disorders such as heart attack, stroke, kidney disease, or other organ failure. Under the guidelines, people with elevated blood pressure and all stages of hypertension are encouraged to make lifestyle changes to manage the disease such as more exercise or eating a more heart-healthy diet. Treatment will depend on the stage the patient is diagnosed with, as well as other risk factors. Patients with Stage 1 who have no other diagnosis may be managed by diet and exercise alone. At Stage 2, doctors are more likely to prescribe anti-hypertensive medication in addition to diet and exercise changes. A hypertensive crisis requires immediate medical attention. Depending on the severity of the blood pressure reading and how easily the pressure is treated, the patient may need to be hospitalized.