Palpate a patient's pulse to determine circulation distal to the pulse site and for rhythm, quality, and strength.

Is
it normal, weak or thready, full or bounding, or absent?

Perform hand hygiene before and after patient care and document your findings on the appropriate flow sheet
or record.

When documenting blood pressure, record the systolic number first, followed by a slash and the diastolic
number, as in 120/80. The difference between the systolic and diastolic values is called the pulse pressure. This

number is usually between 30 and 50 mm Hg and provides information about a patients cardiac function and
blood volume.

How often you measure blood pressure varies from patient to patient. For critically ill patients, it might be every
5 to 15 minutes around the clock. For stable patients, you might only measure blood pressure every 4 or 8
hours or even less often.

When a patient's blood pressure is outside the normal range, further evaluation is often necessary. A blood
pressure with a systolic of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher is considered
high, although for patients with certain chronic conditions, like coronary artery disease, the guidelines vary. In
any case, a single high reading does not automatically mean that a patient has hypertension. Hypertension is
commonly diagnosed after a patient has had two or more high readings at two or more visits after the initial
blood-pressure measurement. Some patients can control hypertension with diet and exercise alone, but many
must take antihypertensive medication.

A blood pressure with a systolic reading below 90 mm Hg or a diastolic reading below 60 mm Hg is usually
considered hypotension. Some patients with low blood pressure experience no problems. Others report feeling
dizzy or lightheaded with position changes. Orthostatic hypotension is a term used when systolic pressure drops
more than 20 mm Hg or the pulse increases by 20 beats per minute or more when the patient moves from a
recumbent to a standing position. Orthostatic hypotension is often related to a decrease in blood volume,
prolonged bed rest, older age, and medications.

Lower-extremities blood pressure

If you cannot measure a patients blood pressure on the upper extremities, use the lower extremities. You might
also measure blood pressure on a lower extremity if an arm pressure in an adolescent or young adult seems
unusually high. If the patient has coarctation of the aorta, a congenital heart defect, the arm blood pressure will
be higher than the leg pressure.

Two areas on the leg where you can measure blood pressure are the thigh just above the knee, using the
popliteal pulse, and the calf just above the ankle, using the posterior tibial pulse. The systolic reading in the
thigh is usually 10 to 40 mm Hg higher than in the arm, and the diastolic number usually remains the same.

Remove the patients clothing to expose the leg, and be sure to use the appropriate-size blood-pressure cuff to
ensure an accurate reading. Wrap the cuff evenly and snugly around the leg about 1 inch, or 2.5 centimeters,
above the knee or ankle. Place the bell or diaphragm of your stethoscope over the pulse and inflate the cuff
quickly to 30 mm Hg above the patients usual systolic blood pressure. Then slowly deflate the cuff at a rate of
2 to 3 mm Hg per second. The first sound you hear is the systolic pressure and silence denotes the diastolic
pressure.
Document the blood-pressure reading on the appropriate flow sheet and indicate the site of the measurement.
Also note the size of the cuff if it is different from the standard adult cuff.

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