Practical Nursing

Diploma Program
Nursing Skills Lab 1

Blood Pressure
Week 12
 Blood Pressure
The force of the blood against arterial walls
Systolic Pressure
 The highest point of pressure on arterial walls
when the ventricles contract
 Diastolic Pressure

 The lowest pressure present on arterial walls as

ventricles relax

Read as systolic number ‘over’ diastolic number

Factors Affecting Blood
Pressure Reading
 Age- walls of arteries are less elastic-increases peripheral
resistance, ^ B/P
 Exercise- ^ systolic pressure
 Race-hypertension more common in African American
 Weight-B/P can be higher in overweight
 Emotional state-anger, fear, pain, excitement ^ B/P
 Smoking-vasoconstriction, ^ B/P
 Medications-oral contraceptives may ^ B/P,
antihypertensives lower B/P
 Ranges of Blood Pressure
[525]
 Optimal= <120/80
 Normal=< 130/85
 High Normal=130-139 over 85-89
 Grade 1 Hypertension (mild) 140-159/90-99
 Grade 2 “ (moderate) 160-179/100-109
 Grade 3 “ (severe) >180/110

Hypotension=90-115 for systolic

 may be normal for some but may be due to blood
loss or medication effects
Orthostatic./ Postural Hypotension
 change in position leads to low BP.
 caused by medications, prolonged bed rest,
loss of blood

Korotkoff Sounds
Sounds you hear when taking a blood
pressure as blood can flow through the
compressed artery. Listen and make note
when they start, change tone, and quickly
stop
Measuring Blood Pressure
 Blood Pressure is measured in millimeters of
mercury (mm Hg)
 Blood Pressure is recorded as a fraction:

The numerator is the systolic pressure

The denominator is the diastolic pressure
Pulse Pressure
 The difference between the systolic and
diastolic pressure ie. systolic – diastolic =
pulse pressure
Methods of Assessing the
Blood Pressure
 Use a stethoscope and sphygmomanometer

 Use a Doppler ultrasound

 Estimate by palpation

 Assess with electronic or automated devices

How to Ensure an Accurate
Blood Pressure Reading
 Ensure equipment is in good working order
 Always use a cuff that is the correct size for
the patient- if too narrow-reading may be
high, if too wide, reading may be low
 Ensure accurate limb placement
 Use recommended deflation rate
 Correctly interpret the sounds heard
ie. LOOK, LISTEN, FEEL
Cuff width 2/3 of arm length
Continued..
 Stethoscope- used to auscultate ie. listen
 Sphygmomanometer and cuff (different
sizes) + manometer ie. mercury or aneroid
 Ensure reading starts at 0
 If using mercury manometer make sure
you read at eye level
 Always read at top of meniscus
• Do not take the B/P on an arm:
• with an IV, on the side of a mastectomy,
weak arm from stroke, casted/injured arm
Assessing Brachial B/P
 Select the appropriate arm for application of the
cuff
 Have the patient assume a comfortable lying or
sitting position with the forearm supported at the
level of the heart and the palm of the hand
upward
 Expose the brachial artery by removing
garments, or move a sleeve, if it is not too tight,
above the area where the cuff will be placed
 Palpate the location of the brachial artery
 Wrap the cuff around the arm smoothly and snugly,
and fasten it. Do not allow any clothing to interfere
with the proper placement of the cuff (1-2” above inner
aspect)
 Palpate the pulse at the brachial or radial artery by
pressing gently with the fingertips
 Tighten the screw valve on the air pump
 Inflate the cuff while continuing to palpate the artery.
Note the point on the gauge where the pulse
disappears
 Totally deflate the cuff and wait 15 seconds
 Place the bell or diaphragm of the stethoscope
firmly but with as little pressure as possible over
the brachial artery
 Pump the pressure 30 mm Hg above the point
at which the systolic pressure was palpated and
estimated. Open the valve on the manometer
and allow air to escape slowly; allowing the
gauge to drop 2–3 mm per heartbeat
 Note the point on the gauge at which the
first faint, but clear, sound appears that
slowly increases in intensity. Note this
number as the systolic pressure
 Read this pressure to the closest even number
 Do not re-inflate the cuff once the air is being
released to recheck the systolic pressure
reading.
 Note the pressure at which the sound first
becomes muffled/disappears. This is the
diastolic pressure
 Open the valve and let remaining air to
escape quickly. Repeat any suspicious
reading, but always wait 30 to 60 seconds
between readings to allow normal circulation
to return to the limb. Deflate the cuff
completely between attempts to check the
Other Methods to Determine
Blood Pressure
 Popliteal Artery Blood Pressure-usually 10-
40 higher

• Patient to assume the prone position

• Use an appropriate size cuff

• Place cuff on thigh above popliteal artery

• Same procedure as for assessing brachial blood

pressure
• Estimating by Palpation

• Only need a sphygmomanometer

• Pump up cuff same as for brachial blood

pressure assessment but using your fingers
you feel for the return of pulse

• You only get a systolic reading

• Doppler/Ultrasound amplifies sounds

 Electronic or Automated Devices

• Determines Blood Pressure by monitoring

vibrations
• Still need to remember to check equipment
• Place cuff in correct position
• Ensure to use correct size cuff
• Check with brachial manual blood pressure
to confirm accuracy of automated device
Nursing Skills Lab 1
 Week 13

• Topical Medications

• Please review the 3 checks and 6

rights of medication preparation
and administration prior to this Lab