Blood pressure

Question 1

Prepare the patient

Answer 1

• Make sure the patient is relaxed by allowing 5 minutes to relax before the first reading.
• patient should sit upright with their upper arm positioned so it is level with their heart and feet flat on the floor.
• Remove excess clothing that might interfere with the BP cuff or constrict blood flow in the arm.
• Be sure you and the patient refrain from talking during the reading.

Question 2

Choose the proper BP cuff size:

Answer 2

• Wrap the cuff around the patient’s arm and use the INDEX line to determine if the patient’s arm circumference falls within the RANGE area.
• Otherwise, choose the appropriate smaller or larger cuff.

Question 3

Place the BP cuff on the patient’s arm:

Answer 3

• Palpate/locate the brachial artery and position the BP cuff so that the ARTERY marker points to the brachial artery.
• Wrap the BP cuff snugly around the arm.

Question 4

Position the stethoscope

Answer 4

On the same arm that you placed the BP cuff, palpate the arm at the antecubical fossa (crease of the arm) to locate the strongest pulse sounds and place the bell of the stethoscope over the brachial artery at this location.

Question 5

Inflate the BP cuff

Answer 5

• Begin pumping the cuff bulb as you listen to the pulse sounds.
• When the BP cuff has inflated enough to stop blood flow you should hear no sounds through the stethoscope.
• The gauge should read 30 to 40 mmHg above the person’s normal BP reading.
• If this value is unknown you can inflate the cuff to 160 - 180 mmHg. (If pulse sounds are heard right away, inflate to a higher pressure.)

Question 6

Slowly Deflate the BP cuff:

Answer 6

• Begin deflation.
• The AHA recommends that the pressure should fall at 2 - 3 mmHg per second, anything faster may likely result in an inaccurate measurement.

Question 8

Listen for the Systolic Reading

Answer 8

• The first occurence of rhythmic sounds heard as blood begins to flow through the artery is the patient’s systolic pressure.
• This may resemble a tapping noise at first.

Question 9

Listen for the Diastolic Reading:

Answer 9

• Continue to listen as the BP cuff pressure drops and the sounds fade.
• Note the gauge reading when the rhythmic sounds stop.
• This will be the diastolic reading.

Question 10

Double Check for Accuracy

Answer 10

• The AHA recommends taking a reading with both arms and averaging the readings.
• To check the pressure again for accuracy wait about five minutes between readings.
• Typically, blood pressure is higher in the mornings and lower in the evenings.
• If the blood pressure reading is a concern or masked or white coat hypertension is suspected, a 24 hour blood pressure study may be required to assess the patient’s overall blood pressure profile.

Question 11

Physiotherapy caution

Answer 11

• Postural hypotension may occur and hence needs to checked prior to mobilisation someone who has been in bed.
• As the BP drops when the patient sits or stands up, leading to dizziness or fainting.
• Patients most often at risk when getting out of bed for the first time after a period of bed rest.
• If the patients BP is low, take extra care when getting them up and ensure you check it again and move slowly.

Question 12

Hypertension

Answer 12

> 140/90mm Hg
warrants a degree of caution with any active treatments or mobilisation.

Question 13

Capillary Refill Test CRT (Ref Broad et al 2012)

Answer 13

A quick test performed on the nail beds to monitor dehydration and the amount of blood flow to tissue.

Question 14

Purpose
CRT

Answer 14

This test is used to assess the amount of blood flow to the tissue and determine the patients tissue perfusion.

• If capillary refill is lower than expected then reduced cardiac output or impaired digital perfusion is suspected and should be investigated further by medical staff.

Question 15

CRT procedure

Answer 15

• This should be performed at the level of the heart
• Pressure is applied to the nail bed until it turns white, indicating that blood has been forced from the tissue (blanching)
• Once the tissue has blanched, pressure is removed
• The time taken for the tissue to return to normal colour is then recorded
• The tissue should normally take less than 2 seconds to return to its normal colour

Question 16

Findings CRT

Answer 16

A slow capillary refill time may indicate dehydration (hypovolaemia) hypothermia, peripheral vascular disease, or sepsis.

Question 17

CRT Why this is good to know:

Answer 17

• If the slow refill time is caused by dehydration the patient may potentially have dry tenacious secretions which will be difficult to expectorate.
• A fast capillary refill time may indicate over hydration, hypervolaemia this may also have an impact on physiotherapy if the patient shows other signs of fluid overload leading to pulmonary oedema.