Blood pressure article

Question 1

_______blood pressure measurement is one of the most frequently and in so many cases, most poorly performed healthcare procedure.

Answer 1

Indirect

Question 2

Blood pressure should be measured in both arms at the first visit; the higher arm should then be used as the reference blood pressure

Question 3

Virtually all epidemiological data used to determined hypertension, referral, and treatment guidelines are based on blood pressures taken by trained observers using the standardized blood pressure technique recommended by the American Heart Association

Question 4

A _______________manometer, the “gold standard” for indirect blood pressure measurement

Answer 4

mercury

Question 5

Indirect blood pressure measurement (BP) is safe, is relatively painless, and provides reliable information when performed accurately. Virtually all the epidemiological data used to determine hypertension, detection, referral, and treatment guidelines are based on BPs obtained by the American Heart Association (AHA) standardized indirect measurement method.

Question 6

Because high BP is almost always “silent” (without symptoms) diagnosis and treatment hinge on accurate BP measurements. The proven benefits of treating high BP can be accomplished only if health professionals are measuring BP accurately.Crucial clinical decisions are based on these measurements.

Question 7

Accurate BP measurement requires the ability to hear, interpret, and record Korotkoff (K) sounds; good eye-to-hand coordination for equipment operation; and the ability to perform the steps outlined below.

Question 8

Failure to practice correct technique and the use of inaccurate equipment are the major reasons for inaccurate BP determinations. Standardized curricula have been developed to ensure mastery of this critical healthcare skill.

Question 9

The aneroid manometer consists of a metal below that expands as the pressure in the cuff increases and is read at the point indicated by a needle on its dial. It is fragile and easily damaged. Users cannot be certain that it is accurate even when the needle is positioned at zero. Therefore, it is necessary to use a “Y” connector to compare the aneroid device to an accurate mercury manometer at least every ______months

Answer 9

6

Question 10

Selecting and caring for BP Measurement and Equipment

The ______________is either a mercury or an aneroid instrument calibrated to the nearest 2mm Hg. The mercury manometer is read at the top edge (meniscus) of the mercury column. It is considered the gold standard measurement because it is the most accurate device available

Answer 10

manometer

Question 11

Calibration is required when the readings differ from the standard mercury manometer by 3mm Hg.

Question 12

The stethoscope head should have a low-frequency detector or _______for listening to the low-pitched sounds. Ear pieces should fit comfortably forward in the direction of the ear canal and block out external noise.

Answer 12

bell

Question 13

For best sound transmission, the tubing should be no longer than 15 inches.

Question 14

Automated BP Measurement Devices

Before using any automated BP instrument, you must document the accuracy of its pressure-registering system (Y tube to mercury device). Then simultaneously compare digital and mercury readings on the patient, because automated devices fail to give accurate readings on many individuals.

Question 15

The use of automated devices is discouraged in most clinical settings.

Question 16

Steps Needed to Obtain Accurate and Reliable Readings
Step 1. Environment

The setting should be private and quiet, with a comfortable room temperature

Question 17

Rationale. To get the best estimate of the patient’s usual BP, you must control for environmental factors that may cause BP variation or interfere with hearing Korotkoff sounds. The manometer must be positioned so the observer can view it at _________ level

Answer 17

eye

Question 18

Rationale. Viewing the manometer above or below the observer’s eye level results in _____________readings

Answer 18

inaccurate

Question 19

The room should have a straight-backed chair next to a table for the patient, a seat for the BP observer, and an adjustable surface to support the arm at heart level during standing measurements. The height of the table should be such that the midpoint of the cuff when in place on the patient’s right arm is supported at heart level, that is approximately at the level of the fourth intercostal space (at the sternum) in the seated position or at the level of the midaxillary line in the supine position.

Question 20

Achieving heart level may require using a cushion to increase the height of the patient in the chair or using an object (such as a book) to support the arm at the correct level.

Question 21

Step 1.

Rationale. Avoids errors induced by differences in hydrostatic pressure btwn the point of artery compression by the cuff and the heart.

Question 22

If the center of the cuff on the arm or leg is above the heart level, the reading will be falsely low by 0.8mm Hg for each 1 cm above the heart level.

Question 23

If below heart level, it will be falsely high by a similar amount. Supporting the back in the seated position and the arm in any position avoids increases in BP due to isometric muscle contraction.

Question 24

Inquire about biological factors that may affect the reading at this time, including the ________ and ________ of medications. If not wearing short, loose sleeves,patients should bare their arm(s). Explain the procedure and that you will take at least 2 readings

Answer 24

time and dose

Question 25

Rationale To get the best estimate of the patient’s usual BP, you must control for biological factors that may cause BP variation at this time: _______,_________,full urinary bladder, recent meal, prescription, over the counter, and street drugs, as well caffeine and nicotine

Answer 25

pain,stress

Question 26

Clothing interferes with cuff placement,pressure, and sound transmission. Prepares patient and avoids elevated readings due to anxiety about the procedure and repeated readings.

Question 27

Instruct patients to sit up straight with legs uncrossed, back resting against the chair, and feet flat on the floor, and to remain silent until you finish taking the BP readings, after which you will answer their questions. Allow a 5 minute rest period before the first reading.

Question 28

Rationale. The lack of back and foot support, such as occurs when the patient is seated on an examination table causes BP elevation averaging 5mm HG diastolic. Talking or active listening during measurement causes BP elevation.

Question 29

Step 3. Proper Cuff (Bladder) Size

To get an accurate reading, the width of the cuff bladder should encircle at least __________ of the arm circumference and the length at least 80%. At first visit , measure circumference at the midpoint of the upper arm, between the olecranon and acromion processes. Arms >53cm in circumference should have the BP measured with a cuff of the appropriate size on the forearm. When arm circumference measurement is not practical, as during screening situations, it is acceptable to estimate the proper cuff size by comparing the bladder width and length to arm circumference

Answer 29

40%

Question 30

When BP is not measured in both arms, the reading should be taken in the right arm unless it is known that BP in the left arm is higher. Note the appropriate cuff/bladder size on each chart.

Question 31

Aneroid instrument being tested by inserting a Y-tube connector or stopcock to create a communicating system with one pressure source. Allows simultaneous pressure application to both instruments.

Question 32

Rationale. Using a bladder that is too narrow or short for the limb is a common error that is serious because it yields false high readings. Diseases that cause BP differences between the arms are much more likely to cause a falsely low BP in the left arm.