Blood Pressure Measurement

Question 1

What equipment do you need to gather for the blood pressure measurement?

Answer 1

• Stethoscope
• Sphygmomanometer: ensure you have an appropriately sized cuff. A cuff that’s too small may overestimate BP and a cuff that’s too large will underestimate BP.

Question 2

What should you do in the introduction?

Answer 2

• Wash hands and PEE
• Introduced yourself
• Confirm patients details
• Explain what you’re going to do
• Gain consent
• Position the patient sitting on a chair with arm at heart level
• Check if the patient has a preference on which arm to use
• Ask patient to adequately expose their arm
• Check if they have any pain

Question 3

How would you describe the blood pressure procedure in patient-friendly language?

Answer 3

Today I would like to measure your blood pressure, this will involve inflating a cuff around your arm whilst listening to your pulse with my stethoscope. The procedure shouldn’t be painful, but it may feel a little uncomfortable when the cuff is fully inflated and you might experience some pins and needles in your hand. If at any point you want me to stop, just let me know.”

Question 4

How do you attach the blood pressure cuff?

Answer 4

1. Check that the blood pressure cuff is appropriate for the patient’s arm and that it is fully deflated
2. Confirm the location of the brachial artery
3. Wrap the blood pressure cuff around the patient’s upper arm, lining the cuff marker with the brachial artery

Question 5

What is next in the blood pressure measurement after attaching the cuff?

Answer 5

To begin with, you need to determine approximate systolic blood pressure.

1. Ensure the valve is closed
2. Palpate the radial pulse
3. Inflate the blood pressure cuff until you can no longer feel the patients radial pulse and not the measurement when this happens on the sphygmomanometer
4. Open valve and deflate the blood pressure cuff

Question 6

What is next after measuring an estimated recording?

Answer 6

An accurate assessment:
1. Close the valve on the blood pressure cuff.

2. Position the diaphragm of your stethoscope over the brachial artery.
3. Re-inflate the cuff 20-30 mmHg above the systolic blood pressure you previously estimated.
4. Then slowly deflate the cuff at around 2-3 mmHg per second.
5. Using your stethoscope, listen carefully for the onset of a pulsatile noise. The first of these pulsatile noises is known as the first Korotkoff sound. The pressure at which the first Korotkoff sound becomes audible represents the patient’s systolic blood pressure.
6. Continue to deflate the cuff, whilst listening through your stethoscope until the pulsatile sound completely disappears. The final pulsatile noise you hear is known as the fifth Korotkoff sound and represents the patient’s diastolic blood pressure.

Question 7

When should you repeat the assessment?

Answer 7

If the patient’s blood pressure is outside of the normal range

Also repeating in the patients other arm

Question 8

What abnormalities could you find?

Answer 8

Hypertension: blood pressure of greater than or equal to 140/90 mmHg if under 80 years old or greater than or equal to 150/90 mmHg if you’re over 80 years old.

Hypotension: blood pressure of less than 90/60 mmHg.

Narrow pulse pressure: less than 25 mmHg of difference between the systolic and diastolic blood pressure. Causes include aortic stenosis, congestive heart failure and cardiac tamponade.

Wide pulse pressure: more than 100 mmHg of difference between systolic and diastolic blood pressure. Causes include aortic regurgitation and aortic dissection.

Difference between arms: more than 20 mmHg difference in blood pressure between each arm is abnormal and may suggest aortic dissection.