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Year 1 OSCE > Manual Blood Pressure > Flashcards

Manual Blood Pressure Flashcards

1
Q

Q: What is the purpose of measuring arterial blood pressure?

A

A: To assess and monitor chronic conditions like hypertension and evaluate cardiovascular function during acute assessments.

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2
Q

Q: What are the main components of a sphygmomanometer?

A

A: A cuff with an inflation bladder, a measuring unit/gauge, and for manual devices, a bulb for inflation.

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3
Q

Q: Name the three main types of sphygmomanometers.

A

A: Mercury, aneroid, and electronic (oscillometric).

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4
Q

Q: Why are mercury sphygmomanometers no longer used in the UK?

A

A: Due to safety concerns, such as mercury spillages and disposal challenges.

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5
Q

Q: Why is selecting the correct cuff size important in BP measurement?

A

A: A cuff that is too small overestimates BP, while one that is too large underestimates it. The ideal bladder width is 40% of the upper arm circumference, and its length is 80–100% of the circumference.

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6
Q

Q: How should reusable and disposable cuffs be managed?

A

A: Reusable cuffs should be cleaned after each use following infection control policies, while disposable cuffs should be used as per local disposal guidelines.

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7
Q

Q: What is the purpose of the bell and diaphragm of a stethoscope?

A

A: The bell detects low-frequency sounds, while the diaphragm is suited for higher-frequency sounds and is most commonly used in BP measurement.

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8
Q

Q: What maintenance checks are crucial for BP equipment?

A

A: Ensure aneroid devices are calibrated, electronic devices are functional, and tubing has no leaks or cracks. Replace cuffs with worn-out hook-and-loop fasteners.

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9
Q

Q: What factors are essential for accurate BP measurement?

A

A: Correct technique, appropriate equipment, patient preparation, and consideration of factors like anxiety and recent exercise.

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10
Q

Q: When should a manual BP measurement be preferred?

A

A: If the pulse is irregular or if electronic cuffs do not fit patients, such as those with obesity.

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11
Q

Q: Why are disposable cuffs used in some clinical areas?

A

A: To reduce the risk of cross-infection, especially in high-risk settings.

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12
Q

Q: What are the limitations of electronic BP devices?

A

A: They may be less accurate for patients with low BP, arrhythmias, or muscle tremors.

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13
Q

Q: What is the difference between direct and indirect BP measurement?

A

A: Direct measurement uses an arterial cannula and is used in critical care, while indirect measurement uses a sphygmomanometer.

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14
Q

Q: What are range markers, and why are they used?

A

A: Range markers help estimate cuff sizing quickly in clinical settings by indicating if a cuff is too small or too large.

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15
Q

Q: What is the recommended rate of cuff deflation during BP measurement?

A

A: Approximately 2 mmHg per second.

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16
Q

Q: How should a stethoscope be cleaned?

A

A: Use an alcohol-based cleaner before and after patient use, following infection prevention policies.

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17
Q

Q: What is the recommended position of the patient during BP measurement?

A

A: The patient should sit with their back supported, feet flat on the floor, arm supported at heart level, and avoid talking.

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18
Q

Q: Why should the patient rest before measuring BP?

A

A: To ensure accurate readings, patients should rest for at least 5 minutes to stabilize their cardiovascular state.

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19
Q

Q: What environmental factors should be controlled during BP measurement?

A

A: Ensure a quiet environment and avoid sources of noise that could interfere with auscultation.

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20
Q

Q: Why is it recommended to measure BP in both arms initially?

A

A: To detect significant differences; the higher reading should guide treatment decisions.

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21
Q

Q: How should repeated BP measurements be conducted?

A

A: Allow at least 1 minute between readings to let blood flow normalize.

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22
Q

Q: How should BP measurement be adjusted for patients with irregular pulses?

A

A: Use a manual sphygmomanometer for better accuracy, as electronic devices may provide unreliable readings.

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23
Q

Q: What common errors can lead to inaccurate BP readings?

A

A: Errors include incorrect cuff size, rapid deflation of the cuff, or improper arm positioning.

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24
Q

Q: What details should be documented after BP measurement?

A

A: Record the systolic and diastolic values, arm used, patient position, and any relevant observations (e.g., irregular pulse).

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25
Q: Why is regular calibration of BP equipment necessary?
A: To ensure accuracy and reliability of the readings, especially for aneroid and electronic devices.
26
Q: What factors can cause variations in blood pressure throughout the day?
A: Activity levels, mental state, behavior, exercise, sleep, emotional arousal, stress, and ingestion of stimulants (e.g., smoking or caffeine).
27
Q: How does posture affect blood pressure readings?
A: Systolic BP is typically lower when standing or sitting compared to a supine position due to the arm's position relative to the heart.
28
Q: Why is patient behaviour important during BP measurement?
A: Talking during measurement can increase BP and hinder accurate auscultation. Both the patient and healthcare professional should remain quiet.
29
Q: What preparation steps should a patient follow before a BP measurement?
A: Avoid exercise, eating, smoking, or caffeine 30 minutes prior, empty the bladder, rest for 3-5 minutes, sit with back supported and feet flat, and avoid crossed ankles.
30
Q: Why is it important to measure BP in both arms initially?
A: To detect hypertension accurately and identify consistent differences, as >10 mmHg differences may indicate cardiovascular risk, and >20 mmHg may signal arterial disease.
31
Q: How should the patient's arm be positioned during BP measurement?
A: The arm should be supported at heart level (midsternal), not higher or lower. A pillow or desk can be used for support depending on the patient's position.
32
Q: Which conditions make an arm unsuitable for BP measurement?
A: Presence of an arteriovenous fistula, venous cannula, PICC line, lymphoedema, mastectomy, wound, cast, dressing, or weakness/hemiparesis after a stroke.
33
Q: What are important environmental considerations during BP measurement?
A: The environment should be quiet and relaxed. The patient and healthcare professional should not talk during the measurement.
34
Q: How does arm muscle tension impact BP measurement?
A: Muscle contraction raises BP, leading to inaccurate results. The arm must be fully relaxed and supported.
35
Q: What should be done if neither arm is suitable for BP measurement?
Use the patient's leg
36
Q: Why is obtaining informed consent important before measuring BP?
A: It ensures the patient understands the procedure and agrees to it, aligning with healthcare policies and ethical standards.
37
Q: Why should sleeves not be rolled up during BP measurement?
A: Rolling up sleeves can create a tourniquet effect, restricting blood flow and leading to inaccurate BP readings.
38
Q: How does the timing of BP measurement affect the results?
A: BP varies throughout the day; measuring at consistent times is important for accurate monitoring and comparison.
39
Q: How should the arm be supported during standing BP measurements?
A: The arm can hang relaxed by the patient's side, but a healthcare professional may need to provide support to ensure accurate readings.
40
Q: When should BP measurement be deferred due to recent activities?
A: If the patient has exercised, eaten, smoked, or consumed caffeine within the last 30 minutes, defer measurement if clinically appropriate.
41
Q: What are the three methods for measuring blood pressure?
A: Direct measurement via an arterial cannula. Indirect measurement using an electronic device. Indirect measurement using auscultation and an aneroid device.
42
Q: Why should healthcare professionals be proficient in manual BP measurement?
A: Manual BP is necessary when electronic devices are inaccurate, such as in patients with irregular pulses or hypotension, and to verify questionable readings.
43
Q: What equipment is needed for manual BP measurement?
A: An aneroid device, an appropriately sized arm cuff, and a stethoscope.
44
Q: What are Korotkoff sounds and their significance?
A: Korotkoff sounds are tapping, thudding, or ticking sounds heard as blood flows through a partially occluded artery. K1: First tapping sound = Systolic pressure K5: Disappearance of sound = Diastolic pressure
45
Q: How is the systolic pressure estimated before taking a manual BP?
A: Inflate the cuff while palpating the artery and note when the pulse disappears. Inflate the cuff 30 mmHg above this point for accurate measurement.
46
Q: How should the BP cuff be positioned on the arm?
A: The cuff should be 2–3 cm above the antecubital fossa, with the bladder centered over the brachial artery.
47
Q: What is the auscultatory gap, and why is it important?
A: It is a temporary disappearance of Korotkoff sounds between K2 and K3, which can lead to underestimation of systolic or overestimation of diastolic pressure.
48
Q: How should the cuff be deflated during BP measurement?
A: Slowly at 2–3 mmHg per second while listening for Korotkoff sounds.
49
Q: What is terminal digit bias in BP measurement?
A: The tendency to round BP readings to the nearest 5 or 10. Guidelines recommend recording to the nearest even number.
50
Q: How should repeat BP measurements be conducted for hypertension diagnosis?
A: Take two readings; if abnormal, take a third. Record the average of the last two readings, with at least 1 minute between readings.
51
Q: How do you measure BP in the leg if the arms are unsuitable?
A: Use a correctly sized thigh or calf cuff while the patient is supine. Palpate the popliteal or dorsalis pedis artery. Doppler may be used if auscultation is difficult.
52
Q: Why is accurate documentation important in BP measurement?
A: To prevent errors, reflect accurate patient status, and escalate care if necessary. Record findings immediately and include any unusual circumstances.
53
Q: What infection control measures should be taken before and after measuring BP?
A: Wash hands with soap and water or use an alcohol-based sanitizer before and after the procedure. Decontaminate all equipment according to local policy.
54
Q: How should the stethoscope be used correctly during manual BP measurement?
A: Insert earbuds angled forward toward the nose and select the diaphragm. Tap gently to ensure sound is detected; if not, rotate the head 180 degrees.
55
Q: How can you ensure the BP cuff fits correctly?
A: The cuff should be snug but not tight: one finger should slide under it easily, but two fingers should feel tight.
56
Q: How does ankle BP differ from arm BP, and why is this important?
A: Systolic BP is typically 17 mmHg higher at the ankle than the arm, while diastolic pressure remains the same. This difference must be considered when interpreting results.
57
Q: What is postural (orthostatic) hypotension?
A: A condition where systolic pressure falls by >20 mmHg or diastolic pressure falls by >10 mmHg after standing for at least 1 minute. It can also occur if systolic BP falls below 90 mmHg.
58
Q: What are the common symptoms of postural hypotension?
A: Dizziness, lightheadedness, blurred vision, weakness, confusion, and transient loss of consciousness. It increases the risk of falls.
59
Q: What is the recommended equipment for measuring lying and standing BP?
A: A stand-mounted aneroid sphygmomanometer, though electronic devices can be used cautiously if the pulse is regular.
60
Q: What preparatory steps should be taken before measuring lying and standing BP?
A: 1. Explain the procedure and obtain consent. 2. Ensure equipment is clean and calibrated. 3. Have the patient lie down for at least 5 minutes in a relaxed environment. 4. Ensure the arm is free of tight clothing. 5. Suggest the patient empties their bladder.
61
Q: What physiological mechanisms prevent postural hypotension in healthy individuals?
A: Baroreceptors in the aortic arch and carotid arteries detect a fall in BP, activating the sympathetic nervous system, hormonal, and renal responses to restore BP.
62
Q: How should BP readings be documented for lying and standing positions?
A: Clearly record lying and standing BP readings at 1-minute intervals (and 3 minutes if necessary), noting any symptoms. Inform appropriate staff if results indicate postural hypotension.
63
Q: Why might electronic devices provide inaccurate BP readings in some cases?
A: They may not be accurate if the patient has an irregular pulse. In such cases, manual measurement is preferred.
64
Q: How should BP be measured after the patient stands?
A: Measure BP at 1 minute and 3 minutes after standing, repeating until readings stabilize. Provide assistance if the patient is unsteady or symptomatic.
65
Q: What actions should be taken if a patient develops symptoms during standing BP measurement?
A: Return the patient to a lying or sitting position immediately and report the findings.
66
Q: What safety precautions should be taken during standing BP measurement?
A: Observe the patient closely for dizziness or unsteadiness, and ensure their arm remains relaxed without muscle tension.
67
Q: What should you do if the patient steadies themselves with the arm being measured?
A: Avoid using that arm for BP measurement, as muscle tension can cause inaccurate readings.
68
Q: What causes the fall in blood pressure when moving to a standing position?
A: Blood pools in the lower extremities due to gravity, reducing venous return to the heart, which lowers cardiac output and BP.
69
Q: Which medications can contribute to postural hypotension?
A: Medications such as beta-blockers, ACE inhibitors, and diuretics can cause or worsen postural hypotension.
70
Q: Why is patient monitoring important during lying and standing BP measurement?
A: Monitoring ensures early detection of symptoms like pallor, confusion, or fainting, allowing timely intervention to maintain safety.
71
Q: What precautions should be taken when using electronic devices for standing BP measurement?
A: Ensure the device’s inflation time does not interfere with timing the BP reading at 1 minute after standing. Avoid muscle tension in the measured arm.
72
Q: What are the thresholds for reporting postural hypotension findings?
A: Report if systolic BP falls by >20 mmHg, diastolic BP by >10 mmHg, or systolic BP drops below 90 mmHg. Also, report any significant symptoms like dizziness.

Year 1 OSCE (17 decks)

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