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1. Prepare. The patient (or client) should be seated or lying down. If the patient has not been injured in an accident, support her arm at the level of her heart.
Placing the BP cuff on the arm.
2. Place the cuff and find the radial pulse. Apply the cuff snugly around the upper arm so that the bottoms of the cuff is just above the elbow. With your fingertips, palpate the brachial artery at the crease of the elbow. Place the ear pieces of the stethoscope in your ears (the ear pieces should be pointing forward in the direction of your ear canals). Position the diaphragn of the stethoscope directly over the brachial pulse or over the medial anterior elbow (front of the elbow) if no brachial pulse can be found. Do not place the head of the stethoscope underneath the cuff, since this will give you false readings.
Measuring blood pressure by ausculation.
3. Inflate the cuff. With the bulb valve (thumb valve) closed, inflate the cuff, watching the gauge. At a certain point, you will no longer hear the brachial pulse. Continue to inflate the cuff until the gauge reads 30 mm of mercury higher than the point where the pulse sound disappeared.
4. Obtain the systolic pressure. Slowly release air from the cuff by opening the bulb valve, allowing the pressure to fall smoothly at the rate of approximately 5 to 10 mm per second. Listen for the start of clicking or tapping sounds. When you hear the first of these sounds, note the reading on the gauge. This is the systolic pressure.
5. Obtain the diastolic pressure. Continue to deflate the cuff, listening for the point at which these distinctive sounds fade. When the sounds turn to dull, muffled thuds, the reading on the gauge is the diastolic pressure. Sometimes you will not be able to hear a change in these sounds. When this happens, the point at which the sounds disappear is the diastolic pressure.
6. Record measurements. After obtaining the diastolic pressure, let the cuff deflate rapidly. Record the measurements and the time of determination. For example, "BP is 140/90 at 1:10 P.M.." Blood pressure is reported in even numbers. If a reading is between two lines on the gauge, use the higher number.
If you are not certain of a reading, repeat the procedure. You should use the other arm or wait one minute before re-inflating the cuff. Otherwise, you will tend to obtain an erroneously high reading. If you are still not sure of the reading you are getting, try again or get some help. Never make up vital signs!
A blood pressure can be obtained on patients (clients) more than 3 years old. Blood pressures on infants and children younger than 3 years are difficult to obtain with any accuracy outside of a health care institution. In the field, client's home, or midwife's or health care provider's office, you can get more helpful information about the condition of an infant or very young child by observing for conditions such as a sick appearance, respiratory distress, or unconsciousness.
Vital signs are usually taken more than once. How frequently they should be repeated depends on the condition of the patient and the patient care interventions you are performing. Stable patients need repeat vital signs at least every 15 minutes. Unstable patients need repeat vital signs at least every 5 minutes. You should also repeat vital signs after every medical intervention. Record every reading of the vital signs.
Taking systolic blood pressure (BP) by palpation.
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