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BLOOD PRESSURE
Blood pressure is one way to measure the condition of a patient's circulatory system. High blood pressure may indicate that the patient is susceptible to a stroke. Low blood pressure generally indicates one of various types of shock.
The blood pressure measurement consists of a reading of two numbers (for example, 120 over 80 millimeters of mercury). These numbers represent the pressures found in the arteries during the contraction and relaxation of the heart.
The upper number (120 in the blood pressure of 120/80) is called the systolic pressure. This measures the force exerted on the walls of the arteries during the contraction of the heart.
The bottom number (80 in the blood pressure of 120/80) is known as the diastolic pressure. This measures the arterial pressure during the relaxation phase of the heart.
NORMAL BLOOD PRESSURE
Blood pressure ranges vary greatly. Excitement or stress may raise a patient's blood pressure. Hypertension (high blood pressure) exists when the blood pressure is greater than 146/90 after repeated examinations over several weeks. Hypertension is a serious medical condition that requires treatment by a health care provider.
MoonDragon's Health & Wellness: Hypertension (High Blood Pressure)
Hypotension (severe low blood pressure) exists when systolic pressure (the first of the two measurements) falls to 90 or below. A patient with this condition is usually in serious trouble. Treatment of shock should be started immediately if the patient is also experiencing other signs of shock (for example, cold, clammy, and pale skin, or dizziness).
TAKING BLOOD PRESSURE BY AUSCULTATION
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. If the person has been injured, apply the cuff to an uninjured (or less injured) arm.
2. PLACE THE CUFF & FIND THE RADIAL PULSE: Apply the cuff snugly around the upper arm so that the bottoms of the cuff is just above the elbow. If the cuff has an arrow printed on it, this arrow should be placed over the brachial artery located on the inside of the arm. Then find the radial pulse on the arm to which the blood pressure cuff has been applied. The bottom of the cuff should be 1 to 2 inches above the elbow.
There are different sizes of blood pressure cuffs for adults, children and infants. Narrow cuffs are for taking children's blood pressures, and extra-large cuffs are for obese adults. Cuffs that are too small may give falsely high readings, and cuffs that are too large may give falsely low readings. Be sure to use a cuff of the correct size for your patient.
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 diaphragm 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. Using your index and middle fingers, hold the diaphragm snugly against the patient's arm. Do not use your thumb! If you use your thumb, you may hear your own heartbeat in the stethoscope.
3. INFLATE THE CUFF: Place the indicator dial (the gauge) in a position where you can easily see the movement of the indicator needle. Make certain that the adjustable valve is closed by turning the knob clockwise to close the valve. This knob is located on the bulb. With the bulb valve (thumb valve) closed, inflate the cuff by squeezing the bulb while watching the gauge and listening with the stethoscope. 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 2 to 4 mm per second. Carefully watch the indicator needle and listen for the start of clicking or tapping sounds of the pulse. 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 slowly deflate the cuff, listening for the point at which these distinctive sounds fade and disappear. 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 with the higher systolic measurement over the top of the lower diastolic measurement. For example, "BP is 140/90 at 1:10 PM." Blood pressure is reported in even numbers (for example, 120 over 84, 90 over 40, or 186 over 98). 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.
To become skilled in taking blood pressures, take every opportunity to practice on as many healthy, uninjured people as possible. Try to take blood pressures of both children and elderly patients; do not spend all your time with young, healthy adults. This practice will help prepare you to measure the blood pressure of a serious ill or injured person, if the situation arises.
RELATED MOONDRAGON LINKS
NOTIFY THE MIDWIFE OR HEALTH CARE PROVIDER IF...
The client/patient has high blood pressure and:
- The blood pressure is usually normal or well controlled but it suddenly goes well above the normal range on more than one occasion.
- The blood pressure is 180/110 mm Hg or higher.
- A sudden, severe headache occurs.
- The client/patient experiences chest pain (angina).
- Know the other symptoms of a heart attack.
- Know the symptoms of a stroke or transient ischemic attack (TIA).
Call the health care provider if:
- The blood pressure is 140/90 mm Hg or higher on two or more occasions (taken at home or in a community screening program). If one blood pressure measurement is high, have another reading taken by a health professional to verify the first reading. Many health care offices or clinics will take blood pressure measurements without charge or an appointment.
- The client/patient develops significant side effects from any medication they are taking for high blood pressure.
Adults are encouraged to have their blood pressure checked regularly. See schedule below:
This schedule shows how often you need to have your blood pressure checked, based on your initial blood pressure readings. Your health care provider or midwife may want to see you more frequently or set up a different schedule for your particular situation.
Recommended regular blood pressure checks by a health professional based on a person's initial blood pressure reading. If your initial blood pressure reading is:
Systolic (mm Hg) Diastolic (mm Hg) Then You Should: Below 130 Below 85 Recheck in 2 years. 130 to 139 85 to 89 Recheck in 1 year. 140 to 159 90 to 99 Recheck within 2 months. 160 to 179 100 to 109 Evaluate within 1 month. Over 180 Over 110 See a health professional immediately.
If the client/patient has high blood pressure, have them see their health care provider regularly to evaluate whether their treatment is working and to discuss any adjustments or side effects.
A diagnosis of hypertension is based on the average of two or more blood pressure readings taken at each of two or more visits after an initial screening.
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