Lab Manual: Blood Pressure

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Instruction Manual: Blood Pressure

HOW TO G ET AN ACCU RATE BLOOD PRESSU RE MEASU REMENT
Difficulty Level: Congratulations, you've taken the next step into being a successful Health Science student! The following manual will show you step-by-step on how to correctly measure blood pressure with an aneroid sphygmomanometer. Monitoring blood pressure is an essential part of any physical examination, and it provides vital information about your patient. This information can be used for a variety of things, such as, assessing health and cardiovascular risk factors and constructing of an exercise program. Don't worry, it won't take too long; Measuring blood pressure is a relatively simple procedure that takes about 10 minutes.

MATERIALS
(1.) Stethoscope

(2.) Sphygmomanometer

(3.) Stop watch (iPhone)

(4.) Measuring tape

(5.) Chair with arm rest area, in subsequent photos.

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BEFO RE YOU ST ART

Use caution when inflating the blood pressure cuff. Over inflation may lead to burst blood vessels and cause other severe injuries. o Ensure the cuff of the sphygmomanometer has a proper, comfortable fit on the participant. o Avoid smoking or drinking caffeine 30 minutes prior to measuring blood pressure.

INST RUC TIONS

STEP 1 Begin by having your subject sit quietly in a comfortable chair for 5 minutes. Insure that the chair has a back and an arm rest. Instruct your subject to relax as much as possible.

STEP 2 Position your subjects dominate arm at heart level for the 5 minute resting period.

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STEP 3 Use a measuring tape to measure the circumference of your subjects arm. This measurement will be used to select the proper size cuff for your subject. Measure the upper arm around its thickest part; about half way between the shoulder and elbow. Use the table below to find the appropriate cuff size for your subject.

PATIENT ADULTS (by arm circumference) 22 to 26 cm 27 to 34 cm 35 to 44 cm 45 to 52 cm CHILDREN (by age) Newborns and premature infants Infants Older children

CUFF SIZE

12 x 22 cm (small adult) 16 x 30 cm (adult) 16 x 36 cm (large adult) 16 x 42 cm (adult thigh)

4 x 8 cm 6 x 12 cm 9 x 18 cm

Figure 1. Recommended cuff size for accurate measurement of blood pressure . Adapted from Practice guidelines, in American Family Physicians, 2005. Retrieved from http://www.aafp.org/afp/2005/1001/p1391.html. Copyright 2005 by American Academy of Family Physicians. Adapted with permission.

STEP 4 Select the proper cuff. The cuffs air bladder should cover approximately 80% of the subjects arm. * The air bladder is a rubber bladder inside of the blood pressure cuff. When attached to the arm and inflated, the bladder applies pressure on the arm.

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STEP 5 Locate your subjects Brachial Artery. The Brachial artery is located in the center of the elbow crease. If not visible with the naked eye, feel for the artery by gently pressing the index finger into the elbow crease. * Imagine pressing on the side of a drinking straw that is lying flat on a table. When you feel that in your subjects arm, you have found their Brachial artery. You may mark the artery with a pen if that will assist you.

STEP 6 Attach the blood pressure cuff to your subjects arm. Use the indicator lines on the cuff to center the air bladder over the Brachial artery. The lower edge of the cuff should be approximately 1 inch (2.5 cm) above the elbow crease.

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STEP 7 Position the pressure gauge so that you can easily read the dial. Often times this is done by clipping the gauge to the outside of the cuff after the cuff has been positioned on the subject.

STEP 8 Put on your stethoscope.

STEP 9 Place the diaphragm of the stethoscope in the elbow crease over the brachial artery. * Apply firm pressure but DO NOT indent skin.

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STEP 10 Close the air release valve on the pressure pump by turning it clockwise until it no longer turns.

STEP 11 Instruct your subject to relax, remain quiet and not to move while you measure blood pressure.

STEP 12 Inflate the blood pressure cuff by squeezing the pressure pump until the pressure gauge reads 160 mm hg.

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STEP 13 When the pressure gauge reads 160 mm hg, slowly turn the pressure release valve counterclockwise to release the pressure. Release the pressure at a rate of 2 to 3 mm hg per second. Begin listening for thumping noises in the stethoscope. These noises will resemble the sound of a typical heart beat.

STEP 14 Watch the indicator on the pressure gauge fall; make mental note of the value indicated on the pressure gauge where you hear the first and last sounds. The first sound you hear will indicate systolic blood pressure. The last sound will indicate diastolic blood pressure. Continue listening until the pressure gauge falls another 10-20 mm hg after the last sound you hear. * Systolic blood pressure represents arterial pressure while the heart is contracting. Diastolic blood pressure represents arterial pressure while the heart is relaxing.

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STEP 15 Rapidly deflate blood pressure cuff by fully twisting the pressure release valve counterclockwise. Completely deflate the cuff.

STEP 16 Completely remove the blood pressure cuff.

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STEP 17 Have your subject rest quietly in the same comfortable position as in the initial resting period for 2 to 3 minutes.

STEP 18 Repeat steps 6 through 16. To assess resting blood pressure, two readings must be taken and averaged together.

STEP 19 Average the recorded values for each first and last sound. Add the two first sound values and divide by two. Add the two last sound values and divide by two. The numbers you calculate are the resting blood pressure. * See general blood pressure reading guidelines in Conclusions.

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CONSIDERATIONS
o One successful attempt does not mean you are a proficient tester. Proficiency and consistency in measurement comes only with thousands of trials. Remember, practice makes perfect! o After two or three measurement attempts, if no sounds are heard in the stethoscope upon inflating the cuff to 160 mm hg, deflate the cuff completely; re-inflate the cuff to 200 mm hg and continue the test as described. The absence of sound at 160 mm hg could be an indication of high blood pressure. o If there is a complete absence of sound or extremely muffled sound, re-adjust the position of the diaphragm on the stethoscope. Ensure the diaphragm is locked in place.

CONC LU SION
Once the average has been calculated, this represents the systolic and diastolic blood pressure. Use the following chart to stratify your subject's blood pressure. Your subject is now free to leave. Follow these instructions for each subsequent blood pressure test you administer.
Blood Pressure Category Normal Prehypertension High Blood Pressure (Hypertension) Stage 1 High Blood Pressure (Hypertension) Stage 2 Hypertensive Crisis (Emergency care needed) Systolic mm Hg (upper #) less than 120 120 139 140 159 160 or higher Higher than 180 and or or or or Diastolic mm Hg (lower #) less than 80 80 89 90 99 100 or higher Higher than 110

** This chart reflects blood pressure categories defined by the American Heart Association. Figure 2. AHA recommendations for a healthy blood pressure. Adapted from Understanding blood pressure readings, in American Heart Association, 2013. Retrieved from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understan ding-Blood-Pressure-Readings_UCM_301764_Article.jsp. Copyright 2013 by American Heart Association. Reprinted with permission.

The normal blood pressure measurement should be less than 120/80 mm Hg (less than 120 mm Hg systolic AND less than 80 mm Hg diastolic). If your subject's blood pressure readings is abnormal, higher or lower than the normal reading, advise him/her to a doctor.