DEMONSTRATION

ON
TAKING BLOOD PRESSURE

Submitted To Submitted By
Madam Mousumi Hembram Priti Dinda

Senior Lecturer M.sc Nursing 1st Year

College of Nursing College of Nursing
Medical College and Medical College and
Hospital, Kolkata Hospital, Kolkata
INTRODUCTION:
Blood Pressure is the fourth Vital sign and extremely important one. By measuring blood pressure, we can
get to assess the cardiovascular system in very basic form. Any underlying disease/pathology of
cardiovascular system if present must tend to reflects in one’s blood pressure.
The magnitude of BP is directly related to the Cardiac Output and the Systemic vascular resistance.
It can be used for diagnosis and treatment of the patient.

DEFINITION:
Blood pressure refers to the force exerted by the blood against a vessel wall. Maximum blood pressure is
exerted on the walls of the arteries during ventricular contractions, when blood is pushed to aorta through
aortic valve. This is called systolic pressure. The lowest pressure exerted on the arterial wall during
ventricular relaxation is called diastolic pressure. The difference between the systolic and diastolic pressures
is called pulse pressure. The normal blood pressure in an adult is 120/80 mm of Hg. and pulse pressure is 40
mm of Hg. Blood pressure reaching above 150/90 mm of Hg is termed as hypertension. If the reading is
below 90/60 mm of Hg it is termed as hypotension.

PURPOSES:
• To get a base line data for diagnosis and comparing the readings in future.
• To check the response to the medical therapy.
• To evaluate the hemodynamic status of the patient.
• To monitor the cardiovascular system preoperatively and postoperatively.

Regulation of Blood Pressure

• Hemodynamic factor:

These are like cardiac output, blood volume, peripheral vascular resistance and blood viscosity. The
factors that increase or decrease the blood pressure are listed below:

Increases Blood Pressure Decreases Blood Pressure

Increased cardiac output decreased cardiac output

Increased peripheral vascular resistance decreased peripheral vascular resistance

Increased blood volume decreased blood volume

Increased blood viscosity decreased blood viscosity

Other factors affecting blood pressure
Age –
The blood pressure is lowest at birth, rising at adolescent and slightly decreases with ageing. But due to
increased peripheral resistance the blood pressure increases in the elderly. Average blood pressure according
to age:

Age Blood Pressure

New born 40 mm of Hg
1 month 85/54 mm of Hg
1 year 95/65 mm of Hg
6 years 105/65 mm of Hg
10-14 years 110/65 mm of Hg
14years and above 120/80 mm of Hg

Time of the Day: Blood pressure is low in the morning and rises as much as 5-10 mm of Hg by late
afternoon and again decreases during sleep.

Sex: Women have lower blood pressure than men of the same age but after menopause their pressure
reading increases over men.

Relationship to food intake: Blood pressure increases after food intake.

Exercise: Muscular exercises raise systolic blood pressure.
Body built: Blood pressure is higher in obese in comparison to thin.
Emotions: Anger, fear, excitement, pain etc. increase the blood pressure.
Posture: Blood pressure tends to be low in a supine position in comparison to a sitting or standing
position.

General Instruction for taking Blood Pressure:

• Provide a comfortable position (sitting position is preferred).
• Select appropriate size of cuff according to the age of client and site of taking blood pressure.(12-14
cm for arm and 18-24 cm for the thigh for an adult). Cuff size according to age is given below:

Age Size of cuff

Under 1 year 2.5 to 3.0 cm
1-4 year 5 to 6 cm
4-8 year 8 to 9 cm
8 year and above 12 to 18 cm

• Deflate the cuff slowly. There should be no noise in environment.

• For Mercury sphygmomanometer view the meniscus from above the eye level.
• Inflate the cuff 20-30mm of Hg above the disappearance of the pulse.
 • Ensure that tubing is not cracked or kinked
• Place the bell on the direct area of the artery.
• Before measuring blood pressure consider the factors, which cause variations in a normal condition.
• Do not take blood pressure more than three times in succession at the same site.

Location of brachial artery

Points to Remember:
• Do not tie the cuff over the clothes of the patient.
• The patient should not have involved
a. in strenuous exercise
b. has smoked
c. ingested caffeine, at least 30 minutes before checking BP because it causes variations in
readings.
• It is contraindicated to take BP on patient's arm if:
a. there is an IV assess
b. there is an injury/burn
c. there is a fistula or shunt
d. the arm is paralyzed.
e. there is radical mastectomy on the same side of the patient.
• Do not fitted too tightly as it causes false high reading.
• Do not fitted too loosely as it causes false low reading.

Procedure of taking Blood Pressure:

Preparation of patient:
• Identify the patient to select appropriate cuff size. Provide a comfortable position.
• Explain the procedure to the patient.
• Assess the arm on which blood pressure is to be taken. Do not take blood pressure on the arm which
has:
a. I/v infusions
 b. Injury
c. Shunt or fistula for renal dialysis.
d. Female patients with radical mastectomy

Collection of articles: A tray containing-

Articles Rationale
1. Sphygmomanometer with cuff of an appropriate To record blood pressure.
size

2. Stethoscope To record systolic and diastolic pressure

3. Spirit swab in a container. To clean ear piece and diaphragm of stethoscope to

prevent transmission of infection.

4. A paper bag. To discard the used spirit swab.

5. T.P.R. Sheets and Nurses' record. To record the findings at the same time

Steps of procedure:
Steps Rationale
1.Identify client, explain procedure to the patient To promote co-operation, relaxation and reduce
and provide comfortable position. anxiety
2. Check the diagnosis, reason for taking BP, To know baseline information about the patient
frequency, previous measurement
3. Wash hands To prevent cross infection
4. Use spirit swab to clean the stethoscope To reduce spread of infection
5. Select the arm by removing constrictive clothing Ensures proper cuff application
6. Palpate brachial artery & position cuff 2.5cm For proper pressure application
above brachial pulsation
7. Wrap cuff evenly around the upper arm Loose fitting or tight fitting may cause false reading
8.Palpatory method:
• Palpate brachial artery with finger tips of To identify approximate systolic pressure
one hand and inflate the cuff with other
hand.
• Inflate cuff to pressure 20-30mm of Hg
above point at which pulse disappears
.
9.Auscultation method: Proper placement of stethoscope ensures optimal
a. Place the stethoscope in ear and diaphragm on sound reception and accurate reading
brachial artery
 b. Close the screw clamp and inflate above the Ensure that the systolic reading is not
point where the pulse has disappeared. underestimated.

10. Slowly release the valve and allow the mercury
to fall at the rate of 2-3 mm of Hg
11. Note the point on manometer when the first
clear sound is heard and continue to deflate
gradually noting that point at which the sound
disappears
12. Deflate cuff rapidly and completely remove the
cuff.
13.Make the patient comfortable, terminate articles
and wash hands.
14. Record blood pressure
15. Inform the client blood pressure reading
Rapid or slow decline in mercury level causes
inaccurate reading
The first sound indicates systolic pressure and the
last point indicates diastolic pressure.
Continuous cuff inflation can cause arterial
occlusion.
To prevent cross infection
To ensure accuracy
Promotes patient participation and understanding
about own health status

Documentation:
Document the reading on the vital sign chart and nurses record and report any abnormal findings.

Termination:
• Make the patient comfortable
• Remove the cuff, roll it and keep in proper place
• Clean stethoscope with spirit cotton swab after procedure
• Keep sphygmomanometer and stethoscope in proper place
• Clean articles and wash hands.

Conclusion:
Blood pressure in the body is regulated through different mechanism which helps the body to
maintain normal physiological function. Mild to moderate variation in it can alter normal physiologic
process.
Thus, it is important to have regular blood pressure monitoring.
Bibliography:
1. The Trained Nurses’ Association of India, Fundamental of Nursing ,1st edition, Secretory general on
behalf of The Trained Nurses association of India, Page no-325-329

2. Ghai Sandhya, Clinical Nursing procedure ,1st edition, CBS publishers and distributors pvt Ltd, page
no -17-19

3. Nancy Sr. Principles and practice of Nursing,7th edition, N.R.publishing house, volume -1, page no -
217-218