Terminology
hypertension, high blood pressure compared to standard values for the patient's age and hypotension is blood pressure below normal levels
Intervention: taking and recording blood pressure
Mr. Ellis has high blood pressure every few minutes. For the evaluation of blood pressure via a mercury sphygmomanometer, the BritishHypertensionSociety (Beevers et al.2001) recommends the following course of action.
° stethoscope.
° to the right size cuff pressure
° Pen and documentation sheets.
PROCEDURE
• Prepare the equipment.
ALERT!
The bladder of the cuff should cover 80 percent of the circumference of the upper arm. Starved or obese patients will also be large or small wrists.
• Explain the procedure to Mr. Ellis. Make sure he understands he can not speak, while his blood pressure is measured, because it falsely high value.
• Have Mr. Ellis to sit or lie down. As a comparison between standing and lying blood pressure is required, the first record of the underlying blood pressure.
• Make sure that Mr. Ellis is comfortable. Differ summary measure up, giving them at least 30 minutes, resting after a meal or alcohol or caffeine.
° When selecting a cuff placement, steer clear of using an arm hit as a result of an intravenous an arteriovenous shunt, cannula, trauma, total or incomplete paralysis, or the side of a mastectomy as these conditions the effect of absorption and can be painful.
• Wash your hands.
• Remove restrictive clothing arm chosen. If necessary for Mr. Ellis's outerwear privacy.
• Place Ellis arm horizontally, and supported so that the cuff is at heart level, management palm up.
° Palpate the brachial artery (which can be found in the shoulder / elbow arm).
• Place the cuff so that the center of the bladder over the brachial artery. The lower edge of the cuff should be 2 to 3 cm above the site of the largest pulse of the brachial artery. Consistently discouraged cuff wrapped around the arm with the rubber tube from the bladder positioned on the top of the sleeve, allowing easy access to the elbow to auscultation.
• Install a pressure gauge at eye level and no more than 3 m (92 cm) apart, so that the balance can be easily read.
° Palpate the brachial artery, although the balloon inflated to thirty mmHg above the point where the pulse disappears. Gradually abandoned the cuff, note the pressure at which the wrist. This is the estimated level of systolic blood pressure. Reduce the cuff. Estimate how high the air with the cuff must be completed by the pulse is important because phase I sounds (just see Table 2.1) can evaporate when the pressure is reduced and reappear at a lower level.
• Place the diaphragm of the stethoscope over the brachial artery at the point of maximum heart rate. The stethoscope should not touch the cuff, cloth or rubber hose as this could cause friction noise. In the haste to rise the cuff to 30mmHg exceeding palpated systolic rate. Gradually reduce the cuff at 2-3 mmHg per second. The first Korotkoff sound is the systolic blood pressure. The disappearance of sounds represents the diastolic pressure. Registration card of blood pressure to the nearest 2 mmHg trademarks used the arm and the position of Mr. Ellis. Document deviations or changes.
• Help Mr. Ellis dress if necessary and a more comfortable position to take.
• Wash your hands.
More Ask Mr. Ellis of your results.
• report any discrepancies or changes in observing a more experienced colleague.
Is this the first occurrence, grade blood pressure in these patients in both arms (Beevers, all 2001). When included in and
Phase I
The first sign of weakness, clear tapping sounds that gradually increase in concentration of at least two consecutive beats of SBP.
Phase II
A brief period may follow when the sounds soften and acquire
a rustling quality. Auscultatory gap in some patients sounds may disappear for a short time.
Phase III
The return of sharper sounds, sharpen or repair
exceed the intensity of the phase I sounds.
Phase IV
The sudden weakening of different sounds that are soft and
folding.
Phase V
The point at which all sounds disappear.
Avoid errors in blood pressure
There are several factors that often lead to errors in determining the blood pressure of a patient. These may relate to the patient, the nurse or equipment.
If a patient has pain, will be anxious, or cold, affect blood pressure. Try to ensure that the patient does not have a full bladder, and has not had a meal or just a cigarette. When you take blood pressure, make sure that the patient's arm is horizontal and supported, and is not restricted by tight clothing.
If the nurse perform the procedure, do not round wrong numbers, and do not guess the pressure. Make sure the cuff and gauge the correct position and not rapid deflation of the cuff. Other errors can be caused if a nurse has poor hearing, or to accurately interpret the Korotkoff sounds.
Check your equipment. The following factors are sources of error: the mercury is set to zero, the glass is dirty, the numbers on the meter are not clearly visible, the equipment can be tilted, or not properly calibrated or installed, there may be a faulty valve or leakage caused by rubber hose cracked or perished.
Aneroid and automated equipment
For the evaluation of blood pressure using a sphygmomanometer aneroid or automated device, the cuff should be applied as described above. The aneroid device is also used, although the position of the wheel is not so important. When using an automated device, it is essential that the manufacturer's instructions are followed, as each machine is different.
Interpretation of results
The treatment of hospitalized patients should never be based on a BP (Beevers et al. 2001). Mean blood pressure normal for a young adult is 120/80 mmHg for an elderly person is 140/90 (Potter and Perry, 1997).
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