14.13:
Special considerations while measuring blood pressure
Consider the following aspects during blood pressure or BP measurement.
During an initial assessment, assess BP in both arms. The systolic value may differ by 10mmHg. For subsequent assessments, use the arm with the higher BP reading.
When the blood pressure is high, reassess in other extremities to compare the findings. Also, check the patient's position, cuff size, stethoscope placement, and equipment accuracy.
Assess for hypertensive symptoms like facial flush, headache, epistaxis, and fatigue.
When blood pressure is low, compare the value with the baseline, restrict activities that could lower blood pressure, and place the patient in a supine position to increase circulation.
Assess for signs of hypotension like tachycardia, dizziness, and pale or cyanotic skin.
In addition, assess the factors contributing to hypotension, including hemorrhage, hyperthermia, and medication side effects.
If unable to obtain BP, use another extremity or alternative method like palpation or Doppler ultrasound.
Raise the arm with the cuff over the head for thirty seconds before rechecking the BP. Then, inflate the cuff and gently lower the arm while supporting it.
14.13:
Special considerations while measuring blood pressure
When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Positional Differences:
Diastolic pressure is approximately five millimeters of mercury higher when measured in a sitting position than a supine one. Systolic pressure is about eight millimeters of mercury higher in the sitting position than when assessed supine.
Interventions for Abnormal Sounds:
In situations with abnormally high or low Korotkoff sounds, consider proper patient positioning, check stethoscope placement, verify device accuracy, and ensure a quiet environment. Repeat the procedure after two to three minutes and report any abnormal results to the care provider.
Clinical Assessment:
When blood pressure is outside the acceptable range, assess for symptoms such as tachycardia, a weak or thready pulse, dizziness, confusion, and pale or cyanotic skin.
Enhancing Korotkoff Sounds:
For weak or inaudible sounds, raise the patient's arm with the cuff overhead for thirty seconds before rechecking the blood pressure. Inflate the cuff and gently lower it while supporting it, enhancing Korotkoff sounds by reducing vascular volume and improving blood flow.
Auscultatory Gap:
During the manual measurement of BP by the auscultatory method, note the brief disappearance of Korotkoff sounds interval between the systolic and diastolic pressures during cuff deflation. It defines an auscultatory gap and indicates vascular stiffness. To obtain an accurate reading, palpate the radial artery and simultaneously increase the cuff pressure to a level above the disappearance of the pulse, followed by Korotkoff sounds auscultation during gradual cuff deflation. Document the auscultatory gap and ensure other healthcare workers know it to prevent future errors.
Caution with Electronic Devices:
Many electronic devices are not advisable for patients with irregular heart rates, tremors, or an inability to keep extremities still, emphasizing the importance of selecting appropriate methods based on individual patient characteristics.