Teaching How to Take a Blood Pressure (Ambulatory) - CE/NCPD

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The intended learner for this teaching skill is the patient, family, and caregivers.

OVERVIEW

Patients with a variety of illnesses such as cardiac, kidney, or vascular diseases are susceptible to wide variations in blood pressure (BP). Patients benefit from knowing how to measure their own BP and pulse because it enables them to seek medical attention early when readings are outside the normal range. Home blood pressure measurement (HBPM) allows patients to participate in their own health care.^{undefined#ref3">3} Also, HBPM helps to reduce health care costs and can improve the quality and outcome of overall management of patients with hypertension.

Examples of patients who need to know these skills include those with heart disease and those involved in cardiac rehabilitation programs. In addition, healthy people who exercise should learn how their body responds to exercise and should be able to create exercise plans based on knowing their BP before, during, and after exercise.

HBPM can be an effective tool in managing hypertension. Furthermore, the combination of self-management and office-based measurement of BP helps health care team members establish baseline data about their patients and analyze trends related to the use of medications, exercise, or rehabilitation programs.³ Factors that affect the accuracy of BP readings, such as cuff placement, tubing movement, and the patient’s position, should be addressed in patient teaching. Acceptable systolic and diastolic values vary and limits for reporting should be individualized. Unmanaged hypertension increases the risks associated with cardiovascular disease, heart failure, stroke, and kidney disease.

Electronic digital sphygmomanometers are safe, lightweight, compact, and portable. These devices, many of which also measure pulse rate, produce a BP measurement without the use of a stethoscope.³ A cuff is placed around the arm or wrist or attached to the fingertip, and a reading is displayed electronically for the patient. Therefore, BP readings measured by a health care team member and BP readings measured by the electronic device should be compared to determine the home device’s accuracy.³ Patients with atrial fibrillation or other arrhythmias may not be good candidates for HBPM with an electronic device because accuracy of the measurement can be affected by an irregular heart rhythm.¹

Electronic BP devices (Figure 1) are easy to use, but the health care team member should teach the patient that they may provide lower systolic readings and higher diastolic readings than aneroid devices, which may be used in health care facilities. This information may spare the patient from undue alarm when different numbers are obtained during HBPM.

One factor that affects the accuracy of BP measurement is cuff size. BP cuffs that are too small tend to overestimate BP, whereas cuffs that are too large tend to underestimate BP. Thus, choosing the correct cuff size, one in which the bladder completely encircles the arm without overlapping, is important. Not all electronic home BP devices come with interchangeable cuff sizes, further complicating the measurement of BP at home.

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Encourage questions and answer them as they arise.

PROCEDURE

1. Explain the teaching plan and be sure that the learner agrees to teaching.
2. Determine if the learner has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
3. Review the learner’s previous experience and knowledge of blood pressure measurement and understanding of the care to be provided.
4. Get a device that is the same as the device that will be used at home.
5. Provide the learner with printed instructions with a written or pictorial guide based on the learner’s health literacy level. If applicable, provide the learner with a video or website address that demonstrates the procedure.
6. Determine the learner’s knowledge of what a BP reading measures, normal BP ranges, which specific medical issues affect BP readings, and why an awareness of variations in BP readings is important to the patient’s well-being.
7. Be sure that the learner understands that BP changes throughout the day and that excessive testing can cause undue anxiety and concern.
8. Instruct the learner to perform BP measurement in a comfortable position with the arm supported and the feet flat on the floor and in a warm, quiet environment.
9. Encourage the learner to perform BP measurement on a routine schedule, measuring it at the same time every day unless otherwise directed by the health care team member.¹
10. Teach the patient to avoid exercise, caffeine, and smoking for 30 minutes before measuring BP to avoid an inaccurate reading.¹
11. Teach the patient to empty the bladder and maintain at least 5 minutes of quiet rest before taking a measurement.¹
12. Explain that the cuff should not be applied to an arm with an arteriovenous (AV) shunt, fistula, or graft; decreased blood flow; trauma; or a cast or bulky bandage.
13. Explain that for patients who have had breast or axillary surgery, the learner may be advised to apply the cuff to the arm on the other side.

    Rationale: The risk of developing lymphedema from occasional BP measurement following breast or lymph surgery is low and there is no established correlation.²

14. Explain that the cuff should not be applied over clothes.¹
15. Explain how to select the correct cuff size.
16. Demonstrate the steps for measuring BP.

    Rationale: Demonstration is the best technique for teaching a psychomotor skill.

17. Demonstrate the correct placement of the cuff, the use of electronic equipment for proper cuff inflation, and the procedure for changing batteries following the manufacturer’s instructions for use.
18. Have the learner attempt each step of the skill on a health care team member or manikin arm.

    Rationale: Errors in technique can be corrected as they occur.

19. Observe the learner demonstrating the technique for BP measurement on self.
    1. Be sure the learner correctly uses the equipment.
    2. Instruct the learner to take two or three readings 1 minute apart.¹
20. Teach the learner to record BP measurement and the time it is taken.
21. Teach the learner how to properly care for the equipment (e.g., storage, cleaning, and battery care).
22. Ask the learner if readings are within the desired range and confirm that the learner knows when to seek additional care for abnormal readings.
23. Ask the learner to describe the reason for BP measurement and any related medications (e.g., antihypertensives, antiarrhythmics) or treatment (e.g., diet and exercise).
24. Have the learner demonstrate proper care of the equipment.
25. Teach the learner to repeat BP measurement if readings are outside of expected values and accompanied by symptoms, such as dizziness, because the patient should seek additional care.³
26. Teach the learner to retake the BP if readings are slightly or moderately higher than normal or are suddenly higher than 180/120 mm Hg and when to seek additional care.¹
27. Teach the learner the signs and symptoms of an acute myocardial infarction (e.g., chest pain, shortness of breath, back pain, numbness or weakness, change in vision, difficulty speaking) and give instructions on when to seek additional care.¹

EXPECTED OUTCOMES

• Learner accurately measures BP.
• Learner explains the importance of measuring BP.

UNEXPECTED OUTCOMES

• Learner is unable to measure BP because of cognitive or sensory problems (e.g., inability to manipulate the equipment or see numbers on the equipment).
• Learner has difficulty explaining the purposes of measuring BP.

DOCUMENTATION

• Learner’s ability to demonstrate procedure
• Learner’s understanding of the procedure
• Teaching methods used
• Evidence of learning (e.g., return demonstration; repeating back instructions, steps, safety protocols and information)

PEDIATRIC CONSIDERATIONS

• Developmentally appropriate strategies should be used. Young children are more likely to cooperate if they can touch or play with equipment before the procedure.
• Performing the procedure first on a family member may be helpful. This allows the patient to observe that the procedure is safe.

OLDER ADULT CONSIDERATIONS

• Musculoskeletal changes such as arthritis or other joint conditions may impair an older adult’s ability to position an arm comfortably or perform the fine motor skills that are required to measure BP.

REFERENCES

1. American Heart Association (AHA). (2017, reviewed 2024). Home blood pressure monitoring. Retrieved August 14, 2024, from https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home
2. Brophy, L. and others. (2022). A review of the literature related to limb precautions after lymph node dissection. Clinical Journal of Oncology Nursing, 26(1), 86-92. doi:10.1188/22.CJON.86-92
3. Pietsch, T. (2025). Chapter 42: Home care teaching. In A.G. Perry and others (Eds.), Clinical nursing skills & techniques (11th ed., pp. 1222-1263). St. Louis: Elsevier.

Clinical Review: Marlene L. Bokholdt, MS, RN, CPEN, TCRN

Published: October 2024