Blood Pressure Education (Ambulatory) - CE
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Patients with a variety of illnesses such as cardiac, kidney, or vascular diseases are susceptible to wide variations in blood pressure (BP). In general, a sustained systolic BP reading of 130 mm Hg or higher and a sustained diastolic reading of 80 mm Hg indicate hypertension.undefined#ref3">3 Unmanaged hypertension increases the risks associated with cardiovascular disease or heart failure, stroke, and kidney disease.
Patients benefit from knowing how to monitor their own BP and pulse because it enables them to seek medical attention early when readings are outside the normal range. Home blood pressure monitoring (HBPM) allows patients to participate in their own health care. 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 determine appropriate 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 monitoring 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. 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.
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. 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 obtained by a health care team member and BP readings obtained by the electronic monitor should be compared to determine the home monitor’s accuracy. 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 monitors 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 monitors, 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 monitoring is cuff size (Box 1). 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 monitors come with interchangeable cuff sizes, further complicating the monitoring of BP at home.
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The postsurgical side may be used if other sites are not available or practical.2
Rationale: Appropriate site selection promotes accuracy in reading and minimizes the potential for trauma. The application of pressure from an inflated bladder temporarily impairs blood flow and compromises circulation in the arm or leg that already has impaired circulation.
Rationale: The risk of developing lymphedema from occasional BP measurement following breast or lymph surgery is low.2
Rationale: Demonstration is the best technique for teaching a psychomotor skill.
Rationale: Errors in technique can be corrected as they occur.
American Heart Association (AHA). (2020). How to accurately measure blood pressure at home. Retrieved June 27, 2023, from https://www.heart.org/en/news/2020/05/22/how-to-accurately-measure-blood-pressure-at-home
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
Clinical Review: Martha Beck, MA, BSN, RN, CNOR
Published: August 2023
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