Blood Pressure: Lower Extremity - (Pediatric) CE
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Discuss the importance of notifying the practitioner and withholding medications when abnormal values in blood pressure (BP) or pulse occur (e.g., in the case of hypotension).
Families should learn to measure BP accurately to assess the effectiveness of their child’s medication regimens or to monitor their child’s rehabilitation or exercise program. Nurses teach families the skill of measuring their child’s BP and the important issues regarding unusual readings. Nurses also teach families about factors that can affect BP readings, such as cuff size, cuff placement, movement of the tubing, and the patient’s position.
In the home, many families use commercially available electronic BP reading devices (Figure 1A) (Figure 1B), which produce a BP measurement without the use of a stethoscope. A cuff around an extremity (preferably the right arm) is used, and a reading is displayed electronically. Although easy to use, electronic monitors are not always accurate.undefined#ref3">3
Cuff size is a major factor that affects the accuracy of BP monitoring (Figure 2). A BP cuff that is too small provides a false high BP, whereas a cuff that is too large tends to provide a false low BP. The nurse should help the family select the appropriate cuff size for their child by measuring the arm circumference at the midpoint between the elbow (olecranon) and shoulder (acromion). For a child, the bladder cuff width should be approximately 40% of this circumference, and the bladder cuff length should cover 80% to 100% of the arm circumference.2,4 For a neonate or infant, the cuff bladder width should be approximately 50% of the mid-arm circumference.1 Cuff size can also be determined using the American Heart Association’s recommendations (Table 1).4 Not all electronic home BP monitors come with interchangeable cuff sizes, further compounding the problem of monitoring BP at home. In addition, as a pediatric patient grows, the required BP cuff size changes.
BP varies by body size; the BP for a child or adolescent should be assessed with respect to height, sex, and age.2
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Rationale: Young pediatric patients are more likely to cooperate if allowed to manipulate or play with the equipment before the procedure.
Rationale: Performing the procedure first on a family member or doll allows the patient to see that the procedure is safe and may enhance cooperation.
Rationale: Avoiding extremities that have wounds, IV lines, vascular compromise, fragile bones, or injuries helps prevent injury to the extremity. Pressure created by the inflated bladder of the BP device can temporarily impair blood flow and compromise circulation in an extremity that already has impaired circulation.
Rationale: Repeated attempts may affect the measurement because of anxiety and the repeated circulatory restriction.
Discuss the importance of withholding antihypertensive medications when the patient’s BP is low and notifying the practitioner when the BP reading is out of the desired range and when medications are not taken.
Rationale: Providing feedback through a return demonstration of psychomotor learning is the best means to evaluate learning and ensures that the family is using the appropriate-size BP cuff.
Flynn, J.T. and others. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), e20171904 doi:10.1542/peds.2017-1904
*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.
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