Blood Pressure Measurement Education - CE
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Discuss with the patient and family the importance of notifying the practitioner and withholding medications when blood pressure (BP) values are abnormal.
Patients with a variety of illnesses such as cardiac, kidney, or vascular diseases are susceptible to wide variations in their 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#ref4">4 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 acceptable 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.
Research demonstrates that HBPM can be an effective tool in managing hypertension.3 Furthermore, the combination of self-management and office-based monitoring of BP helps practitioners establish baseline data about their patients and analyze trends related to the use of medications, exercise, or rehabilitation programs. Patients should be taught how to monitor their BP regularly and how to interpret readings that are outside of individualized normal values. Self-monitoring should be a collaborative effort. Factors that affect the accuracy of BP readings, such as cuff placement, movement of the tubing, and position of the patient, should be addressed in patient teaching.
Aneroid sphygmomanometers for BP monitoring in the home are commercially available. Measuring BP with an aneroid sphygmomanometer requires a stethoscope and a skilled operator.
Newer devices such as electronic digital sphygmomanometers are safe, lightweight, compact, and portable. Many patients who receive home care choose to use electronic BP devices, which are commercially available. These devices, which often 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. Although electronic monitors are easier to use, they often provide systolic readings that are a little lower than the reading obtained by a health care team member, and their diastolic readings are often a little higher than that of a health care team member. Therefore, BP readings obtained by a health care team member and BP readings obtained by the electronic monitor should be compared to assess the accuracy of the home monitor.
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. Not all electronic home BP monitors come with interchangeable cuff sizes, further complicating the monitoring of BP at home. The nurse should help patients and families resolve issues about cuff size, calibration, and accuracy of the electronic equipment before they determine which type of BP monitor to purchase.
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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 extremity 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.
Rationale: Making repeated BP attempts restricts circulation.
Rationale: Keeping an organized record of BP readings and medications empowers the patient and provides accurate information to the practitioner.
Rationale: Printed and audiovisual references promote confidence for independent performance.
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.
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills and techniques (10th ed.). St. Louis: Elsevier.
Clinical Review: Martha Beck, MA, BSN, RN, CNOR
Published: August 2023
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