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

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The intended learners for this teaching skill are the patient, family, and caregivers. The patient should be included if developmentally and cognitively capable.

ALERT

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).

OVERVIEW

Families should learn to measure BP accurately to assess the effectiveness of their child’s medication regimens or to monitor blood pressure if serial blood pressure readings are needed. Nurses teach learners the skill of measuring their child’s BP and the important issues regarding unusual readings. Nurses also teach 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, 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#ref2">2}

For the most accurate BP, the cuff must be sized to the patient. For a child, the bladder cuff width should be approximately 40% of the circumference³ of the arm, measuring at a point midway between the olecranon (elbow) and acromion (bony projection of the shoulder blade) and the bladder cuff length should cover 80% to 100% of the arm circumference.³ Extremity circumference should be used when measuring for cuff size as well as when determining placement. For a neonate or infant, the cuff bladder width should be approximately 50% of the mid-arm circumference.¹ A cuff that is too large can result in a false low reading. A cuff that is too small can result in a false high reading. As the patient grows, the learner should be taught to get a larger cuff.

BP varies by body size; the BP for a child or adolescent should be assessed with respect to height, sex, and age.³

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.

ASSESSMENT AND PREPARATION

Assessment

1. Determine if the learner has health literacy needs or require tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
2. Review the learner’s previous experience and knowledge of BP and understanding of the teaching to be provided.
3. Review the diagnosis and reason for BP measurement.
4. Assess the learner’s visual and auditory acuity as well as their ability to use BP monitoring equipment.

Preparation

1. Gather needed teaching materials and supplies for demonstration.

PROCEDURE

1. Discuss the reason for taking BP measurements.
2. Review medications that affect BP.
3. Help the learners develop a plan for BP monitoring.
4. Remind the learner that the patient should be in a comfortable position and have avoided caffeine, smoking, or vaping.
5. Discuss the best sites for measuring BP. Explain that the cuff should not be applied to an extremity that has a vascular access device, an arteriovenous shunt, trauma, inflammation, a cast, or a bulky bandage.
6. If using a sphygmomanometer and stethoscope, teach the learner how to perform these steps:
   1. Palpate the artery to be used.
   2. Position the cuff and wrap it around the limb.
   3. Place the stethoscope over the identified artery.
   4. Inflate and slowly and smoothly release the cuff.
   5. Listen for pulsing sounds to become audible and to stop.
   6. Match the beginning and ending of audible pulse sounds to the gauge for the systolic and diastolic readings.
7. Have the learner perform each step of the skill on an assistant or another learner. Correct any errors in technique as they occur.
8. Use a dual-earpiece teaching stethoscope to verify accuracy of the learner’s readings.
9. Have the learner demonstrate the BP on the patient. Do not allow multiple repetitive attempts on any one extremity.

   Rationale: Repeated attempts at taking a BP can cause discomfort and anxiety. This can result in an elevated BP reading.

10. Acknowledge that developing competence in measuring BP may take time and repeated effort.
11. If using an electronic BP monitor, demonstrate the correct placement of the cuff and the use of electronic equipment.
12. Discuss the desired BP range based on the patient’s sex, age, condition, and medications.
13. Review criteria for reporting readings to the practitioner.

    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.

14. Help the learner to develop a log for recording the BP readings. The following information should be included in the log:
    1. The limb that was used
    2. The date and time of BP measurement
    3. If medication that affects BP was taken or held
    4. Time of administration of medication that affects BP
15. Advise the learner to use this written record to report BP readings to the practitioner.
16. Show the learner how to care for the BP equipment (e.g., storage, cleaning, battery care).

MONITORING AND CARE

1. When the learner is providing care, monitor the competency in performing care until the learner is proficient.

EXPECTED OUTCOMES

• Learner states the purpose of BP measurement.
• Learner demonstrates accurate BP measurement.

UNEXPECTED OUTCOMES

• Learner cannot state the purpose of BP measurement.
• Learner cannot demonstrate accurate BP measurement.

DOCUMENTATION

• Teaching methods used
• Evidence of learning (e.g., return demonstration, repeating back instructions, steps, safety protocols, and information)

REFERENCES

1. Dionne, J.M. and others. (2020). Method of blood pressure measurement in neonates and infants: A systematic review and analysis. The Journal of Pediatrics, 221, 23-31. doi:10.1016/j.jpeds.2020.02.072
2. National Heart, Lung, and Blood Institute (NHLBI), U.S. Department of Health and Human Services. (2012). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Full report. Retrieved January 2, 2025, from https://www.nhlbi.nih.gov/files/docs/guidelines/peds_guidelines_full.pdf
3. Scott, K.L. (2024). Chapter 4: Communication and physical assessment of the child and family. In M.J. Hockenberry, E.A. Duffy, K.D. Gibbs (Eds.), Wong’s nursing care of infants and children (12th ed., pp. 74-130). St. Louis: Elsevier.

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

Published: February 2025