Practical Nursing
Diploma Program
Nursing Skills Lab 1
Blood Pressure
Week 12
Blood Pressure
The force of the blood against arterial walls
Systolic Pressure
The highest point of pressure on arterial walls
when the ventricles contract
Diastolic Pressure
The lowest pressure present on arterial walls as
ventricles relax
Read as systolic number ‘over’ diastolic number
Factors Affecting Blood
Pressure Reading
Age- walls of arteries are less elastic-increases peripheral
resistance, ^ B/P
Exercise- ^ systolic pressure
Race-hypertension more common in African American
Weight-B/P can be higher in overweight
Emotional state-anger, fear, pain, excitement ^ B/P
Smoking-vasoconstriction, ^ B/P
Medications-oral contraceptives may ^ B/P,
antihypertensives lower B/P
Ranges of Blood Pressure
[525]
Optimal= <120/80
Normal=< 130/85
High Normal=130-139 over 85-89
Grade 1 Hypertension (mild) 140-159/90-99
Grade 2 “ (moderate) 160-179/100-109
Grade 3 “ (severe) >180/110
Hypotension=90-115 for systolic
may be normal for some but may be due to blood
loss or medication effects
Orthostatic./ Postural Hypotension
change in position leads to low BP.
caused by medications, prolonged bed rest,
loss of blood
Korotkoff Sounds
Sounds you hear when taking a blood
pressure as blood can flow through the
compressed artery. Listen and make note
when they start, change tone, and quickly
stop
Measuring Blood Pressure
Blood Pressure is measured in millimeters of
mercury (mm Hg)
Blood Pressure is recorded as a fraction:
The numerator is the systolic pressure
The denominator is the diastolic pressure
Pulse Pressure
The difference between the systolic and
diastolic pressure ie. systolic – diastolic =
pulse pressure
Methods of Assessing the
Blood Pressure
Use a stethoscope and sphygmomanometer
Use a Doppler ultrasound
Estimate by palpation
Assess with electronic or automated devices
How to Ensure an Accurate
Blood Pressure Reading
Ensure equipment is in good working order
Always use a cuff that is the correct size for
the patient- if too narrow-reading may be
high, if too wide, reading may be low
Ensure accurate limb placement
Use recommended deflation rate
Correctly interpret the sounds heard
ie. LOOK, LISTEN, FEEL
Cuff width 2/3 of arm length
Continued..
Stethoscope- used to auscultate ie. listen
Sphygmomanometer and cuff (different
sizes) + manometer ie. mercury or aneroid
Ensure reading starts at 0
If using mercury manometer make sure
you read at eye level
Always read at top of meniscus
• Do not take the B/P on an arm:
• with an IV, on the side of a mastectomy,
weak arm from stroke, casted/injured arm
Assessing Brachial B/P
Select the appropriate arm for application of the
cuff
Have the patient assume a comfortable lying or
sitting position with the forearm supported at the
level of the heart and the palm of the hand
upward
Expose the brachial artery by removing
garments, or move a sleeve, if it is not too tight,
above the area where the cuff will be placed
Palpate the location of the brachial artery
Wrap the cuff around the arm smoothly and snugly,
and fasten it. Do not allow any clothing to interfere
with the proper placement of the cuff (1-2” above inner
aspect)
Palpate the pulse at the brachial or radial artery by
pressing gently with the fingertips
Tighten the screw valve on the air pump
Inflate the cuff while continuing to palpate the artery.
Note the point on the gauge where the pulse
disappears
Totally deflate the cuff and wait 15 seconds
Place the bell or diaphragm of the stethoscope
firmly but with as little pressure as possible over
the brachial artery
Pump the pressure 30 mm Hg above the point
at which the systolic pressure was palpated and
estimated. Open the valve on the manometer
and allow air to escape slowly; allowing the
gauge to drop 2–3 mm per heartbeat
Note the point on the gauge at which the
first faint, but clear, sound appears that
slowly increases in intensity. Note this
number as the systolic pressure
Read this pressure to the closest even number
Do not re-inflate the cuff once the air is being
released to recheck the systolic pressure
reading.
Note the pressure at which the sound first
becomes muffled/disappears. This is the
diastolic pressure
Open the valve and let remaining air to
escape quickly. Repeat any suspicious
reading, but always wait 30 to 60 seconds
between readings to allow normal circulation
to return to the limb. Deflate the cuff
completely between attempts to check the
Other Methods to Determine
Blood Pressure
Popliteal Artery Blood Pressure-usually 10-
40 higher
• Patient to assume the prone position
• Use an appropriate size cuff
• Place cuff on thigh above popliteal artery
• Same procedure as for assessing brachial blood
pressure
• Estimating by Palpation
• Only need a sphygmomanometer
• Pump up cuff same as for brachial blood
pressure assessment but using your fingers
you feel for the return of pulse
• You only get a systolic reading
• Doppler/Ultrasound amplifies sounds
Electronic or Automated Devices
• Determines Blood Pressure by monitoring
vibrations
• Still need to remember to check equipment
• Place cuff in correct position
• Ensure to use correct size cuff
• Check with brachial manual blood pressure
to confirm accuracy of automated device
Nursing Skills Lab 1
Week 13
• Topical Medications
• Please review the 3 checks and 6
rights of medication preparation
and administration prior to this Lab
