Blood Pressure Training Module PDF

Blood Pressure Blood Pressure Station Why Measure BP? ○ High BP is a major risk factor for kidney disease. ○ Hypertension can damage nephrons of the kidney Tips: ○ Some participants may need additional privacy (e.g., pulling up the sleeve to accurately measure...

Blood Pressure Blood Pressure Station Why Measure BP? ○ High BP is a major risk factor for kidney disease. ○ Hypertension can damage nephrons of the kidney Tips: ○ Some participants may need additional privacy (e.g., pulling up the sleeve to accurately measure). ○ Position the participant appropriately (sitting upright, not talking, arm flat towards you) ○ Use correct blood pressure cuff size, and attach blood pressure cuff correctly to obtain accurate readings. Blood Pressure Station Station Procedure Introduce yourself, explain the station, obtain content. Sanitize hands, put on gloves Ask the patient to roll up their sleeve if needed ○ If the clothes will be too tight after they roll up the sleeve, it’s okay to take the measurement over a single layer of clothing Select the right-sized cuff and position the blood pressure cuff correctly ○ Most blood pressure cuffs should have an arrow or white dot that aligns with brachial artery Press start on the blood pressure machine (or begin working with the manual BP cuff) and wait for the result ○ Make sure the patient is sitting up straight with both feet flat on the ground, legs uncrossed, not talking, arm on table at heart level Note down the results on patient’s forms and direct them to the next station Sanitize hands with hand sanitizer and clean blood pressure cuff with alcohol wipes Sample setup - Blood Pressure Station Blood Pressure Training Kidney Disease Screening and Awareness Program (KDSAP) Susan Cheung, MD, MS Renal Division, Department of Medicine, Harvard Medical School, Harvard University  Objectives By the end of this session, you will learn and demonstrate adequate techniques to measure blood pressure correctly  Question 1: What is Blood Pressure (BP)?  What is blood pressure (BP)? BP is the force of blood pushing against the walls of arteries. BP is expressed as two numbers: systolic/diastolic BP. Systolic BP: the pressure in the blood vessel when the heart beats Diastolic BP: the pressure in the blood vessel when the heart is at rest between beats  Question 2: Whatisthe normal BP?  Definition of Hypertension Currently used in the Clinical setting: – Normal BP: < 130/80 mmHg According to AHA (American Heart Association):  Question 3: Why do we worry about high blood pressure? Complications of Persistent High Blood Pressure Nephrosclerosis and chronic kidney disease (CKD):  Question 4: What do you need to measure BP? Anatomy of Brachial Artery 1. Stethoscope 2. BP cuff 3. Patients Stethoscope Anatomy 1. Check the tubing for holes 2. Clean the ear tips with alcohol wipes 3. Point earpieces forward when ready to use Choosing the right size cuff 1. Use the “bladder” of a blood pressure cuff Check: 1. Screw valve 2. Measure the circumference of the arm 2. Air leak Distance around the arm Blood pressure cuff size 7 to 9 inches Small adult cuff 9 to 13 inches Standard adult cuff 13 to 17 inches Large adult cuff  Question 5: What are the mechanics behind measuring BP?  Mechanics Behind Measuring BP You are indirectly measuring the pressure in the blood vessel When the pressure in that bladder exceeds the pressure of the artery, the artery is compressed and distal blood flow diminishes, then stops As you release the air in the cuff, the bladder deflates and cuff pressure falls Pressure in cuff reaches the pressure generated by the heart during contraction, blood begins to flow through the artery again Mechanics Behind Measuring BP Blood flow produces Korotkoff's sounds: these sounds vary through 5 different phases The cause of these sounds is still debated: may be caused by blood jetting through the partly occluded vessel. The jetting causes turbulence in the open vessel beyond the cuff  Korotkoff’s Sounds According to the American Heart Association, Korotkoff's sounds occur in five phases:  Question 6: How do we take an accurate BP?  Accurate BP Measurements Check your equipment before you start Check the environment – Make sure the environment is quiet and without disturbance Check your patient – Make sure your patient is relaxed, if needed, have him sit or lie down for 5 minutes. – Ask your patient not to talk during measurement – Remove all clothing from forearm – Support your patient’s arm at heart level – Ask about cigarettes, alcohol, and caffeine intake in the last 15 minutes which may affect BP readings Check yourself – Make sure the manometer is in your direct line of sight – Make sure you are relaxed – Keep your eyes not only on your equipment but also your patients – Deflate the cuff slowly, 2-3 mmHg per second and listen carefully for the Korotkoff’s sounds Questions?  Protocol for BP Measurement Step 1: Always introduce yourself! And put the patient at ease. Step 2: Appropriately expose and position patient's arm at heart level on table or cradle Step 3: Select the right size cuff Step 4: Place cuff appropriately around patient’s arm and make sure manometer is readily in sight and feel for brachial/radial artery: Look! Look! Look! Step 5: Estimate systolic blood pressure by inflating the cuff and palpating the brachial/radial artery Look! and Feel! Step 6: Proper placement of cuff and place stethoscope over brachial artery and make sure all equipment is appropriately positioned. Look! Look! Look! Step 7: Deflate cuff and take systolic blood pressure (Korotkoff phase 1) and diastolic blood pressure (Korotkoff phase 5) Look and Listen! Step 9: Remove equipment as appropriate and address the patient  Protocol for BP Reading Write down the BP reading: systolic BP/diastolic BP (i.e. 140/90 mmHg) Take two readings at least two minutes apart Be sure to tell your patient about their BP reading