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Observation:
Blood Pressure
Overview
Blood pressure (BP) is the force which the blood exerts on the blood vessels
in which it is contained. It is recorded by an instrument called sphygmomanometer
and is measured in millimeters of mercury (mmHg).
Electronic BP set is now commonly used at home.
Blood pressure is measured as "upper" and "lower" pressure. The
upper pressure is called a systolic pressure. This is the greatest
pressure exerted against the blood vessel (arterial wall) during the
contraction of the heart. The lower pressure is called the diastolic
pressure. It is the lowest pressure exerted against the blood vessel
(arterial wall) when the heart is in a state of rest.
The
normal systolic pressure is less than 130 mmHg, and diastolic
pressure, less than 80 mmHg. This is expressed on paper with the
systolic figure over the diastolic in the following way -
120/80 mmHg. The diastolic pressure is usually about
two-thirds of the normal systolic pressure (systolic
pressure normally exceeds diastolic pressure by about 40
mmHg). One has hypertension if his systolic pressure
is 140 mmHg or more, or diastolic pressure is 90 mmHg or
more, or both.
The level of blood pressure is affected by emotion, posture, age and
disease. It usually drops during sleep and rises when in stress.
Close monitoring of blood pressure is recommended during
illness or condition that threatens cardiovascular
stability. Regular measurement is indicated for
patients with history of hypertension or hypotension.
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Tips in Measuring Blood Pressure Using
an Electronic BP Set
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Take blood pressure at approximately the same time
daily. Choose a time between meals when the
person is calm and relaxed so that the reading stays at
its normal level. Do not take
measurement after the person has eaten, ambulated,
exercise, or appeared anxious. If possible,
wait until he
becomes calm to avoid falsely elevated readings.
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To calm the
person while taking his blood pressure,
take your time and talk to him.
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The person
has to be either lying or sitting
down unless the doctor has specifically asked you to record his blood
pressure while he is standing up.
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If the person is on antihypertensive medications,
measure his blood pressure in a sitting position to
ensure accurate measurements.
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If the person is not able to achieve a comfortable
sitting position due to medical reasons, take the blood pressure in the
same position and in the same arm for consistency in
readings.
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Expose the person's arm above the elbow. Instruct
him to relax his arm.
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The person's arm should be extended at heart level and be
well supported. Place the
BP set beside his arm and on the same level.
The blood pressure may read falsely high
if the
arm is below heart level.
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Choose an arm band of appropriate size for the person.
Make sure the cuff (the inflatable elastic bladder) is 20% wider than the
circumference of the arm being used for measurement.
An excessively small cuff may cause a falsely high
pressure reading; an excessively big one, a falsely low
reading.
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Apply
the deflated arm band firmly around the upper arm,
approximately 1 inch above the elbow. Center the
arrow marked on the cuff along the brachial artery.
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Alternate arms when performing
numerous blood pressure measurements on an elderly
to prevent thin and fragile skin from breaking down.
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Do not take blood pressure in the arm on the affected
side of a mastectomy patient because it may decrease
already compromised lymphatic circulation, worsen edema,
and damage the arm.
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Do not take blood pressure readings in the arm in which
there is an intravenous (IV) access device because the access may
be compromised.
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Do not take blood pressure on the
arm with an arteriovenous fistula or a hemodialysis
shunt because blood flow through the vascular device may
be compromised.
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If
the reading is abnormal, try not to show any anxiety. Reassure
the person that you are taking his blood pressure in order to monitor
his progress. Check
it again in 10 minutes and if it is still abnormal, consult your doctor.
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Document the readings, time, positions and the
arms used for blood pressure taking. Correlate the
readings with medications, and notify your doctor about
abnormal findings or deviations from the baseline
status.
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