Now let's talk about our friend,
You know, when I was first learning vocabulary,
I thought that was like such
a super fun word to say;
it sounds like a lot of fun.
Now, you'll see a picture of a cuff there.
You probably use those in your nursing lab,
but it'll be hard pressed for you
to find these in most hospitals.
But here's what a sphygmomanometer is.
It's a device that we use to measure the
systolic and the diastolic blood pressure.
Now in the hospitals, I've only
seen automatic machines.
Like, you can't find a manual cuff,
or a manual sphygmomanometer.
Maybe you can in your place, but usually,
they're real tough to find in our places.
Because whether it's manual or whether it's
automatic, all units have an inflatable cuff.
So you can see examples of 2
types of cuffs that are there.
In most hospitals now, the cuffs are disposable,
or we use them just 1 patient at a time.
An inflatable cuff applies pressure
and then collapses the artery and
then it releases the artery.
Usually, we take blood pressures
in the arm, if at all possible.
That's the most desirable spot
to take the blood pressure.
So, whether it's a manual cuff that you have to…
pump up by hand, or is it… automatic cuff,
that both have the ability
to measure the pressure,
a representation of the pressure by using
it in your arm, in units of mm/Hg.
That's why you see the letters mm/Hg
that just means millimeters of mercury.
Now, we use a sphygmomanometer, we get both
a systolic reading and a diastolic reading.
So I want to walk you through 6 key
points about what you need to do
to make sure that you're taking
accurate blood pressures.
Now, you see step 1, it says, "For
30 minutes before the measurement,
you should not smoke, exercise, drink
caffeinated beverages, or drink alcohol."
So you actually want to ask your patients…
best practice would be to ask them,
"Hey, in the last 30 minutes, have you had a
cup of coffee or anything with caffeine in it?
Have you exercised?
Have you smoked or have you had any alcohol?"
Next, you want the person to
sit in a chair, if you can.
Now, in the hospital, a lot
of times people are in a bed.
So you want to document whether
they were up right, their…
the head of the bed was elevated, or they were
laying flat because that does make a difference.
But if this was somebody who was just
coming in for an outpatient visit,
or who was capable, we have them sit in a chair.
We ask them not to talk and to rest their
arm comfortably on a flat surface.
We'd like to let them wait there for 5 minutes.
Now, if you've been to a doctor's office
recently, or you've been in the hospital,
you've likely had your blood
pressure taken in a much faster way.
And probably, you haven't been asked these
questions, but we're giving you the best practice
to make sure that the blood pressures
you're taking are really accurate.
This is also what you want to
teach patients when they go home.
You want them…because they're taking
medications based on these numbers,
and their health care providers are making
decisions based on these numbers…
you want them to be as accurate
and consistent as possible.
So, make sure they try and
have that 30-minute window,
they wait 5 minutes while
they're resting comfortably.
And then we want them to make
sure that while they're sitting,
they sit still with their feet flat
on the floor and their back straight,
because we want to have that
non-impeded blood flow.
When we say feet on the floor, because you don't
want the person to cross their legs at the ankle.
So make sure they know when they
sit down, not to cross their legs,
keep their feet flat on the
floor and their back straight.
Now, we're going to start to
check their blood pressure.
So we want to ask them to check it twice a day,
because blood pressure for everyone
can vary a lot during the day.
So when they take it in the morning, especially
if they're on blood pressure medications,
we'd like them to take the blood pressure
before their morning medications,
and then take it again in the evening.
Now, walk your patients through a really
simple way to record the results.
A lot of the automatic cuffs that people have
at home have a [inaudible 00:04:10] line.
They will…it's a digital machine.
It will keep recording the numbers for them.
But encourage them to write it down.
Also, if something could happen to their
machine and you really want that information.
So remind them to remember to
record all the results they have,
and have a backup written copy, just in case.
Now they need to make sure that their instrument
is properly calibrated and validated.
An easy way to do that is to bring their blood
pressure cuff with them to a physician's visit,
or take it to a pharmacy that has the regular…
the big, giant blood pressure machines
that you can sit and put your arm in,
and they can compare the difference between
that blood pressure machine and their reading.
But it's really better if they could
bring it to their doctor's office,
and you can take their blood
pressure, wait a period of minutes,
then use their machine and see how close they are.
That's a really easy way to validate
if their machine is correct.
There's all kinds of machines out
there and some of them do the wrist,
some of them do their arm.
So you just want to make sure that that
machine is a good fit for your patient,
it's working, and providing
Now, the cuff size can get really, really touchy,
because if the cuff size is
too small for the patient,
they have an arm that's larger than the cuff, then
it's going to give you an inaccurate reading.
If the cuff is too big for the patient's arm,
then you're also going to
get an inaccurate reading.
So you want to really work with your patients
and know that the cuff can
fit snug and comfortably,
but doesn't tend to pop off when
it gets blown up for the reading.
So you want the bottom of the
cuff to not be in the elbow.
Now, I watched my own father take his blood
pressure and we had to go over this with him
because the cuff placement he'd
been taught was incorrect.
So you want to make sure that the bottom of
the cuff is above the bend in your elbow.
So the patient should be able to…
not that you ask them do that,
but they should be able to bend their arm freely.
Again, don't do that because
you want their arm relaxed,
but just make sure, visually, to check that
the bottom of that cuff is above the elbow,
the bend in the elbow.
You should be in good shape.