Sphygmomanometer and 6 Steps to Accurate Blood Pressure (Nursing)

00:01 Now let's talk about our friend, the sphygmomanometer.

00:03 You know, when I was first learning vocabulary, I thought that was like such a super fun word to say; sphygmomanometer, because it sounds like a lot of fun.

00:12 Now, you'll see a picture of a cuff there.

00:15 You probably use those in your nursing lab, but it'll be hard pressed for you to find these in most hospitals.

00:22 But here's what a sphygmomanometer is.

00:24 It's a device that we use to measure the systolic and the diastolic blood pressure.

00:30 Now in the hospitals, I've only seen automatic machines.

00:33 Like, you can't find a manual cuff, or a manual sphygmomanometer.

00:38 Maybe you can in your place, but usually, they're real tough to find in our places.

00:42 Because whether it's manual or whether it's automatic, all units have an inflatable cuff.

00:48 So you can see examples of 2 types of cuffs that are there.

00:51 In most hospitals now, the cuffs are disposable, or we use them just 1 patient at a time.

00:56 An inflatable cuff applies pressure and then collapses the artery and then it releases the artery.

01:03 Usually, we take blood pressures in the arm, if at all possible.

01:06 That's the most desirable spot to take the blood pressure.

01:10 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.

01:29 That's why you see the letters mm/Hg that just means millimeters of mercury.

01:35 Now, we use a sphygmomanometer, we get both a systolic reading and a diastolic reading.

01:41 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.

01:49 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.

02:16 Now, in the hospital, a lot of times people are in a bed.

02:20 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.

02:27 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.

02:33 We ask them not to talk and to rest their arm comfortably on a flat surface.

02:38 We'd like to let them wait there for 5 minutes.

02:41 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.

02:51 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.

02:59 This is also what you want to teach patients when they go home.

03:03 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.

03:13 So, make sure they try and have that 30-minute window, they wait 5 minutes while they're resting comfortably.

03:20 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.

03:30 When we say feet on the floor, because you don't want the person to cross their legs at the ankle.

03:35 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.

03:42 All right.

03:43 Now, we're going to start to check their blood pressure.

03:46 So we want to ask them to check it twice a day, because blood pressure for everyone can vary a lot during the day.

03:53 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.

04:02 Now, walk your patients through a really simple way to record the results.

04:06 A lot of the automatic cuffs that people have at home have a reddened line.

04:10 They will…it's a digital machine.

04:12 It will keep recording the numbers for them.

04:14 But encourage them to write it down.

04:15 Also, if something could happen to their machine and you really want that information.

04:20 So remind them to remember to record all the results they have, and have a backup written copy, just in case.

04:27 Now they need to make sure that their instrument is properly calibrated and validated.

04:32 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.

04:49 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.

04:58 That's a really easy way to validate if their machine is correct.

05:02 There's all kinds of machines out there and some of them do the wrist, some of them do their arm.

05:07 So you just want to make sure that that machine is a good fit for your patient, it's working, and providing accurate information.

05:13 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.

05:24 If the cuff is too big for the patient's arm, then you're also going to get an inaccurate reading.

05:30 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.

05:39 So you want the bottom of the cuff to not be in the elbow.

05:42 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.

05:51 So you want to make sure that the bottom of the cuff is above the bend in your elbow.

05:57 So the patient should be able to… not that you ask them do that, but they should be able to bend their arm freely.

06:03 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.

06:13 You should be in good shape.