NURSING PROCEDURE 46-5

Measuring Blood Pressure (Aneroid Manometer and Manual Cuff)

SUPPLIES AND EQUIPMENT

✓ Stethoscope ✓ Alcohol wipe

✓ Sphygmomanometer ✓ Paper or flow sheet
✓ Blood pressure cuff (appropriate size) ✓ Pen

RECOMMENDED TECHNIQUE E S NP Comments

Using a Manual Cuff for an Adult

Follow LPN WELCOME steps and then
1. Select a cuff that is the appropriate size for the client. Cleanse the
stethoscope’s earpieces and diaphragm with an alcohol wipe.
2. Assist the client to a comfortable position. Ask the client to sit or lie still
for about 5 minutes. Support the selected arm; turn the palm upward.
Remove any constrictive clothing. Instruct the client to relax the arm and
place both feet flat on the floor when sitting.
3. Palpate the brachial artery in the bend of the elbow. Center the cuff’s
bladder approximately 1 in (2.5 cm) above the site where you palpated the
brachial pulse.
4. Wrap the cuff snugly around the client’s arm and secure the end
appropriately. Make sure the reading on the aneroid manometer starts at
zero.
5. Palpate the radial or brachial pulse with one hand. Close the screw clamp
on the bulb and inflate the cuff while still checking the pulse with the other
hand. Observe the point where the pulse is no longer palpable.

6. Open the screw clamp, deflate the cuff, and wait 30 seconds.
7. Position the stethoscope’s earpieces comfortably in your ears (turn tips
slightly forward) and place the diaphragm portion of the chestpiece over
the client’s brachial artery.
8. Close the screw clamp on the bulb and inflate the cuff to a pressure of 30
points above the number where the pulse had disappeared.
9. Open the clamp and allow the aneroid dial to fall at a rate of two to three
points per second.
10. Note the point on the column or dial at which you initially hear a distinct
sound.
11. Continue deflating the cuff and note the point where the sound disappears.

12. Release any remaining air in the cuff and remove it. If the reading must be
rechecked for any reason, allow a 1-minute interval before taking the BP
again.
13. Assist the client to a comfortable position. Advise the client of the reading.

Follow ENDDD steps.

Copyright © 2017 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Textbook 1
of Basic Nursing, eleventh edition, by Caroline Bunker Rosdahl and Mary T. Kowalski.
 NURSING PROCEDURE 46-5

Measuring Blood Pressure

(Aneroid Manometer and Manual Cuff) (Continued)

RECOMMENDED TECHNIQUE (Continued) E S NP Comments

Special Reminder
• Record the systolic pressure over the diastolic (e.g., 120/70). Indicate the
site where you took the BP if the brachial site was not used. Report any
irregular findings.

RECOMMENDED TECHNIQUE E S NP Comments

Using a Manual Cuff for an Adult

Follow LPN WELCOME steps and then
1. Wrap the cuff in the same manner as above. Let the client know that the
cuff will probably be quite tight, but it will not remain inflated. Ask the
client to sit very still with both feet on the floor and relax the arm.

2. Turn on the machine. Push the “BP” or “start” button. Wait until it
registers that it is ready.
3. Read the blood pressure and pulse values on the digital screen. Most
machines beep when the reading is completed.
Follow ENDDD steps.
Measuring Thigh Blood Pressure
Use the same procedures as in measuring BP on the arm. The cuff must be
designated as a “thigh” cuff and must be large enough to fit comfortably around
the client’s thigh. If a stethoscope is used, it is held behind the bend of the knee
(the popliteal space).

MEASURING ORTHOSTATIC BLOOD PRESSURE

SUPPLIES AND EQUIPMENT

✓ Blood pressure equipment ✓ Paper or flow sheet

✓ Alcohol wipe ✓ Pen

RECOMMENDED TECHNIQUE E S NP Comments

Follow LPN WELCOME steps and then

1. Measure the client’s blood pressure and pulse with the client lying down
(or sitting). Wait at least 5 minutes.
2. Without removing the BP cuff, ask the client to stand.

Copyright © 2017 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Textbook 1
of Basic Nursing, eleventh edition, by Caroline Bunker Rosdahl and Mary T. Kowalski.
 Measuring Blood Pressure (Aneroid Manometer and Manual Cuff)   46-5 3
NURSING PROCEDURE 46-5

Measuring Blood Pressure

(Aneroid Manometer and Manual Cuff) (Continued)

RECOMMENDED TECHNIQUE (Continued) E S NP Comments

3. Immediately measure the BP and pulse (P) again. Report a significant drop
in blood pressure (25 points systolic or 10 points diastolic). A drop in BP
may also affect the pulse rate. The pulse rate may decrease, but often it
increases. Report a pulse rate increase of more than 12 to 15 beats per
minute (BPM).
4. The client may feel dizzy or light-headed on standing and may be
susceptible to falling or fainting. Carry out measures to ensure the client’s
safety.
5. In some cases, three readings are made: lying down, sitting, and standing.
Allow at least 5 minutes between each measurement.
Follow ENDDD steps.
Special Reminders
• Orthostatic blood pressure is recorded as follows, with appropriate times:

↓150/80, P 76 (lying down or sitting)

↑120/66, P 92 (standing)

KEY: E = Excels S = Satisfactory NP = Needs Practice

 Pass    Fail

Student’s Signature: _____________________________________________________________________ Date: __________________

Instructor’s Signature:____________________________________________________________________ Date: __________________

Copyright © 2017 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Textbook
of Basic Nursing, eleventh edition, by Caroline Bunker Rosdahl and Mary T. Kowalski.