BLOOD PRESSURE

Prepared by: Rami Mchawrab ,Clinical Educator.

 OUTLINE

I. Introduction.
II. Clinical alert.
III. Equipment.
IV. Preparation of Equipment.
V. Implementation.
VI. Using data scope machine for BP taking .
VII. Using a manual BP sphygmomanometer
VIII. Completing the procedure.
IX. Special Considerations.
X. Documentation
XI. References.
 OBJECTIVES

At the end of the presentation, the learner will be able to:

I. Take blood pressure correctly .
II. Know the equipment needed to measure BP.
III. Know how to prepare the equipment.
IV. Know how to use manual and data scope BP machines.
V. Know how to document the BP.

3
 INTRODUCTION
• Blood pressure assessment provides insight into a child's general health status and
helps monitor response to treatment.
• Blood pressure should be measured from the child's right arm, unless the child has
atypical aortic arch anatomy .
• Before measuring blood pressure in a child, assess for factors that can affect blood
pressure, such as pain, anxiety, crying, and the child's activity level. Other causes
include hypovolemia, hemorrhage, and sepsis
INTRODUCTION
 CLINICAL ALERT
• Don't use an extremity with an incision, trauma, deep vein thrombosis, grafts, or arteriovenous
fistula or with ischemic changes.

• If the child's initial blood pressure is at or above the 90th percentile, perform two additional
oscillometric measurements at the same visit and average them.
 EQUIPMENT

Appropriate-sized blood pressure

sphygmomanometer cuff
 EQUIPMENT

Automated blood pressure device Data scope

 PREPARATION OF EQUIPMENT

• Carefully choose an appropriately sized cuff for the child based on the mid arm circumference.
To choose the appropriate size, make sure that the width of the cuff's inflatable bladder is at
least 40% of the arm circumference.1 The inflatable bladder length should cover 80% to 100% of
the arm circumference.
• You can also refer to the manufacturer's marks on the cuff to determine the correct size or
measure the arm circumference midway between the olecranon of the elbow and the acromion
of the scapula with the shoulder in a neutral position and the elbow flexed at a 90-degree angle.
• If the cuff is too small, select the next largest cuff (even if it appears too large).
ARTERIAL SITES USED TO MEASURE
BLOOD PRESSURE
 ICE BREAK

USING AN AUTOMATED BLOOD PRESSURE DEVICE

 ICE BREAK
MEASURING BLOOD PRESSURE USING
AUSCULTATION
 IMPLEMENTATION
•Gather the appropriate equipment and supplies.
•Perform hand hygiene.
•Confirm the child's identity using at least two patient identifiers.
•Provide privacy.
•Explain the procedure to the child and parents or guardians according to their individual
communication and learning needs to increase their understanding, allay their fears, and enhance
cooperation. For example, tell a younger child, "I'm going to see how your heart is working. You'll feel
like your arm is getting a hug."
•Measure the blood pressure in the right arm for consistency and comparison with standard tables, and
to avoid a falsely low reading from the left arm in the case of coarctation of the aorta.1 Measure the
blood pressure in both arms and in a leg at the second visit if the child has a confirmed elevated blood
pressure or stage 1 hypertension or at the first visit if the child has confirmed stage 2 hypertension.1
(See Arterial sites used to measure blood pressure.)
 COMPLETING THE PROCEDURE.

•Don't reinflate the cuff during deflation. If a repeat blood pressure

measurement is needed, allow a few minutes between measurements.
•Completely deflate the cuff, and remove it.
•Assess the child's skin under the cuff.
•Perform hand hygiene.
•If the cuff isn't designated for single-patient use, clean and disinfect it
using a disinfectant pad.
•Clean and disinfect your stethoscope, if used, using a disinfectant pad.
•Discard used supplies in appropriate receptacles.
•Perform hand hygiene.
•Document the procedure.
 SPECIAL CONSIDERATIONS
•Blood pressure shouldn't be measured routinely in children with osteogenesis imperfecta because of the
associated high risk of fractures. Blood pressure in this population should be measured only with a direct order
from a practitioner.
•Decreased blood pressure in a child is a late and ominous sign of shock.
•With neonates, blood pressure measurements that are significantly higher in one arm than the other or
significantly higher in the arms than in the legs require further investigation. In such cases, measure blood
pressure again.
•Persistent disparity may indicate coarctation of the aorta, which may require echocardiography. Immediately
notify the practitioner and document your findings.
 COMPLICATIONS
• Improper technique can cause inaccurate readings, which can lead to
unnecessary or inadequate treatment. Bruising and skin irritation may occur
from compression.
 DOCUMENTATION

•Document the date and time of the assessment.

•Record the child's blood pressure and level of activity, position during measurement, extremity
and site used, method used, and cuff size.
•Note changes from previous measurements and the child's response to any interventions.
•If you reported abnormal results, record the name of the practitioner and the date and time of
notification.
•Document teaching provided to the child (if applicable) and parents or guardians, their
understanding of that teaching, and any need for follow-up teaching.
 REFERENCES

• Lippincott