Nursing 521L: skill

Blood Pressure Cuff Preparation

  • Check for faults: When starting, ensure that there are no leaks or issues with the cuff. If there are any problems, notify instructor for replacement.

  • Valve adjustment: The valve on the bulb must be closed before pumping.

  • Tightening process:

    • Righty tighty, lefty loosey: Turn to the right to tighten; after achieving tightness, slightly loosen to avoid difficulty when releasing air.

    • New cuffs can be tight; practice using the pump frequently to develop muscle memory for gradual inflation and deflation awith the dial.

Sphygmomanometer Overview

  • Reading blood pressure: The sphygmomanometer is marked with numbers, long lines, and short lines for measurement.

    • Long lines represent increments of 20.

    • Short lines between long ones indicate increments of 2 mmHg.

  • Odd and even numbers:

    • Manual readings will always result in even numbered blood pressures.

    • Automated machines can give odd numbers.

  • Cuff size importance: Correct cuff size is crucial for accurate blood pressure readings. Misfit cuffs can lead to incorrect readings.

Cuff Size Guidelines

  • White line on cuff: Indicates the correct placement and fit for the patient’s arm.

    • Ensure it covers about 40% of arm circumference.

  • Ensure line within range: The white index line should fall within the indicated range on the cuff.

    • Adjust size as needed for accurate reading.

Stethoscope Components and Use

  • Earpieces: Must be positioned correctly in the ear for proper sound reception. The holes should face away from the user’s face.

  • Diaphragm vs. Bell:

    • Diaphragm: Larger end used for higher-frequency sounds (e.g., heart sounds).

    • Bell: Smaller end used for lower-frequency sounds.

  • Switching between ends: Hold the tubing, twist to switch between diaphragm and bell, ensuring it clicks.

Vital Signs Overview

  • Definition: Vital signs include heart rate, respiratory rate, blood pressure, temperature, and pain.

  • Expected ranges:

    • Pulse: 60-100 bpm.

    • Respiratory rate: 12-20 breaths per minute.

    • Blood pressure: Average is 120/80 mmHg, acceptable range is 90/60 - 140/90.

    • Temperature range: Normal being around 97-99°F (average 98.6°F).

Techniques for Measuring Respiration

  • Counting method: Count without letting the patient know, to avoid influencing their breathing.

  • Using alternate distractions: Observe physiological indicators while engaged in other assessments (e.g., blood pressure).

Blood Pressure Measurement Technique

  1. Preparing the patient: Ensure patient is comfortably seated and relaxed.

  2. Locating the brachial artery: Important for proper cuff placement on the arm.

  3. Cuff application:

    • Place cuff with arrow over the brachial artery, one inch above it.

  4. Pump procedure:

    • Inflate until the sound disappears, then slowly release to find systolic (1st sound) and diastolic (last sound) pressures.

  5. Expected sounds:

    • First sound heard indicates systolic pressure; last sound indicates diastolic pressure.