Archive:Blood pressure: Difference between revisions
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==Performance== | ==Performance== | ||
*palpate radial pulse (note | *palpate radial pulse (note ''arrythmias'') | ||
*inflate cuff to ~ 30 mm Hg above palpable pulse | *inflate cuff to ~ 30 mm Hg above palpable pulse | ||
*drop the pressure by 2 mm Hg / second (prolonged filling will lead to venous congestion, making the sounds harder to hear) | *drop the pressure by 2 mm Hg / second (prolonged filling will lead to venous congestion, making the sounds harder to hear) | ||
*repeat '''after ≥ 2 minutes''' of standing to assess for '''orthostatic hypotension (drop in 20/10)''' | *repeat '''after ≥ 2 minutes''' of standing to assess for '''orthostatic hypotension (drop in 20/10)''' | ||
*for all patients on the | *for all patients on the first visit, take at least '''2 readings separated by 2 minutes''' | ||
**if first 2 readings differ by > 5 mm Hg, another reading is indicated | **if first 2 readings differ by '''> 5 mm Hg''', another reading is indicated | ||
**Elevated readings should be '''confirmed on 3 readings''' | **Elevated readings should be '''confirmed on 3 readings''' | ||
Revision as of 02:18, 22 May 2007
Taking a Blood Pressure
General
- No:
- smoking or caffeine x 30 mins
- constrictive clothing
- Yes:
- rest for ≥ 5 minutes
- breathing normal and relaxed
- During recording: no talking and patient’s legs uncrossed
Equipment
- cuff size
- bladder width > 40 % of arm circumference
- length > 80% of arm circumference
Positioning
- Level: devices and columns at eye level, patient’s arm held at heart level
Placement
- lower edge of cuff ~ 3 cm above elbow crease
- bladder centered over brachial artery (palpate medial to biceps tendon)
Performance
- palpate radial pulse (note arrythmias)
- inflate cuff to ~ 30 mm Hg above palpable pulse
- drop the pressure by 2 mm Hg / second (prolonged filling will lead to venous congestion, making the sounds harder to hear)
- repeat after ≥ 2 minutes of standing to assess for orthostatic hypotension (drop in 20/10)
- for all patients on the first visit, take at least 2 readings separated by 2 minutes
- if first 2 readings differ by > 5 mm Hg, another reading is indicated
- Elevated readings should be confirmed on 3 readings
Pitfalls
- anxiety, pain
- arrhythmias
- wrong cuff size (too small overestimates, too large underestimates)
- white coat hypertension (up to 25%)
Classification
(criteria for adults > 17 and not taking antihypertensives)
- OPTIMAL < 120/80
- NORMAL < 130/85
- HIGH NORMAL < 140/90
- HTN STAGE 1 < 160/100
- HTN STAGE 2 < 180/110
- HTN STAGE 3 < 210/120
- HTN STAGE 4 > 210/120
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence