*****************When does blood pressure peak? Blood pressure is lowest in the morning and peaks in late afternoon or evening. There are some unexpected blood pressure outcomes that make the blood pressure high.
You should check if the arm was supported and don't abduct the arm. Check if the blood pressure cuff was too narrow. Check if the cuff was deflated too slowly.
If the blood pressure is coming out as an unexpected outcome then ask if the person has pain or if they are anxious or if they just exercised or if they had just eaten or smoked.
In this case I would recheck the blood pressure and use the pressure as indicated. In this case you have to check the blood pressure on both arms as the normal difference from one arm to another arm is no more than five points.
It is also important to identify if the stethoscope was placed correctly on the brachial artery.
Hypotension take all blood pressures vs take more frequently (such as every 15 mins to 2 hrs) until the blood pressure is stable.
Place the patient in supine position with the lower extremities elevated 45 degrees and the head and the pillow. Assess the cause of hypotension.
**************When to check vital signs
Supine and prone are opposites.
When a patient comes back from the operating room check postoperative patients for signs of bleeding. If a patient comes back with internal bleeding, hypotension or tachycardia you must take the vitals signs.
You have to take the blood pressure, the pulse, the temperature and ask about their pain.
Although the vital signs yield important information in and of themselves compare the patient's vital signs with the patient's diagnosis, lab tests, history and records.
**********What does taking a blood pressure sound and feel like?
When putting on the blood pressure cuff the velcro goes on the outside and fits on the middle of the arm.
Make sure that you line up the artery on the dot here and don't take the blood pressure through clothing the patient or you has to roll up their sleeve. Now measure antecubital to the shoulder.
Bring the cuff around and the dot where the brachial artery is the velcro is on the outside. Secure the cuff and use two of your fingers to slide in to make sure it is two fingers loose I put in two fingers.
To take a blood pressure I must support his arm with the joint or support the arm on the table.
I need to be able to palpate a pulse. You ask the patient what is your normal blood pressure. The systolic is the contraction and the diastolic is the resting period.
When you blow up the cuff you're putting pressure on the artery so no more than 30 above his normal systolic.
So only go 30 above his normal blood pressure so if it is normally 120 I can go to 150 and stop.
I've occluded the artery when I move the cuff up 30 mm Hg above now listen for the first sound.
The systolic I hear the blood going through the pressure in the bladder and cuff and machine are equal and the blood starts to be equal.
I hear lub dub now I can't hear it because there is no occlusion now the blood is flowing freely (after the pressure is released.)
Now there is no more occlusion because now the pressure has been released.
The bottom number is the last sound that you hear and that is the diastolic when there is no more occlusion there.
***********How is blood pressure taken?
First off you feel his pulse. Then when you have the pulse you blow up the cuff. I still feel a radial pulse as soon as I don't feel a pulse any more I am going to go up 30 mm Hg more and I am going to lock it there.
Now the pulse when you can't feel it you go 30 above and stop it.
The bulb is closed and now blow up your cuff and quickly take the stethoscope and place it in your ears and place it on the artery and let the air out slowly and listen for the first sound which is the systolic and listen for the last sound which is the diastolic.
You have to get used to palpating a pulse. You will put the stethoscope a little below the arm and put it three inches from the crack of the arm on the inside of the arm. You get to play with this a lot in clinical.
***********Vital Signs from a movie on vital signs
This is taken from Lippincott's Video Series for Nursing Assistants.
The doctors depend upon my vital signs measurements. So you have to wash your hands and gather needed supplies and always knock before entering a person's room.
Introduce yourself with your name and your title.
Identify the person and explain the procedure and provide privacy closing the door and the curtain.
Then drape the person for modesty and see to safety and do equipment use and infection control measures before taking the vital signs.
