Blood Pressure

Blood pressure measures the force of the blood on the inside of the blood
vessel or the walls of the artery. This measurement shows how well the heart is
working. There are two parts of blood pressure: the systolic and diastolic
measurement. A blood pressure has two numbers. The higher number or
systolic measures the force when the heart is contracting. This measurement
should be under 130. The lower number or diastolic measures the force when
the heart muscle relaxes. This measurement should be less than 85.
Blood pressure is affected by time of day (low at night; peak about eight
hours after awakening); emotions (stress increases blood pressure); weight
(obesity typically increases blood pressure); activity level; excess sodium (salt)
intake; excessive alcohol consumption; and use of certain drugs, including birth
control pills, steroids, decongestants, and anti-inflammatory medications.
If high blood pressure is suspected or has been diagnosed, the doctor may ask
the DSP to take consistent readings under the same conditions over a period of
time. Blood pressure should be measured with the same device, at the same
time of day, on the same arm (or leg), and with the individual in the same position
(for example, sitting up). Mark down anything that might have affected the blood
pressure, such as exercise (for example, the individual came in 10 minutes after
riding a bike). In these situations, the DSP will follow the doctor’s instructions for
taking blood pressure and documenting blood pressure readings.
A blood pressure is taken with a stethoscope and a blood pressure cuff
(commonly called a sphygmomanometer). The cuff has an inflatable balloon
inside and it expands when air is pumped into the cuff. There are two pieces of
tubing connected to the cuff. One leads to a rubber bulb that pumps air into the
cuff. A pressure control button lets you control the release of air from the cuff.
The other piece of tubing is connected to a pressure gauge or dial with numbers.
There may be electronic blood pressure cuffs available. There are a variety of
these available, some automatically inflate and deflate, some are placed on the
finger, wrist, or arm. All units display the blood pressure (systolic and diastolic)
and pulse readings digitally. Follow the manufacturer’s instructions for the proper
use of this type of equipment.

Refer to worksheet “Reading a Manometer” to learn how to read the

gauge/dial on the blood pressure cuff.
How to take an individual’s blood pressure:
􀂾 Clean ear pieces and diaphragm of stethoscope with alcohol and cotton
balls. The diaphragm is the larger round side of the stethoscope.
􀂾 Locate brachial pulse on the inside of the elbow. It is about one to one
and a half inches above the elbow; you should be able to feel a strong
steady pulse with two or three of your fingers.
􀂾 Wrap and fasten deflated cuff smoothly and snuggly around persons
upper arm. (Place cuff at least one inch above elbow; point arrow on cuff
at brachial pulse)
􀂾 Place ear pieces of stethoscope in your ears
􀂾 Place diaphragm of stethoscope over the brachial pulse
􀂾 Close valve on air pump (turn knob to the right to close)
􀂾 Pump air to inflate cuff until the dial points to 170
􀂾 Deflate cuff slowly and at a constant rate (turn knob to the left slowly)
􀂾 Watch numbers as needle falls
􀂾 Listen for the first thumping sound
􀂾 Note number where first thump (systolic pressure) is heard
􀂾 Note number where last clear thump (diastolic pressure) is heard
􀂾 Deflate cuff completely
􀂾 Document and report any abnormal readings
Learning to take an accurate blood pressure with a manual cuff takes time and
practice. Be patient, the more you practice the more information you will gather
about the person. Here are some common errors to avoid:
􀂾 Not squeezing all the air out of the cuff before putting it on the arm
􀂾 Not putting cuff high enough on the arm
􀂾 Not putting the cuff tight enough on the arm
􀂾 Not keeping the stethoscope pressed firmly against the pulse on the inside
of the elbow
􀂾 Trying to hear pulse before inflating the cuff
􀂾 Letting the air out too quickly
􀂾 If you hear nothing…adjust the earpieces on the stethoscope by pushing
them forward
After Completing any Procedure:
􀂾 Wash Hands

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􀂾 Document
􀂾 Report abnormal readings
􀂾 Clean and put away equipment

Steps

1. 1

Remove the cuff, stethoscope, pressure gauge, and bulb (also known as a "bladder") from the kit,
taking care to untangle the various tubes.

2. Sit down at a table or desk where you can easily rest your arm so that when you bend your elbow,
your elbow is parallel to your heart. (Some experts recommend you use your left arm; others suggest
you test both arms. But while you're first adjusting to self-testing, use the left arm if you're right-
handed, or vice versa.)
3. Bend the arm you're going to test.
4. Wrap the cuff around your upper arm (upper middle arm), slipping the top part of the cuff through
the metal bar that's attached to the cuff. If your shirt has long sleeves, roll them up first. You can put
the cuff over very thin clothing. Most cuffs have Velcro, making it easy to keep the cuff in place.
5. Make sure the cuff is snug, but not too tight -- if you cut off your circulation and become agitated,
you're going to get an alarming blood pressure reading!
6. Gently put the earpieces of the stethoscope in your ears. They should feel comfortable in your ears. If
not, try holding the stethoscope out in front of you and slightly shifting the earpieces away from you
7. Place the wide head of the stethoscope (the diaphragm) entirely on your skin just above the elbow,
on the inside of your now straightened arm; the brachial artery. Do not hold the head of the
stethoscope with your thumb-your thumb has its own pulse and this will confuse you while you try to
obtain a reading. A good method is to hold the chest piece between your index and middle fingers with
your fingertips in the vertical space between the diaphragm and bell. You will not normally hear a
thumping until you have begun to inflate the cuff. To aid in finding this you can press two fingers (not
your thumb) to the area where it should be and move around until you feel a pulse.
8. If the pressure gauge is clipped to the cuff, unclip it and attach the clip to something sturdy, such as a
hardcover book, that you can place on the table so you can watch it. It's important to keep the gauge
anchored and stable. Make sure there is adequate light and you can see the needle and pressure
markings well before you begin to test.
9. Take the rubber bulb and tighten the valve at the base. Be sure to turn the valve all the way clockwise
to shut it off so that air doesn't escape when you pump. Do not over-tighten the valve. This is key,
doing so will not allow you to release air from the cuff slowly enough at first. This is because you will
twist it open too far and let out air too fast due to the force needed to open it. Only turn the valve
closed until you feel it stop.
10. Pump the bulb using slow but very steady pressure until the needle on the gauge is at about 20-30
points above your usual systolic (top) number. Now, gently turn the bulb's valve counter-clockwise
slightly so that air is released slowly and steadily. Doing this yourself as you listen is a little tricky, you
should release the valve with the hand on your cuff arm and hold the stethoscope with your free
arm. The needle should ideally be moving down at a rate of two marks per second for accuracy.
11. As you watch the needle fall back down the gauge, listen for a thumping sound (The clinical name for
this is "Korotkoff sounds"). Keep your eyes on the gauge -- when you first hear thumping, you have
your systolic number, which represents the greatest amount of pressure exerted on the artery walls as
your heart pumps blood.
12. Keep watching the gauge and listening to the beats. Eventually the hard thumping sound will turn into
a "whooshing" sound (these are called the 4th Korotkoff sounds). These sounds are helpful to listen to
because they tell you that you are close to your diastolic blood pressure. When the thumping fades to
silence, you have your diastolic (bottom) number, the lowest amount of pressure.
13. If you miss the exact measure of either number, it's perfectly acceptable to pump the cuff back up a
little to catch it. Just don't do it too much (like more than twice) because that can affect accuracy.
Switch to the other arm in that event and start again.

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Tips

 For best results, take a second reading five to ten minutes after your first reading. (You may want to test
your other arm, too, for the second reading. This may also be a good idea if your first reading was
abnormal) Blood pressure fluctuates within minutes (sometimes dramatically), and if you take two
readings within about a ten-minute period, you can come up with an accurate average number.
 You may want to check your blood pressure about fifteen to thirty minutes after exercising (or
meditating or other stress relief activities), to see if there is an improvement in your numbers. There
should be an improvement, which will provide good incentive to keep up your exercise regimen!
(Exercise, like diet, is key to controlling blood pressure.)
 It may also be a good idea to take readings in different positions: standing up, sitting and lying down
(possibly having someone do it for you there). These are called orthostatic blood pressures and are
helpful for determining how your Blood Pressure varies by position.
 Take a reading when you're especially relaxed: that will give you an idea of how low you can go. But
also force yourself to take a reading when you're upset, as unpleasant as that thought is; you need to
know how high your blood pressure goes up when you're angry or frustrated.
 Give this diary to your doctor at your next appointment. Your doctor may be able to glean an important
pattern or clue to your fluctuations in blood pressure.
 Accept the fact that the first few times you try using a sphygmomanometer you'll likely make some
mistakes and become frustrated. It takes a few tries to get the hang of this. Most kits come with
instructions; be sure to read them.
 Keep a diary of your blood pressure readings. Note the time of day when you took the reading and
whether it was just before you ate, before or after exercise, or when you were agitated.
 If you don't prefer saying "Blood Pressure Cuff", then here is the pronunciation for Sphygmomanometer
according to dictionary.com:

Edit Warnings

 Your blood pressure becomes elevated when you smoke, eat, or consume caffeinated beverages. You
may want to wait until an hour after smoking, eating, or drinking coffee or cola, to take a reading.
 Do not hold the bell (aka. "head", "diaphragm") of the stethoscope with your thumb. The thumb has a
beat of its own, which may interfere with the reading. Always two fingers.
 Self checking with non-digital blood pressure cuff is unreliable. It's better to have a friend or family
member who knows how to do it assist you.
 Conversely, you may want to check your blood pressure just after smoking -- the elevation in numbers
will be another inducement to kick the butts. (The same goes for caffeine if you know you're addicted to
coffee or caffeinated sodas; and for salty foods, if snacks like chips and pretzels are your Achilles heel.)

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