Blood Pressure
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Purpose: Taking patient vitals, such as blood pressure, are a great indicator for determining a patient’s general health or physiological status. Physical Therapists should be aware of abnormal blood pressure responses to exercise or other treatment activities. It may be necessary to modify or terminate treatment if these abnormalities are serious or persistent. Further, uncontrolled hypertension increases the risk for cardiovascular pathology.
Procedure: Patient Position: Position the patient sitting with the forearm supported on a firm object approximately at the level of the heart, with the thighs parallel to each other and the feet flat on the floor. The patient should not be talking and resting at least 5 minutes prior to taking his/her BP. Physical Therapist Position: Position yourself so that you are comfortable and can view the manometer gauge easily. If the patient is sitting or recumbent, you should sit facing the person. If the patient is standing, elevate the arm and support it between your arm and lateral area of the chest while you face the patient. Description: Applying the Blood Pressure Cuff and Stethoscope: 1. Expose the antecubital space of either the left or right arm; do not roll the shirt or blouse sleeve too tightly because it may partially occlude the artery. 2. Palpate the brachial pulse so you know where to place the diaphragm of the stethoscope. 3. Apply the deflated cuff to the arm with the center of the bladder over the medial aspect of the arm so it will occlude the artery when it is inflated. 4. The cuff should be applied approximately 2 ½ cm above the antecubital space (about 1 ½ finger widths) with the manometer attached to the cuff or placed so that the needle and scale can be observed easily without being held in your hand. 5. Apply stethoscope to ears with the earpiece directed forward. 6. Place the diaphragm on the skin where the brachial artery was palpated, but avoid contact with patient clothing or with the cuff. 7. Apply firm, but light pressure on the diaphragm to maintain contact with the skin. 8. To obtain the proper cuff, the bladder length should be at least 80% and a width of at least 40% of your patient’s arm circumference. 9. For new patients take BP twice on each arm, alternating between the right and left. Average each of the two measurements to obtain a right and left BP. 10. For existing patients, BP should be taken twice and averaged on the arm that exhibited the higher BP on the initial exam. Please ensure at least one minute between each trial. Occluding the Brachial Artery: 1. To determine the amount of pressure needed in the cuff to occlude the brachial artery, palpate the radial pulse and inflate the cuff by closing the valve on the inflation bulb and squeezing the bulb until the radial pulse is no longer palpable. 2. It is recommended to add 30 mm Hg to this value and this will serve as your baseline for the cuff-pressure inflation level. 3. Another method is to auscultate the brachial pulse and inflate 30 mm Hg above the point at which the tapping noise (Korotkoff) sounds disappear. Recording Systolic and Diastolic Pressure: 1. To deflate the cuff, release the valve on the inflation bulb so that the needle drops at the rate of 2 to 3 mm Hg per second. 2. Listen for normal Korotkoff’s sounds and mentally note the needle position when the initial sound is hear through the stethoscope. This is the systolic pressure value. 3. Continue to deflate the cuff, listening for the absence of the sound of a pulse or beat and mentally note the needle position. This is the diastolic pressure value. 4. Please deflate cuff completely when you are finished taking BP, remove it from the patient, and remove the stethoscope from your ears. 5. Record your results and whether the BP was at rest, during or post exercise. Additionally, indicate which arm was tested. 6. Clean the stethoscope earpiece and diaphragm with an alcohol wipe. Normal Response to Exercise: • SBP should increase and DBP should stay the same or a slight decrease. • SBP should gradually decline as the exercise intensity declines. • It should return to normal resting value within 3 to 5 minutes after termination of exercise. Abnormal and Normal Results: Classification of Blood Pressure Findings Systolic Blood Pressure (mm Hg)/Diastolic Blood Pressure (mm Hg) Normal: <120/<80 Prehypertension: 120-139/80-90 Stage 1: hypertension: 140-159/90-99 Stage 2: Hypertension: ≥160/≥100 Abnormal Response to Exercise
Pulse Pressure is defined as the force that the heart can generate each time it contracts
Key Clinical Points:
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Reference:
Pierson F, Fairchild S. Principles & Techniques of Patient Care. 3rd ed. Philadelphia, PA: Elsevier; 2002.
Frese EM, Fick A, Sadowsky HS. Blood pressure measurement guidelines for physical therapists.
Cardiopulmonary Physical Therapy Journal. 2011; 22(2): 5-12
Pierson F, Fairchild S. Principles & Techniques of Patient Care. 3rd ed. Philadelphia, PA: Elsevier; 2002.
Frese EM, Fick A, Sadowsky HS. Blood pressure measurement guidelines for physical therapists.
Cardiopulmonary Physical Therapy Journal. 2011; 22(2): 5-12
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