Blood Pressure Measurement Techniques

This assignment focuses on the technique of manual blood pressure measurement. It outlines the steps involved, emphasizes the importance of accurate cuff size selection and deflation rate, and highlights potential sources of error during measurement. The document also explores the significance of auscultatory gap avoidance, Korotkoff sound phases, patient stabilization time, and the guidelines for measuring blood pressure in both arms. Risk factors and symptoms of hypertension are also addressed.

Lesson Plan – Manual Blood Pressure
Measurement
1

Learning program How to perform a blood pressure test
Session title Teach one student theoretical and practical aspects for performing manual blood pressure measurement.
Date 03/11/2017
Time 0900hrs- 1000hrs
Duration 60 minus
Venue Tutorial Room
Venue set up requirements Table, Chairs, Lap top, Pens, Projector, Parameter chart, Sphygmomanometer, BP cuff, Stethoscope, Alcohol
wipes.
Participant description A year one nursing student 19 years girl. She is study in Nanyang polytechnic. This is her first-time clinical
attachment in the ward.
Participant numbers One
Prerequisite knowledge or
skills
A year one student already have the basic knowledge of blood pressure measurement and cardiovascular
system.
Resources required Handouts, Article, Book, Power point, Paper.
Aim of the session Student nurse able to perform blood pressure measurement at the end of this session.
Learning outcomes Student nurse able to verbalise normal and abnormal blood pressure.
Student able to discuss the purpose and importance of blood pressure measurement.
Student nurse able to perform manual blood pressure measurement correctly and independently and
contribute in the clinical setting for blood pressure measurement.
Student nurse able to corelate blood pressure values with health condition of the patient.
Student nurse able to administer or change medication based on the BP value.

Structure of session
Component Time allocation Strategy
Opening
Engagemen
t of
learners
2mins Introduction
-self introduction of name, age, education level, social background.
-outline the objective of this topic.
Assess prior
knowledge
8mins Questions:
-what is the normal range of blood pressure?
-what are the factors will affect blood pressure?
- why it is necessary to measure blood pressure on regular basis?
- whether patient should be sitting or standing while measuring blood pressure?
- whether patient should be talking or calm while measuring blood pressure?
-what have you learned in school about blood pressure measurement?
-5mins quiz before start the session.
Body
Time Content Learning
activity
Rationale
supported by
literature
Identify
chosen
educational
theory
Physical resources
required
Question/Anticipated
difficulties
5mins Blood pressure is one of the
vital signs for the
assessment of human
health. Disorders related
to blood pressure can be
classified into hypotension
and hypertension. In
hypotension, there is
decrease in blood pressure
and in hypertension there
is increase in blood
pressure. Most prevalent
Power point/
Book
To understand
the
physiological
and
pathological
aspects of the
cardiovascular
system. It would
also be helpful
in identifying
reasons behind
abnormal
Cognitivism Lap top What is the upper
and lower limit of
abnormal blood
pressure ?
What should be BP
range for
implementing lifestyle
intervention and what
should be BP range
for implementing
therapeutic

condition is hypertension.
Two types of blood
pressure can be measured.
These include systolic and
diastolic blood pressure.
Maximal blood pressure
which occurs after
ventricle ejects into aorta is
called as systolic pressure.
The lowest pressure which
occurs prior to ejection of
ventricle into aorta is called
as diastolic pressure.
Normal range of blood
pressure : Blood pressure
ranges between systolic
120 mmHg and diastolic 80
mmHg.
Difference between the
systolic and diastolic blood
pressure is called as pulse
pressure and it is generally
40-50 mmHg.
Factors which affect blood
pressure include : smoking,
lack of physical activity,
overweight or obesity,
excessive consumption of
alcohol, excess amount of
salt in the diet,
psychological stress, older
age and genetic factors.
Previously, more attention
is used to be given to
increase or
decrease in
blood pressure.
(Bassett &
Pack. 2011).
intervention?
What are the
aetiological factors
responsible for
deviation from the
normal blood
pressure?
What are different
blood pressure ranges
for classifying BP
patients as mild and
severe BP patients ?
Are there different
factors responsible
for abnormal changes
in systolic and
diastolic blood
pressure?

diastolic blood pressure,
however now a days,
systolic blood pressure is
also considered as
important diagnostic tool.
With each heartbeat, BP
oscillates between systolic
and diastolic blood
pressure (Weber and
Drayer, 2013)
5 mins Blood pressure
measurement is important
because increase in blood
pressure can augment risks
of health problems in the
future. Rise in blood
pressure can put additional
strain on the arteries and
heart. In long term, this rise
in blood pressure either
cause arteries to become
thicker or weaker. There
may be loss of flexibility of
thicker arteries and these
become narrower and
clogged up. Consequently,
there can be occurrence of
diverse adverse health
conditions like heart attack,
stroke, and kidney disease.
Weaker artery can lead to
bursting which can result
in heart attack or stroke.
Power point To know the
baseline blood
pressure value
and based on
the baseline
values
abnormal
conditions of
the person can
be predicted. To
understand
extent of rise in
blood pressure
and accordingly
to decide upon
whether it
require lifestyle
intervention or
medical
intervention
(Stockley.
2013).
To plan for the
preventive or
Cognitivism Lap top What should be the
frequency of BP
measurement in
patients with
hypertension?
What should be gap
between two BP
measurements in the
same person?
For how much
duration, we can
consider or use
measured BP value ?
Which disease
conditions can
exaggerate if BP is not
measured for the
longer duration ?
Can I change
medication without

Overestimation of blood
pressure by 5 mmHg can
lead to unnecessary
treatment with
antihypertensive drugs
which can lead to adverse
effects, psychological stress
and extra financial burden.
Even though, there is
normal blood pressure in a
person, blood pressure
measurement is important
because it gives idea about
normal health condition of
the person.
There is possibility of
increase in blood pressure
without display of signs
and symptoms. Hence, BP
should be measured to
understand problem in the
patient.
BP controls whole body
and even there is
possibility serious
emergency conditions like
fainting and paralysis in
hypertensive patients.
High BP has direct effect on
functioning of kidney
which is one most
important elimination
organ in human body
(Beevers et al., 2014).
therapeutic
measures to
stabilise blood
pressure of the
patient
(Wallymahmed.
2008).
To provide
early
intervention to
the patient
(Alexis. 2009).
To prevent
patient from
occurrence of
other
cardiovascular
conditions.
measurement of the
BP ?

10 mins Demonstrate the correct
technique of performing
manual blood pressure
measurement:
1) Blood pressure cuff
size should not be
less than 80 % of
the arm size and it
should not be more
than 100 % of arm
size. There are
different sizes of
cuff are available
based on the size.
Small – 17 – 22 cm,
Medium – 22 – 32
cm, Large – 32 – 42
cm (Geddes, 2013.)
2) Brachial artery is
Blood pressure
cuff size should
be selected
based on the
size of the arm.
Arm
measurement
should be done
midpoint
between
shoulder and
elbow and
based on this
measurement
cuff size should
be selected.
BP cuff should
If cuff size is
less than 80 %,
air bladder may
cover arm and
blood vessels
would not get
covered by cuff.
Inflation of cuff
may occur and
blood pressure
monitor would
give higher
reading than
actual BP. If cuff
size is more
than 100 % , air
bladder in the
cuff gets overlap
and inflation of
cuff may occur.
It may result in
decrease in
blood supply
and BP monitor
would give less
reading. (Alexis.
2009).
Pulse of the
Cognitivism Sphygmomanometer,
Stethoscope, BP cuff
Alcohol swab.
What is procedure to
measure correct BP
cuff ?
Is there any
significance of using
correct BP cuff ?
What is the exact

the major artery in
the upper arm and
this the ideal place
for measurement of
blood pressure
using cuff method
(Geddes, 2013)
3) During BP
measurement
listening to the
stethoscope and
observing
sphygmomanometer
should be
simultaneously
performed. First
knocking sound like
korotkoff reflects
systolic blood
pressure while
disappearance of
the sound reflects
diastolic pressure
(Muruganathan,
2016).
be kept
midpoint
between
shoulder and
elbow of the
upper arm.
Stethoscope
diaphragm
should be kept
over brachial
artery at the
edge of BP cuff.
brachial artery
are palpable on
medial tendon
of biceps and
anterior part of
the elbow.
Hence, it can
give accurate BP
measurement.
(Perry. 2015).
Korotkoff
sounds can be
listened in five
phases. In first
phase faint,
repetitive,
strong beat
sound appears
which gradually
increases for
minimum two
beats. In second
phase sound
gets soften and
acquire
whistling
quality. In third
phase, sounds
get sharper and
more intense
comparable to
position for the
measurement of BP ?
Why brachial artery is
the correct position
for the measurement
of BP ?
What are the other
locations where I can
measure BP ?
How can I confirm
Korotkoff sound ?
Can I measure BP
without knowledge of
Korotkoff sound ?
Are there different
Korotkoff sounds for
systolic and diastolic
blood pressures.
What should be the
exact position of
stesthoscope ?

or more than
phase one
sounds. In
fourth phase,
sounds start
disappearing. In
fifth phase,
sounds
completely
disappears.
(Bonewit-West.
2015).
15mins Demonstration on blood
pressure measurement
using live demo and video
demo.
Practice To improve
practical
knowledge and
management of
clinical skills. To
apply
theoretical
knowledge in
actual clinical
practice. (Khan,
Ali, Vazir,
Barolia &
Rehan. 2012).
Cognitivism Sphygmomanometer,
Stethoscope, BP cuff
Alcohol swab
Student may feel
difficulty in following
the correct technique
of manual blood
pressure
measurement
2mins Documentation of blood
pressure in case file of the
patient. Blood pressure
record in both paper and
electronic form.
Show the
example of
documentation
of blood
pressure
To provide vital
information for
correct
treatment. To
keep back up
for measured
reading. To
provide
Cognitivism Parameter chart Student will feel
difficulty to document
it in time

information for
the future
treatments.
(Rushton &
Smith. 2015).
Conclusion Time Strategy
Summarize the
topic
3 min I got adequate knowledge about the physiological and pathological aspects of the blood pressure. After
this lesson, I am well versed with the both theoretical and practical aspects of the blood pressure
measurement. I can effectively implement this technique in actual clinical practice. I understand
importance of accurate blood pressure measurement and precautions need to be taken for accurate
blood pressure measurement. I can corelate BP values in a patient with his/her health condition and I
can change medications accordingly. I am completely convinced that, there should be regular BP
measurement in patients with cardiovascular abnormalities.
Assessment of
learning
Strategy
Return
demonstration
and evaluate
self-
performance
10mins Following is the checklist for measurement of BP:
Preparation of patient:
 Enquire patients whether he/she consumed coffee prior to 60 minutes and exercised 30 minutes
prior.
 Ensure patients is sitting quietly 5 minutes prior.
Selection of correct size of BP cuff:
 Measurement of size of upper arm.
Checking of equipment:
 Ensure mercury column is at zero.
 Ensure availability of stethoscope.
Correct position of patient and equipment:
 Removal of sleeve and not the rolling it up.
 Patient comfortably sitting in chair with back support.
 Feet of the patient flat and uncrossed legs.

 Arm in the bent position with palm up.
 Manometer in the eye sight of nurse.
 Brachial artery palpitation.
 Positioning of cuff’s bladder centre over the brachial artery.
 Positioning of cuff one inch above bend arm.
Measurement of accurate BP :
 Palpitation of radial artery pulse.
 Inflation of the cuff to the point where there is disappearance of pulse.
 Rapid deflation of cuff to the point of reappearance of pulse.
 Determination of rapid inflation level.
 Waiting time of 15-30 seconds prior to reinflation.
Other accessories:
 Paper and pen for recording BP.
 Cleaning diaphragm of stethoscope with alcohol.
Quiz :
 How many BP measurements need to be taken during BP measurements?
 Which are the potential errors can occur during BP measurements?
 Whether rounding off the BP measurement values need to be done ?
 What should be rate of cuff deflation ?
 What is the procedure for selection of correct cuff size?
 What are the guidelines available for the measurement of BP ?
 How to avoid auscultatory gap ?
 What are the different phases of Korotkoff sound ?
 How much time patient need to stabilize prior to BP measurement ?
 Whether BP should be measured in both arms or one arm ?
 What are the risk factors for hypertension ?
 What are signs and symptoms of hypertension ?
References:

Alexis, O. (2009). Providing best practice in manual blood pressure measurement. British Journal of nursing, 18(7).
Doi:http://dx.doi.org.ez.library.latrobe.edu.au/10.12968/bjon.2009.18.7.41654.
Beevers, D. G., Lip, G. Y. H., & O'Brien, E. T. (2014). ABC of Hypertension. John Wiley & Sons.
Bonewit-West, K. (2015). Clinical procedures for medical assistants (9th ed). London: Elsevier Health Sciences.
Bassett, S & Pack, P. E. (2011). CliffsNotes Anatomy and Physiology Quick Review. Hoboken: Wiley.
Geddes, L. A. (2013). Handbook of Blood Pressure Measurement. Springer Science & Business Media.
Khan, B. A., Ali, F., Vazir, N., Barolia, R & Rehan. (2012). Students’ perception of clinical teaching and learning strategies: A
Pakistani perspective. Nurse education today. 32(1).85-90. Doi:10.1016/j.nedt.2011.01.016.
Muruganathan, A. (2016). Manual of Hypertension. JP Medical Ltd.
Rushton, M & Smith, J. (2015). How to measure blood pressure manually. Nursing standard. 30(21). 36-39.
Perry, A. G. (2015). Nursing intervention and clinical skills. Saint Louis: Elsevier Health Sciences.
Stockley, M. A. (2013). Blood pressure measurement. The Gale Encyclopedia of Nursing and Allied Health. 511-513.
Wallymahmed, M. (2008). Blood pressure measurement. Nursing standard. 22(19).45-48.
Weber, M.D., & Drayer, I.J. (2013). Ambulatory Blood Pressure Monitoring. Springer Science & Business Media.