Nursing Assessment Tool: Sphygmomanometer Analysis Report

This report provides a comprehensive overview of the sphygmomanometer as a crucial nursing assessment tool. It begins by introducing the context of nursing assessments and the importance of tools like the sphygmomanometer in ensuring patient safety and effective care. The report then describes a clinical scenario involving a 56-year-old patient with a history of hypertension and stroke, emphasizing the sphygmomanometer's role in evaluating the patient's condition. The report details the sphygmomanometer's function, including its manual and digital variations, and the rationale behind its use in the described situation. A critical analysis of the assessment tool follows, discussing its reliability, validity, advantages, and disadvantages, as well as factors that can influence its accuracy. The report also touches upon the historical development of the instrument, comparing manual and digital methods, and emphasizing the importance of proper maintenance and calibration for accurate results. The report highlights the importance of the sphygmomanometer in diagnosing and monitoring conditions like hypertension. Overall, the report provides a detailed examination of the sphygmomanometer's role in clinical practice, its strengths, and its limitations.

Running Head: NURSING ASSESSMENT TOOL
SPHYGMOMANOMETER
Name of the Student
Name of the University
Author’s Note

1
NURSING ASSESSMENT TOOLS
Introduction
The profession of nursing has different segment that needs to be understood to be an
efficient performer. Nursing assessment is the foundation of patient safety and care, which is
done with the help of assessment tools. It is the collection of data about a patient’s psychological,
spiritual, physiological and sociological status by a registered nurse (Wu et al. 2016). It is the
first step in the process of nursing because it is the foundation of any treatment or evaluation,
which decides the efficiency of the future stages. The nursing assessment tool differs in
functionality because sometimes it has a broad scope of view and at times it is focused on a
specific body part or a system. It is also utilized for identifying the future and current trends in
the area of practicing. Some of the assessment tools are thermometer, sphygmomanometer,
penlight, otoscope, stethoscope, eye charts, speculum and bladder scanner. All these are designed
for different organs and bodily functions that diagnoses or gives an idea about the health status of
a person (Ličen and Plazar 2015.
This essay will discuss about the assessment tool known as sphygmomanometer, which is
used for evaluating the blood pressure of patients. It will have its description and the description
of the situation where it was used, critical analysis of the instrument, reliability, and validity. The
confidentiality of the patient’s information will maintained under the confidentiality clause, so a
pseudo name will be given to the patient.
Description of care situation
Nurses during their shift hours experience numerous cases that increases their exposure to
clinical practice. A similar scenario occurred in a geriatric ward when a patient was admitted
during an emergency. As a nurse, it is a common situation to see such patients and this patient

2
NURSING ASSESSMENT TOOLS
was suffering from breathlessness and left chest pain, which made him feel extremely uneasy.
The moment he was admitted he needed to be assessed and evaluated so that his treatment could
be started for positive patient outcome. He was a 56 year old man with a medical history of
diabetes mellitus type 2, blood pressure and an incident of stroke. He was a manager in a
restaurant, which made his schedule tiring and sedentary. He has a routine of sitting in his
workplace all day and consuming fast food that is making his dietary intake full of saturated fats
and refined foods. This is the major reason he is not able to keep his health in control and keeps
having such episodes of medical illness. His condition was critical when he was admitted and his
vital signs needed to be identified and after using various assessment tools his condition was
getting in control, which made him take medications. One of the assessment tool that was used
was known as sphygmomanometer (Wohlfahrt et al. 2016). This assessment tool is used to
measure the blood pressure of a person when there are symptoms of high or low blood pressure.
He needed to be assessed because he had a medical history of blood pressure, which can be
measured with the help of a sphygmomanometer and he was also vulnerable to stroke. The
assessment tool used is an important factor in this situation because the patient’s diagnosis
depends on that. His blood pressure was 170/90 mm/Hg, blood glucose was 110 mg/dl, his pulse
rates were 99 bpm and his respiratory rate was 30 breaths per minute. This evaluation did not
show a positive picture about his condition, which was done through several assessment tools but
sphygmomanometer was a significant tool during this case. The patient needs to be kept under
strict monitoring and surveillance because this is a critical condition as diseases due to high
blood pressure and heart complications can turn fatal. After the treatment he needs to be taken
for the follow up so that his health condition can be managed. Sphygmomanometer is a

3
NURSING ASSESSMENT TOOLS
necessary tool for this condition because he is patient with hypertension that makes it necessary
for his blood pressure to be assessed in certain intervals.
Description of the Assessment Tool
A blood pressure meter, blood pressure gauge, and blood pressure monitor is also known
as sphygmomanometer that is used to measure the blood pressure, which is the speed of the
blood from the heart to the other parts of the body. The device consists of an inflatable cuff that
is used to collapse and later release the artery below the cuff, which is done in a controlled
manner, the pressure is measured with the help of mercury or a mechanical manometer (Pukall
and Naef 2015). The overall machine has an inflatable cuff, a measuring unit (mercury
manometer or an aneroid gauge), an in built mechanism for inflation, which is a manually bulb
that is operated manually, electrically operated valve or a pump. Manual sphygmomanometers
are used with the help of stethoscopes. It is used to determine the pressure at which the blood
flow starts and the pressure at which it is unimpeded. There are 2 types of sphygmomanometer,
one is manual and the other one is digital. Both of them have different mechanism and they
require different effort and experience (Mcdougall et al. 2014). The rationale for choosing this
instrument is that it is an accurate method to determine the condition of the patient’s blood
pressure because that is the major way to find out the reason for his breathlessness.
This instrument was discovered by Samuel Siegfried Karl Ritter von Basch during the
1980s. After several researchers and scientists giving their inputs and new developments in the
machine, finally in 1981 Donald Nunn invented the first fully automatic oscillometric blood

4
NURSING ASSESSMENT TOOLS
pressure cuff. It was designed to measure the heart rates including diastolic and systolic blood
pressure (Shahbabu et al. 2016).
The cuff is used to smoothly place around the upper arm of a person and in the same
height as the heart, roughly. The subject should be seated while supporting the arm, the other
sites of the placement is dependent on the species and might be the tail. The correct size of the
instrument should be used depending on the patient because the small length of the cuff can lead
to high blood pressure and the cuff that is too large leads to a low blood pressure (Wibmer et al.
2015). During the initial diagnosis sessions, both the arms are measured to find out the difference
between both the results. A difference of 10 mm/Hg between both the arms can signify
coarctation of the aorta. When the manual instrument is used, the examiner listens with the help
of a stethoscope to the brachial artery at the elbow and then the examiner slowly reduces the
pressure in the cuff. In the digital instrument, the cuff is placed in the upper arm, finger or the
wrist according to the instrument. And it is elevated to the level of the heart. The observation of
the mercury is necessary to come to an accurate result while releasing the pressure with the
control valve (Shibata and Mitsunami, 2014).
Critical analysis of the Assessment Tool
Over 100 years have passed since the development of the manual manometer that is
measured with the help of mercury. The critical analysis of this assessment tool will define its
reliability and validity. The first description of this instrument was regarding the sound
phenomena above the brachial artery during upper arm compression. In the recent times, this
method is used as a non-invasive blood pressure measurement. There have been various
developments related to this instrument, which has led to a silent revolution of blood pressure
monitoring in domestic and medical use. These instruments are manually operated as well as

5
NURSING ASSESSMENT TOOLS
digitally depending on the requirement of the situation. In the manual instrument, the blood
pressure is measured by the auscultation and the result is measured by the oscillometric
principle, which is used to analyze the pulses in the cuff (Davis et al. 2015). In a medical setting,
the use of manual sphygmomanometers are common for measuring blood pressure but in
intensive care or emergency care units the digital method is also preferred for its less labor
intensive mechanism. The automatic or digital instrument can be used for self-patient
monitoring, which also has the oscillometrc principle. The mercury manometer has the highest
accuracy because of its high level of technical agreement between the devices of various
producers. All the instruments can have different values due to its manufacturing, which can be
inaccurate in certain critical conditions (Armstrong et al. 2015). The advantages of a mercury
based manometer is that it has a simple technique and has a simple baseline correction. Several
reports suggest that the low maintenance of this instrument has resulted to inaccurate results in a
medical setting. The servicing of this manual is a necessary step towards maintaining the
efficiency of the device because the quality of the product affects the result that determines the
condition of the patient. The defects in the parts of the manometer also influences the result of
the instrument because the cuff and the tubing systems can get tampered when not maintained
properly. The technical evaluation and calibration is required for the proper mechanism of the
instrument if it is done in a yearly basis (Neuhauser et al. 2014). Another issue that comes
between the smooth working of this instrument is that the use of mercury is banned in certain
countries, which leads to a lower flow of use in the medical setting. The observation of the
auscultation sound requires attention span and quite environment because any loud noise can
interfere with the reading of the results. These points can be critically analyzed for the reliability
of this instrument for domestic and medical purposes (Jung et al. 2014). The use of stethoscope

6
NURSING ASSESSMENT TOOLS
is required for the manual method to observe the auscultation and it is used by trained
practitioners because experience is necessary for the observance of the reading done through
only palpation, which only gives the systolic pressure. Another type of manual
sphygmomanometer is known as aneroid sphygmomanometer that has a mechanical instead of a
mercury tube. The dial needs calibration checks and considered safer than mercury manometers
and less expensive than them. An issue with this method is the mechanical jarring, which affects
the result of the instrument. Whereas, mercury manometers are considered to be a gold standard
because the result is measured by the elevation of the level of the mercury, which does not
require recalibration. The accuracy of this instrument is the reason why it is popularly used in
clinics by medical professionals for the evaluation of high risked patients that includes pregnant
woman (Schempp, Vibrans and Mitsunami 2015). The use of such instruments are vital for
patient who are suffering from hypertension or people who are showing the symptoms of such
disease. The digital manometer includes oscillometric principles and electronic calculations and
not the sound of the auscultation. This instrument does not require training or expertise and it can
be measured in a noisy environment because it is automatic and is less labor intensive as it
measures the diastolic and systolic pressure through the help of oscillometric detection (Tolonen
et al. 2015). Automatic sphygmomanometers have microprocessors, which accurately measures
the pulse rate and the heartbeat. However, automatic sphygmomanometers are not accurate for
the measurement of diastolic and systolic pressure. The use of digital manometers are not
recommended for people with arteriosclerosis, preeclampsia, arrhythmia, pulses paradoxus and
pulses alternans the readings will not be accurate for these conditions due to the complications of
these diseases. Sphygmomanometers in general shows the accurate result and is commonly used
for the diagnosis of this lifestyle disorder, which is the reason this instrument is being used for

7
NURSING ASSESSMENT TOOLS
the patient in the above scenario. The excess or extremely low amounts of blood exerted against
the walls of the cardiac arteries are known as hypertension and the sphygmomanometer helps in
calculating the force of the blood volume (Myers 2014). The result that is more or less than
120/80 mm/Hg is considered to be abnormal or the detection of hypertension.
The validity of the result is not only dependent on the quality of the instrument or the
mechanism but it also depends on the skills and expertise of the user who is handling the tool.
The instrument has guidelines about the methodology of the handling and blood pressure
measurement, which is not always followed accurately. The condition of patient is influential for
the accuracy of the result because the position in which the patient lies affects the blood pressure
measurement or the time they took to take rest before the test influences the reading (Martins et
al. 2014). The patient should not be disturbed by hustle, noises, talking and distraction through
other means. The wrists device instrument is not always accurately placed in the correct position
with heart and the manual instrument makes the pressure of the cuff releases too fast. It is
necessary for the cuff to not be released before 3mm mercury per second so that it gives an
accurate decision. The size of the cuff is also essential for the accuracy of the result because the
wrong size of the cuff will enhance movements that will result in the wrong reading. Talking is
to be strictly avoided because that obstructs the accurate method of reading and the results
should not be rounded upwards or downwards to change the results according to expectations.
This instrument is used to provide holistic assessment to the patient above because he suffers
from hypertension and the evaluation of his vital signs are necessary for his treatment (McEniery
et al. 2014). This tool promotes service user involvement because the digital sphygmomanometer
is user friendly and does not involve trained individuals. It can be beneficial for the identification

8
NURSING ASSESSMENT TOOLS
of diagnosis in a person’s family nursing diagnosis because it will not require medical
professionals in a domestic setting.
Conclusion
The assessment tool of sphygmomanometer is a useful instrument for the detection of
certain chronic lifestyle such as hypertension and the symptoms of this disease can be measured.
After the critical analysis of this assessment tool, the reliability and validity of
sphygmomanometer will influence the area of practice and the experience as a nurse. The use of
this assessment tool will be utilized in my further practice because it explores the diagnostic
practices of lifestyle disorders such as hypertension. The difference between manual and digital
sphygmomanometer influence their reading and the type of people using them because both of
the tools can be accessed by different set of people. The manual sphygmomanometer is more
accurate due to the mercury tube, which is used for the reading and that is done through manual
observation. Whereas, the digital manometer can be inaccurate for certain patients due to their
health conditions. This assessment tool is accurate for the patient above because this patient is
suffering from hypertension and has survived a stroke. The manual sphygmomanometer will be
accurate for this scenario because it will be accurate in diagnosing people with a high blood
pressure or stroke. The above analysis has conveyed that this assessment tool is used worldwide
and it is accurate for a medical setting, which is a positive aspect for the practice of nursing. To
conclude, sphygmomanometer is a simple measuring technique that monitors the blood pressure
of a person that is essential for the process of diagnosis.

9
NURSING ASSESSMENT TOOLS
References
Armstrong, D., Matangi, M., Brouillard, D. and Myers, M.G., 2015. Automated office blood
pressure–being alone and not location is what matters most. Blood pressure monitoring, 20(4),
pp.204-208.
Davis, G.K., Roberts, L.M., Mangos, G.J. and Brown, M.A., 2015. Comparisons of auscultatory
hybrid and automated sphygmomanometers with mercury sphygmomanometry in hypertensive
and normotensive pregnant women: parallel validation studies. Journal of hypertension, 33(3),
pp.499-506.
Jung, M.H., Kim, G.H., Kim, J.H., Moon, K.W., Yoo, K.D., Rho, T.H. and Kim, C.M., 2015.
Reliability of home blood pressure monitoring: in the context of validation and accuracy. Blood
pressure monitoring, 20(4), pp.215-220.
Ličen, S. and Plazar, N., 2015. Identification of nursing competency assessment tools as
possibility of their use in nursing education in Slovenia—A systematic literature review. Nurse
education today, 35(4), pp.602-608.
Martins, J.C., Teixeira-Salmela, L.F., Lara, E.M., Moura, J.B., Aguiar, L.T. and de Faria,
C.D.C.M., 2014. Validity and reliability of the modified sphygmomanometer test to assess
strength of the lower limbs and trunk muscles after stroke. Journal of rehabilitation
medicine, 46(7), pp.620-628.
McDougall, A., Hutton, B., Davies, W., Peluso, M. and Iannella, R., Qardio, Inc., 2014. Blood
pressure monitor. U.S. Patent Application 29/459,134.

10
NURSING ASSESSMENT TOOLS
McEniery, C.M., Cockcroft, J.R., Roman, M.J., Franklin, S.S. and Wilkinson, I.B., 2014. Central
blood pressure: current evidence and clinical importance. European heart journal, 35(26),
pp.1719-1725.
Myers, M.G., 2014. Replacing manual sphygmomanometers with automated blood pressure
measurement in routine clinical practice. Clinical and Experimental Pharmacology and
Physiology, 41(1), pp.46-53.
Neuhauser, H.K., Ellert, U., Thamm, M. and Adler, C., 2015. Calibration of blood pressure data
after replacement of the standard mercury sphygmomanometer by an oscillometric device and
concurrent change of cuffs. Blood pressure monitoring, 20(1), pp.39-42.
Pukall, B. and Naef, T., Robert Bosch GmbH, 2015. Sphygmomanometer. U.S. Patent
Application 29/493,636.
Schempp, B., Vibrans, B. and Mitsunami, Y., Omron Healthcare Co Ltd,
2015. Sphygmomanometer. U.S. Patent Application 29/497,717.
Shahbabu, B., Dasgupta, A., Sarkar, K. and Sahoo, S.K., 2016. Which is more accurate in
measuring the blood pressure? A digital or an aneroid sphygmomanometer. Journal of clinical
and diagnostic research: JCDR, 10(3), p.LC11.
Shibata, F. and Mitsunami, Y., Omron Healthcare Co Ltd, 2014. Sphygmomanometer. U.S.
Patent Application 29/475,246.
Tolonen, H., Koponen, P., Naska, A., Männistö, S., Broda, G., Palosaari, T. and Kuulasmaa, K.,
2015. Challenges in standardization of blood pressure measurement at the population level. BMC
medical research methodology, 15(1), p.33.

11
NURSING ASSESSMENT TOOLS
Wibmer, T., Denner, C., Fischer, C., Schildge, B., Ruediger, S., Kropf-Sanchen, C., Rottbauer,
W. and Schumann, C., 2015. Blood pressure monitoring during exercise: comparison of pulse
transit time and volume clamp methods. Blood pressure, 24(6), pp.353-360.
Wohlfahrt, P., Cífková, R., Movsisyan, N., Kunzová, Š., Lešovský, J., Homolka, M., Soška, V.,
Bauerová, H., Lopez-Jimenez, F. and Sochor, O., 2016. Threshold for diagnosing hypertension
by automated office blood pressure using random sample population data. Journal of
hypertension, 34(11), pp.2180-2186.
Wu, X.V., Enskär, K., Lee, C.C.S. and Wang, W., 2015. A systematic review of clinical
assessment for undergraduate nursing students. Nurse Education Today, 35(2), pp.347-359.