Sonja R. Fuqua, Phd, Rn Director Of Clinical Quality Mississippi

Transcript

Sonja R. Fuqua, PhD, RN Director of Clinical Quality Mississippi Primary Health Care Association  At the conclusion of this presentation, the participant will be able to: ◦ Define the stages of Hypertension ◦ Discuss the Jackson Heart Study’s standardization of blood pressure measurement ◦ Outline the steps of American Heart Association recommendations for blood pressure measurement ◦ Demonstrate proper procedure for blood pressure measurement  Did you know that although auscultatory blood pressure measurement has been the standard for over 50 years, surveys indicate that providers rarely follow the well published guidelines for their use.    Increased Blood pressure  increased risks of ischemic heart disease and complications Diagnosis and treatment depend on accurate measurement. Measurement should be standardized.     Study of cardiovascular disease risks among African Americans in Jackson, MS Correct blood pressure measurement is essential for success of the study Blood pressure comparability study Standardized measurement technique       Standardized technique Participants given specific instructions during scheduling and reminder calls Standardized environment Stopping rules for elevated blood pressure Clinic staff trained/certified with recertification annually Quality assurance program The most common error in blood pressure measurement is use of inappropriate cuff size.  Choose the right equipment ◦ Aneroid or mercury column sphygmomanometer stethoscope ◦ Automated device with manual inflate mode  Prepare the patient ◦ ◦ ◦ ◦ Seated comfortably—relaxed Back supported Legs uncrossed Upper arm bared  Patient’s arm should be supported at heart level. ◦ If the upper arm is below the level of the right atrium, the readings will be too high ◦ if the upper arm is above heart level, the readings will be too low ◦ If the arm is unsupported and held up by the patient, pressure will be higher.  Choose proper cuff size and place on patient’s arm ◦ Cuff bladder should encircle 80% or more of the patient's arm circumference. ◦ Palpate/locate the brachial artery and align artery markers. ◦ Wrap snugly about 2cm above the elbow  Position the stethoscope (if required)   Again, palpate/locate the brachial for the strongest pulse Place the bell of the stethoscope a that location  Inflate the BP cuff to 30-40 mmHg above the person’s normal reading ◦ If normal reading not know, inflate to 160-180 mmHg ◦ Listen for cessation of pulse sounds  Slowly deflate the BP cuff ◦ 2-3 mmHg per second is recommended  Deflation rates greater than 2 mm per second can cause the systolic pressure to appear lower  the diastolic pressure can appear higher  Listen for the systolic reading ◦ The first audible sound should be recorded as systolic pressure ◦ The last audible sound should be recorded as diastolic pressure. ◦ Measurements should be given to the nearest 2 mmHg.  Double check for accuracy ◦ Take a BP on both arms and average the readings ◦ Wait 5 minutes between readings  Neither the patient nor the person taking the measurement should talk during the procedure.  Clinicians (staff) are responsible for accurate blood pressure readings in order to make informed decisions for patient diagnosis and treatment plans.