Blood Pressure Lying Sitting Standing P1-4 0 PDF

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Observations

Adults

Measuring blood pressure lying/sitting and standing (manual recording) Edited by Richard Hatchett, Deputy Head of School, The Royal Marsden School ©2015 Clinical Skills Limited. All rights reserved

In healthy people there is little difference between lying, sitting and standing blood pressure measurements. However, standing up from sitting or lying can lead to a significant fall in blood pressure (20 mmHg or more) if postural (orthostatic) hypotension is present. Postural hypotension is more common in the elderly and in people taking hypotension-inducing medication such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and tricyclic antidepressants.

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Accurate measurement of lying (supine) or sitting and standing blood pressure is advisable in anyone who reports episodes of dizziness, fainting and unexplained falls. Individual readings are influenced by many factors such as age, ethnicity, disease, the time of day, posture, emotions, exercise, meals, medicines, fullness of bladder, pain, shock, dehydration, acute changes in temperature and changes in altitude (NCGC, 2011). Such factors may therefore determine the timing of the procedure. For example, if a patient reports dizziness each morning after taking medication, it is advisable to carry out the procedure at this time. Blood pressure should be measured using a properly maintained, calibrated and validated device. Mercury sphygmomanometers have been used for blood pressure measurement for many years. However, with the withdrawal of this type of equipment for health and safety reasons, mercury devices are seen much less frequently. Aneroid devices may be less accurate than mercury sphygmomanometers and their alternatives, especially over time (NCGC, 2011). The website of the British Hypertension Society (www.bhsoc.org) contains a list of validated automatic digital blood pressure devices. For detailed guidance on blood pressure measurement, refer to the relevant procedures on clinicalskills.net (Hatchett, 2015).

Decontaminate your hands and prepare the patient

Stand-mounted manometers are recommended, largely because they are mobile and easily adjusted for height.

Position the blood pressure device

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NCGC (2011) and the British Hypertension Society (BHS 2014) advise that the patient should rest for at least five minutes before a blood pressure measurement is taken, as blood pressure settles on rest. Decontaminate your hands and, if using a communal stethoscope, clean the ear pieces as per local policy. Explain the procedure to the patient, gain consent and remove any tight or restrictive clothing from the arm you will use.

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Place the blood pressure device near to the patient so that you can read the display easily. If using a box or desk sphygmomanometer, it must be placed on a firm and stable surface. Measure the blood pressure in both arms initially, and if the values differ, use the arm with the higher value for subsequent recordings (NCGC, 2011).

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person. Always first explain the procedure to the patient and obtain his/her consent, in line with the policies of your employer or educational institution For References and Key Reading please see html page. www.clinicalskills.net

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Adults

Observations Measuring blood pressure lying/sitting and standing Page 2

Position the arm

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Position the patient’s arm so that it is horizontal at the level of the mid-sternum (NCGC, 2011). Use a pillow to support the arm because muscle tension can raise the blood pressure (Frese et al., 2011).

Recommended bladder sizes

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Dependency of the arm below heart level leads to an overestimation of systolic and diastolic pressures of about 10 mmHg (NCGC, 2011; O’Brien et al., 2003). Correspondingly, raising the arm above heart level leads to underestimation of pressures (NCGC, 2011).

Apply the cuff (a)

Recommendations on bladder size (width x length): 12 x 26 cm (standard bladder) is appropriate for most adult arms (arm circumference...