Alternative Methods of Blood Pressure Measurement – Vital Signs (Nursing)

00:00 So let's talk about some alternative methods of measuring a patient's blood pressure.

00:08 We talked about using a manual cuff. Now, sometimes there are contraindications for using a regular manual cuff on the patient's arm so we may need to use a lower extremity blood pressure cuff such as one that goes around the thigh. Also, very commonly in the hospital you will see use of an automatic blood pressure monitor. This is electric. We're going to hook it to our patient and push a button and it gives our reading pretty quickly. Now, just know that many times a client's going to have to measure their blood pressure at home.

00:43 As you can imagine, high blood pressure otherwise known as hypertension does not go away overnight. So, monitoring is really important in regards to controlling that blood pressure and making better treatment decisions. So there are portable home devices.

00:59 Now, these are really helpful in giving us results and helping our patients track our blood pressure, but sometimes they can be with a regular cuff or sometimes it can be electronic.

01:09 Also, they're pretty sensitive and sometimes they can lead to incorrect readings. So if you see the image here, this is what we call a home device, but this one's around the patient's wrist. Now, usually if you take a blood pressure in the patient's wrist, it's going to read a little higher. So again, the portable home devices are great but they are highly sensitive and we can get some inaccurate readings. And don't forget, sometimes a portable home device can be expensive or maybe a patient's insurance will not approve it so we may have to go to a stationary automatic blood pressure device. Now, this is usually found at a specific drugstore, for example, or maybe a large store and these are found in public places.

01:54 Now, there are some limit to reliability here and again the blood pressure can vary about 5-10 mmHg. And that can make a difference in your physician's treatment decisions.

02:06 So let's discuss some benefits and disadvantages of a client measuring their blood pressure at home. So some of the benefits is detection of new problems. So, a patient that maybe normotensive maybe routinely checking their blood pressure at home and they notice that their blood pressure is more elevated than normal. This is a great detection here because they can collaborate with their healthcare provider and maybe treat this issue. Now, clients with hypertension can provide this information to the healthcare provider. This is really important because this is going to give us patterns or trends of the patient's blood pressure. Now, as you can imagine, when you go to the doctor, it's usually a one-time visit or maybe once every 3 months or 6 months, but it's just a small snippet in time. Now, this isn't a really good info to give patient new medications or to make a treatment decision so those patterns and trends that the patient provides are really helpful. And also, self-monitoring can help adhere the patient to their therapy that's prescribed. Now let's talk about these disadvantages. Now as you can imagine, there can be a proper use of equipment or inaccurate readings and this is going to give some necessary alarming of clients. This can really trigger your clients to think "Okay, I've got to adjust my medications" and they may do this in an inappropriate way and cause hypotension or other complications for themselves. So we've talked a lot about blood pressure, but when do we need to take a manual blood pressure? If you recall, automatic blood pressure monitoring devices are really popular in the hospital because it makes it much more efficient and quick for each patient. Now, there are certain key times we need to take a manual blood pressure for accuracy. So for clients, for example, with a regular heart rate, if a patient has a diagnosis or a past medical history of atrial fibrillation or an irregular heart rate for example, we want to take a manual blood pressure because those automatic machines may give us a false reading. Now, if we have an abnormal blood pressure measurement that's different than normal, we need to verify with a manual blood pressure taken. We did this all the time on the stroke center. As a nurse in the stroke center, it's very crucial to monitor a patient's blood pressure and I used to have to go take a manual to double check the reading that I received because I would either treat or not treat depending on this measurement. Now, as you can imagine, patient's may have excessive tremors from Parkinson's, for example, or shivering, this can also create an inaccurate reading and a manual blood pressure will help here. Also if you're evaluating certain cardiac medications, really if we're going to treat with these medications we want the most accurate results so a manual blood pressure is ideal. Now, assessment of blood pressure and the pulse, again it evaluates our general state of cardiovascular health. It gives us a great idea of the hemodynamic status of our patients.