CNA Skill: Measuring And Recording Blood Pressure

Changes in a patient’s blood pressure can be an indication of a much more serious condition that may require immediate medical intervention.  By monitoring blood pressure as ordered by a physician, you will be able to assist the medical team in determining the necessary treatment for your patient.  Before you begin, ensure your equipment is clean and serviceable.  Wash your hands thoroughly.  Greet your patient, and tell them that you are going to take their blood pressure.  Then, follow these steps to get an accurate result:

1. Verify the identity of your patient.   Wrap the blood pressure cuff around the patient’s arm, just above the elbow.  Ensure you can comfortably reach the bulb of the cuff.
2. Place the bell of the stethosocope over the brachial artery, located in the bend of the elbow.
3. Begin pumping the bulb of the blood pressure cuff.  Watch the dial on the cuff, and continue squeezing the cuff until the needle reaches between 150 and 180 mmHg.
4. Slowly release the presure by lightly loosening the dial on the bloodpressure cuff while listening through the stethoscope.
5. When you first hear a pulse, note the level on the meter.  This is the upper number, called the systolic pressure.
6. Continue listening to the pulse, and wait until you hear the pulse fade away.  Again, note the level on the meter.  This number is the lower number, and is called the diastolic blood pressure.
7. Record the results as directed by the physician, and provide the result to the patient.  The number is usually recorded as systolic over diastolic, for example, 120 over 80.
8. Wash your hands, and wipe down equipment with anti-bacterial wipes.

The blood pressure measurement is one of the most used diagnostic tools in medical offices.  By carefully measuring and recording this information, you are creating an important record that will be used by the physician to determine what, if any, treatment a patient may need.

Examiner’s Checklist For This Skill:

1) Performed beginning tasks.
2) Cleaned earpieces of stethoscope.
3) Positioned resident sitting or lying.
4) Made sure the room was quiet; turned down loud TV or radio.
5) Selected the appropriate size cuff and applied it directly over the
skin, above the elbow.
6) Positioned the stethoscope over the brachial artery.
7) Inflated the cuff per the instructor’s direction.
8 ) Identified the systolic and diastolic measurements while deflating
the cuff.
9) Deflated the cuff in a timely manner.
10) Re-measured, if necessary, to determine the accuracy (waited one
minute if using the same arm or use the other arm, if appropriate).
11) Recorded blood pressure measurement to be compared with the
blood pressure recorded by the evaluator.
12) Performed completion tasks.

Expert Tip by Tanya Glover, CNA

Blood pressure is a skill that must be mastered during your skills test, although I am not sure why that is. The majority of facilities use automatic blood pressure takers or wrist cuffs. Very few require manual readings anymore. Check with any facility that you work with to see what their rules are on this. Keep in mind though that during your skills test, a manual cuff will be required, so practice, practice, practice! Hearing those thumps can be difficult, especially when you are so nervous that you can hear your own heart pumping as well! The key is to take your time and block out all other noises. If you think you messed up, tell your instructor and they will allow you to try again. In fact, many instructors will allow you to try as many times as you need to get it right. They understand that you are under pressure and typically work with you. However, if you think you got it wrong and still give the instructor a number, be prepared to fail if you are too far off because they will go behind you and check themselves to verify your accuracy.

When working in a facility, never skip or make up a number for blood pressure to add to patients chart. This could be deadly. If you are using a electronic cuff and get a reading that is way too high to be possible, or get a reading that is way out of range of the patients usual number, you will have to do it manually. If you are still getting an unusual reading it is time to get the hall nurse and they will do a BP check to see if your findings were correct. This can mean the difference between your patient living or dying. Keep this in mind while doing all your vital checks and be a responsible caregiver!