Measuring Blood Pressure

1Step-by-Step Procedure

1. 1

   Gather equipment: aneroid or mercury sphygmomanometer, stethoscope, alcohol wipe, pen, paper.

2. 2

   Clean the stethoscope earpieces and diaphragm with an alcohol wipe.

3. 3

   Wash hands.

4. 4

   Identify the resident and explain the procedure.

5. 5

   Assist the resident to sit or lie comfortably with the arm at heart level, palm up, elbow slightly flexed.

6. 6

   Ask the resident to sit quietly and not talk during the measurement.

7. 7

   Expose the upper arm; remove or roll up sleeve — do not constrict by rolling too tightly.

8. 8

   Palpate the brachial artery on the inner aspect of the antecubital fossa.

9. 9

   Center the bladder of the cuff over the brachial artery, aligning the artery marker if present.

10. 10

    Place the lower edge of the cuff 1–2 inches (2–3 cm) above the antecubital fossa.

11. 11

    Secure the cuff snugly — you should be able to slide two fingers under it.

12. 12

    Place the stethoscope diaphragm (or bell) over the brachial artery.

13. 13

    Close the bulb valve and inflate the cuff to approximately 180 mmHg (or 30 mmHg above the estimated systolic pressure).

14. 14

    Open the valve slowly, deflating at 2–3 mmHg per second.

15. 15

    Note the pressure at which you first hear a clear Korotkoff sound (systolic).

16. 16

    Continue deflating and note the pressure at which sounds disappear (diastolic).

17. 17

    Deflate the cuff completely and remove it.

18. 18

    Record both readings as systolic/diastolic (e.g., 120/80 mmHg), arm used, and position.

19. 19

    Wash hands and report abnormal values to the nurse.

What the Examiner Is Watching For

• ✓

  Cuff is placed 1–2 inches above the antecubital fossa, centered over the brachial artery.

• ✓

  Cuff is snug but not too tight (two-finger rule).

• ✓

  Stethoscope is placed over the brachial artery, not under the cuff.

• ✓

  Deflation is slow and steady (2–3 mmHg per second).

• ✓

  Both systolic and diastolic readings are recorded accurately.

Common Mistakes That Cause Failure

• ⚠

  Placing the stethoscope under the cuff rather than below it on the artery.

• ⚠

  Deflating too fast — this causes inaccurate readings.

• ⚠

  Cuff too loose or too tight — use the two-finger rule.

• ⚠

  Not cleaning the stethoscope before use.

• ⚠

  Failing to record the arm used and the resident's position.

Tips for Exam Day

• →

  Clean the stethoscope first — it is part of the evaluated procedure.

• →

  The lower edge of the cuff is 1–2 inches ABOVE the elbow crease.

• →

  Deflate slowly and steadily; rushing causes you to miss the sounds.

• →

  Normal adult BP is approximately 90–120 mmHg systolic and 60–80 mmHg diastolic; know the ranges.

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