Algorithm for measuring blood pressure (blood pressure) nursing. Devices, rules, technique, methods

Blood pressure measurement requires a competent approach. It is important to know the research methods and algorithm for a specific method of measuring pressure in order to get the most correct research result. Violation of the research technique or illiterate interpretation of the results can affect the wrong choice of treatment method and aggravate the state of health.

Measurement indications

Measurement of blood pressure is not necessary in all cases. If you are feeling well, blood pressure can be measured to obtain the working level of this indicator or during a general examination. Most often, pressure measurement is carried out after consultation with a doctor and an appointment.

In general, it is recommended to measure blood pressure in the following cases:

• a fast or uneven heartbeat;
• the appearance of weakness or dizziness;
• with tinnitus, nausea, or vomiting;
• when a headache appears;
• for routine pressure control in the presence of chronic cardiovascular diseases.

Any changes in the frequency and strength of the heartbeat, as well as sharp manifestations of weakness or malaise, can be the result of a rapid drop or increase in blood pressure. Failure to take action in this case can cause serious health consequences, as well as taking medications without changing the pressure.

The algorithm for measuring blood pressure is quite simple and available for different states of health. You can take the measurement yourself or ask your relatives and friends. Only after the person measures the pressure, you can visit a doctor for a consultation or call an ambulance.

How is it determined

All pressure measurement methods are divided into direct and indirect:

1. Direct way pressure measurement is considered the most accurate. During it, the catheter, in which the pressure sensor is located, is inserted into a large artery through a special tube. With this measurement, the pressure is measured continuously and can be displayed on the monitor. Most often, this method is used during operations or in cardio research.
2. Indirect methods studies assume the absence of surgical intervention and allow you to measure pressure in other ways, which include:

• Auscultatory a method in which pressure is measured by processing the sound effects that occur in the cuff when the blood flow is clamped. When the pressure on the blood flow decreases, the sound effects change and make it possible to determine the turbulent flow (oscillation of the stressed and weakened vessel wall or sound tones over the artery). The lower pressure on the blood vessel makes it possible to measure all the tones caused by the vibration. When the pressure on the hand stops, the vibrations of the walls also disappear.

With this method, pressure can be measured when the rhythm of the heartbeat is disturbed and when hand movements are made. However, the result of the study depends on the presence of extraneous sounds, which may affect the accuracy of the study.

All mechanical blood pressure monitors of the standard type, which allow you to measure pressure "by ear", work according to this type. Only specialists who know how to use the device and perform difficult manipulations can check the pressure with such a device.

• Oscillometric the method analyzes the pressure pulsations created in the clamped hand. Changing the cuff pressure range allows you to analyze compression and decompression pulsations. By a sharp change in the amplitude of pulsations, the upper and lower levels of blood pressure are set and the result is displayed.

Devices of this type are semi-automatic (require manual pumping of pressure with a pear) and automatic (operate autonomously). They allow you to measure pressure through thin clothing, but in terms of results, the accuracy of the study can deviate by 10-15%.

It is recommended to use such devices in strict accordance with the technique of use and with the possible re-verification of the results in the event of a sharp deviation from the norm.

• Tachooscelometric the method basically uses a change in pulse fluctuations in the total volume of the vessel. With this method of measurement, pressure is created in a small area, for example, on a finger. The pressure level is determined by the appearance of a sharp jump in the change in pulse fluctuations in pressure during compression and subsequently with a decrease in the level of blockage of the vessel.
• Algorithm for measuring blood pressure by ultrasound method research gives indicators using ultrasonic waves. The sensor records the change in the position of the walls of the vessels with increasing and decreasing pressure on the vessel. Analysis of changes in the frequency of signals received by the device allows you to determine the level of blood pressure automatically. The indicators of such a study give accurate results for the period of the measurement.
• Light plethysmography examines the pressure level by analyzing the amount of loss in the intensity of the light flux that is transmitted through the tissues of the hand. The level of light triggering obtained indicates the amount of vessel change as the cuff pressure increases and decreases. Such research is considered new and is used in specialized fields of medicine.

Preparation and measurement

Most hospitals and clinics use standard indirect pressure measurement methods. (auscultatory, oscillometric), which do not require special training and can be performed in any conditions.

However, in order to obtain the most adequate research results, before checking the pressure, it is necessary:

• the person taking the measurement, wash their hands with soap and wipe them dry;
• prepare the tonometer device for use and plug it into an outlet if necessary;
• in 10-15 minutes. before the examination, the patient is advised to sit or lie down in a calm environment to restore the heartbeat;
• it is necessary to measure the pressure before eating or drinking, or after 2 hours. after eating;
• it is not recommended to use the device for routine examination when consuming alcoholic beverages and medicines.

  

The algorithm for measuring blood pressure with a semi-automatic and automatic tonometer is simple and includes a number of steps:

• The patient sits on a chair in a comfortable position and leans against the back of the chair. The patient's hand is raised and placed freely, palm up, on the table.
• The patient's sleeve is rolled up and released above the elbow, without creating compression of the tissue.
• The cuff is placed on the patient's shoulder, arm above the elbow, or wrist, depending on the type of examination being performed. The cuff is tightened and firmly fixed on the patient's body.
• The patient should then take a few deep and calm breaths.
• The bulb of the device is screwed in and air is pumped into the cuff manually or automatically to the desired mark. The delivery pressure should be slightly above the patient's average working pressure.
• Then, automatically or manually, the air pressure in the cuff is gradually reduced. At the same time, pressure tones or a change in the size of the vessel when the pressure level in it changes.
• The air is completely deflated from the device.
• The upper and lower arterial pressure of the patient is marked on the display of the device or on the scale.
• If necessary, the pressure is re-measured.
• Then the cuff is removed.

Based on the results of the study, the doctor or patient draws conclusions about a satisfactory state of health or the presence of changes of varying degrees.

The auscultatory measurement method is identical to the standard procedure.

However, when the cuff is installed near the arm, a tonometer is fixed, and a stethoscope head is installed at the bend of the patient's elbow to listen to heart sounds. Otherwise, the procedure is repeated and the obtained indicators depend on the sensitivity of fixing the tones of changes in pressure fluctuations and the experience of the specialist who conducts the measurement.

Measuring instruments rating

The blood pressure measurement algorithm divides all devices of this type according to the research method. In pharmacies and medical institutions, devices that use the auscultatory method (all mechanical tonometers) or the oscilloscope method to obtain the result are more common.

Devices for testing the pressure level are also distinguished into:

• mercury devices;
• hand-held tonometers with aneroid manometer;
• semi-automatic;
• automatic devices.

Each device has its own characteristics and functionality. For professional use, mechanical blood pressure monitors are more often chosen, while at home it is easier to use semi-automatic and automatic devices.

Depending on the functional set, availability and brand, there is a rating of the best devices of this type:

Tonometer Omron M2 Basic

It is one of the most famous blood pressure monitors.

Such a device is fully automatic and works both from the mains and on batteries. The 22-32 cm long cuff is suitable for measuring pressure in most patients. This model is also available with a universal 42 cm cuff.

The tonometer allows you to measure blood pressure and pulse to units within a few minutes, has the memory of previous uses, therefore, it helps to easily monitor your health. An adapter is included with the device. The cost of the device averages 1,750 rubles.

Tonometer B. Well PRO-33 (М-L)

Sold with an adapter. The device is automatic and allows you to measure pressure, pulse within 3 minutes. The tonometer can be used autonomously (on batteries) or from the mains. The device has a memory that stores information about the indicators of the last measurement.

The cuff in the tonometer is universal (22-42 cm) and is suitable for measuring blood pressure in people with increased body weight. The device is affordable, its cost varies within 1600 rubles.

Tonometer AND UB-202

It is made to measure pressure on the wrist, therefore it is recommended for people up to 60 liters.

The blood pressure measurement algorithm in the device is fully automatic. The device works independently of the mains, on batteries. The universal cuff (13.5-21.5 cm) fits all body types. In addition to blood pressure, the device provides information on the measurement of heart rate and has a multi-measurement mode. The device has a memory function for the last measurement. The cost of the device is about 1900 rubles.

Automatic Tonometer AND UA-777

Has a standard cuff (22-32 cm).

It works at will from the mains or from batteries, which are simply replaceable. The device also has functions for measuring heart rate, blood pressure and multi-measurement mode. The tonometer has a memory for the last measurements. Its cost reaches 2400 rubles.

Tonometer Armed YE-630A

It has an enlarged cuff (22-45 cm) and is oriented for overweight people.

Its cuff is wider and equipped with an extra layer of Velcro. The fully automatic tonometer works quickly both from the mains and on batteries. As a result of the measurement, the device gives information about the pressure and heart rate by means of a voice notification. The device has a memory of the last measurement and has a price of 2200 rubles.

Tonometer Armed 3.02.008 (white head)

It is a mechanical device equipped with an ergonomic bulb and a convenient pressure measuring scale.

A sensitive thin needle allows you to record minor fluctuations when listening to tones of pressure changes. The device is equipped with a standard thin cuff and comfortable flexible tubes. The cost of the device is 700 rubles.

Compact tonometer Nissei WS-1011

Fits completely on the wrist. Its enlarged cuff (12.5-22.5 cm) fits snugly from the surface of the arm thanks to special stitching. The device is powered by batteries, which are enough for several dozen measurements.

The device provides information not only about the pressure, but also about the pulse rate. The device has a mode of several measurements and has a memory of the last measurement. The tonometer is suitable for 2 users and costs about 2000 rubles.

Tonometer Medisana HGN

Considered a proven automatic wrist pressure measurement device.

The device measures the heart rate and has a WHO scale. The device is powered by batteries. The device has a built-in memory about the last measurement, which can be used for 2 users. The cost of the device is 1400 rubles.

Each type of tonometer has different subspecies and configurations, depending on the size of the cuff, the type of measurement and a set of additional functions, so each user can choose the device for individual requirements.

Decoding the results

The readings that the tonometer gives after measurement are easy enough to decipher if you know the normal indicators. It is important to remember that normal blood pressure depends on many factors, primarily age. The average pressure for an adult is 120 to 80 mm Hg. Art. However, depending on age and gender, the level of blood pressure may vary slightly.

Age, l.	Average blood pressure for women, mm Hg Art.	Average blood pressure for men, mm Hg Art.
17-20	116/72	123/76
20-30	120/75	126/79
30-40	127/80	129/81
40-50	135/84	135/83
50-60	135/85	135/85
60 and more	135/89	138/90

Blood pressure levels naturally rise with age. And for people over 70 y.p. working blood pressure can be 140/95 mm Hg. Art.

It is important to remember that the measurement result is influenced by many side factors:

• measurement time;
• the presence of stressful situations;
• taking medications or stimulants;
• increased physical activity or vigorous activity.

Therefore, for each person, the working pressure is established after several measurements over a long period of time. The pressure is checked for 3-5 days. in a row at the same time, namely after 1-2 hours. after waking up and 2 hours before. before sleep.

Deviations in health status are determined from the working pressure. A slight decrease in pressure can be caused by fatigue and other household factors, as is the case with a slight increase in pressure.

When to see a doctor

Increased pressure is considered to be an increase in its level by 10 or more units.

So:

• An easy stage of pressure increase is considered to be an increase in the upper values ​​up to 20 units. and lower by 10 units. (up to 140/90 mm Hg. Art.). The first stage is considered not dangerous and is most often provoked by a change in the external conditions of life. With a slight change in the level of pressure, the state of health can return to normal with adherence to a diet, avoidance of stress and minor recommendations and without medication. However, if it is repeated for a long time, a circumstance arises when the patient's health condition requires additional verification and identification of the causes of the violation.
• The middle stage is considered to be an increase in pressure up to 160/100 mm Hg. Art. In the middle stages of increasing pressure, the state of health requires medication adjustments after the causes of the change have been eliminated.
• The most severe stage is noted at a pressure of 180/110 mm Hg. Art. and higher. With a significant increase in the level of pressure, the patient requires urgent hospitalization and treatment.

A decrease in pressure does not always lead to negative health consequences, but it is also considered a deviation. Pressure at 100 / 65-60 mm Hg. Art. considered hypotension. Most often, a decrease in pressure is the cause of vitamin deficiency or a low iron content in the blood. In rare cases, circulatory disorders may be the cause.

However, there are people with a genetic predisposition to hypotension or structural features of the body. Despite the harmlessness of a low pressure level, with a prolonged repetition of such a factor, it is necessary to consult a doctor for advice and additional examination.

Possible complications

Increased or decreased blood pressure causes unpleasant symptoms, which intensify with an increase in the deviation of the upper and lower values. In each case, patients experience different changes in their general well-being.

Most often, when the level of pressure changes in patients, there are:

• dizziness, weakness;
• swelling and cramps in the limbs;
• headaches;
• tinnitus and nausea;
• vomit;
• heartache.

With a severe degree of pressure increase or its increase to medium indicators for a long time in patients can develop:

• pre-stroke or pre-infarction state;
• hemorrhage in the brain;
• thrombosis and circulatory disorders;
• increased muscle weakness and atrophy;
• decreased vision and impaired coordination;
• diseases of the cardiovascular system, which can be fatal.

Due to the large number of inexpensive automatic blood pressure monitors, blood pressure measurement is available to any category of patient. The pressure measurement algorithm has been greatly simplified due to the automatic analysis of indicators.

Any patient with a predisposition to changes in blood pressure or chronic diseases is recommended constantly monitor the level of blood pressure and, if necessary, undergo additional examination.

Modern examination methods will help to quickly establish the cause of the change, and the latest generation drugs able to normalize blood pressure levels for several days and improve health for a long time time.

Blood pressure measurement video

How to measure blood pressure: