Policy Manual sample

MDT Home Health Care Agency, Inc. 21 BLOOD PRESSURE PURPOSE: Blood pressure measures the lateral force exerted by blood on the arterial walls. A blood pressure is obtained according to the plan of care and/or the patient's condition. For patients receiving intermittent nursing visits, the blood pressure should be obtained on every visit. Abnormalities in the blood pressure should be reported to appropriate medical personnel immediately . RESPONSIBLE PERSONNEL: RN, LPN, HHA (as allowed by state regulation) Rehabilitation Therapists, RT, CRTT EQUIPMENT: Sphygmomanometer with cuff, stethoscope, alcohol pads SPECIAL CONSIDERATIONS: 1. Blood pressure should not be measured in the affected arm when: • The patient has an A.V. fistula for dialysis • The patient has a shoulder, arm or hand injury. • The patient has had breast or axillary surgery. • The patient has had blood or other intravenous fluids infusing. • The patient has a cast or splint . 2. Avoid taking blood pressure more than 2 or 3 times consecutively in the same arm 3. Implement the following if you are having difficulty hearing blood pressure sounds: a. Inflate blood pressure cuff quickly. b. Raise patient's arm for several seconds before inflating blood pressure cuff. c. Instruct patient to open and close the fist rapidly about eight times after blood pressure is inflated. d. Check placement of stethoscope to be certain the instrument's diaphragm is over patient's brachial artery. PROCEDURE: 1. Wash hands. 2. Explain procedure to patient. 3. The patient may lie in supine position, sit, or stand during the blood pressure measurement. Extend and support the arm. 4. Instruct or assist the patient in rolling up the sleeve to expose the upper arm. 5. Position yourself so that you have direct and clear visibility of the sphygmomanometer. 6. Attach the cuff according to the manufacturer's directions, 1-2 inches above the bend in the arm. The center of the cuff should be directly in line with descending brachial artery. Some cuffs are specifically marked for placement. 7. Remove all air from the cuff. 8. Insert the earpieces of the stethoscope into your ears. 10. Place the diaphragm of the stethoscope directly over the brachial artery. 11. Close the valve on the bulb of the cuff. Pump the cuff up to a point about 10mm-20mm above the anticipated systolic sound. 12. Open the valve on the pump carefully, slowly and evenly.