Blood Pressure  

Purpose: 

To measure the force of blood flowing through the arteries and report any abnormal readings to the attending physician. 

Equipment: 

• Sphygmomanometer 

• Stethoscope (use appropriate cuff size; incorrect cuff size can alter the blood pressure reading) 

• Antiseptic pad 

• Pen or pencil and paper 

Procedure: 

1. Preparation: 

• Wipe the earplugs of the stethoscope with antiseptic pads. 

• Ensure the resident is resting quietly, either lying down or sitting in a chair. 

• If using a mercury sphygmomanometer, ensure the measuring scale is at eye level. 

• The resident’s arm should be bare up to the shoulder and resting fully extended on the bed or on the arm of a chair. 

2. Cuff Application: 

• Unroll the cuff and loosen the valve on the bulb. Squeeze the compression bag to deflate it completely. 

• Wrap the cuff snugly and smoothly around the resident’s arm about 1 inch above the elbow, with the arrows on the cuff pointing toward the brachial pulse. Ensure it is not wrapped so tightly that it causes discomfort. 

• Position the manometer so you can easily read the numbers. 

3. Measuring Blood Pressure: 

• Put the earplugs of the stethoscope in your ears. 

• Find the brachial pulse at the inner side of the arm above the elbow with your fingertips. Place the diaphragm or bell of the stethoscope there, ensuring it does not touch the cuff. 

• Tighten the thumbscrew of the valve to close it, turning it clockwise without overtightening. 

• Hold the stethoscope in place and inflate the cuff until the dial points to 170 mmHg (200 mmHg for older or obese persons) and the pulse is no longer heard. 

• Open the valve counterclockwise to let the air escape slowly until the pulse sound returns. If pulse sounds are heard immediately, deflate the cuff completely, wait a few seconds, and then reinflate to a higher calibration above 200 mmHg. 

• Note the calibration at the first pulse sound (systolic pressure). 

• Continue releasing air until the sounds change to a softer, faster thud or disappear, noting the calibration (diastolic pressure). 

• Deflate the cuff completely and remove it from the resident’s arm. 

4. Post-Procedure: 

• Record your readings (systolic and diastolic pressures). 

• Roll up the blood pressure cuff over the manometer and place it in the proper storage area. 

• Wipe the earplugs of the stethoscope with an antiseptic pad and store the stethoscope properly. 

Documentation: 

• Document the blood pressure readings on the Vital Signs sheet in the medical record. 

• Include the date and time of the measurement. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Ensure all procedures and readings are documented accurately in the resident’s medical record. 

• Regularly review and update techniques for measuring blood pressure according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper blood pressure measurement procedures to ensure accuracy and resident safety. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.