Which method is appropriate to ensure correct measurement of the brachial artery blood pressure quizlet?

Assessing blood pressure of infant or child:

To select the proper cuff size, compare the cuff to the size of the child's upper arm or thigh.

The bladder of the cuff should encircle 80-100% of the extremity used and have a width that covers two thirds of the length of the extremity used.

Oscillometry - often used for infants and children. Transducer uses pressure oscillations received and transmitted by the BP cuff to ID the mean arterial pressure and estimate the systolic and diastolic BP.

1. Wrap cuff around the arm.

2. Place the arm with the antecubital fossa at the heart level with muscles relaxed. Stabilize arm. Movements interfere with readings.

3. Ensure the tubing is free of kinks, and activate the equipment according to the manufacturer's recommendations.

4. Pressure is recorded as the number over "D"

5. Document the BP reading and compare values for age, sex, and height percentiles should be verified by auscultation using a manual sphygmanometer.

Step 1 - Choose the right equipment:
What you will need:
1. A quality stethoscope
2. An appropriately sized blood pressure cuff
3. A blood pressure measurement instrument such as an aneroid or mercury column sphygmomanometer or an automated device with a manual inflate mode.

Step 2 - Prepare the patient: Make sure the patient is relaxed by allowing 5 minutes to relax before the first reading. The patient should sit upright with their upper arm positioned so it is level with their heart and feet flat on the floor. Remove excess clothing that might interfere with the BP cuff or constrict blood flow in the arm. Be sure you and the patient refrain from talking during the reading.

Step 3 - Choose the proper BP cuff size: Most measurement errors occur by not taking the time to choose the proper cuff size. Wrap the cuff around the patient's arm and use the INDEX line to determine if the patient's arm circumference falls within the RANGE area. Otherwise, choose the appropriate smaller or larger cuff.

Step 4 - Place the BP cuff on the patient's arm: Palpate/locate the brachial artery and position the BP cuff so that the ARTERY marker points to the brachial artery. Wrap the BP cuff snugly around the arm.

Step 5 - Position the stethoscope: On the same arm that you placed the BP cuff, palpate the arm at the antecubical fossa (crease of the arm) to locate the strongest pulse sounds and place the bell of the stethoscope over the brachial artery at this location.

Step 6 - Inflate the BP cuff: Begin pumping the cuff bulb as you listen to the pulse sounds. When the BP cuff has inflated enough to stop blood flow you should hear no sounds through the stethoscope. The gauge should read 30 to 40 mmHg above the person's normal BP reading. If this value is unknown you can inflate the cuff to 160 - 180 mmHg. (If pulse sounds are heard right away, inflate to a higher pressure.)

Step 7 - Slowly Deflate the BP cuff: Begin deflation. The AHA recommends that the pressure should fall at 2 - 3 mmHg per second, anything faster may likely result in an inaccurate measurement. *

Step 8 - Listen for the Systolic Reading: The first occurence of rhythmic sounds heard as blood begins to flow through the artery is the patient's systolic pressure. This may resemble a tapping noise at first.

Step 9 - Listen for the Diastolic Reading: Continue to listen as the BP cuff pressure drops and the sounds fade. Note the gauge reading when the rhythmic sounds stop. This will be the diastolic reading.

Step 10 - Double Check for Accuracy: The AHA recommends taking a reading with both arms and averaging the readings. To check the pressure again for accuracy wait about five minutes between readings. Typically, blood pressure is higher in the mornings and lower in the evenings. If the blood pressure reading is a concern or masked or white coat hypertension is suspected, a 24 hour blood pressure study may be required to assess the patient's overall blood pressure profile.

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The Snellen letter chart is the most common test of visual acuity in children beyond infancy. The HOTV test is a wall chart composed of the letters H, O, T, and V. The child is given a board with a large H, O, T, and V; the examiner points to the letter on the wall chart and the child matches the correct letter on the board by holding it up by hand. The tumbling E is used to assess visual acuity in children who cannot read letters or numbers. The HOTV and tumbling E are excellent tests for preschoolers, but not the most commonly used methods. Photoscreening is a technique used to screen for amblyopia, refractive disorders, and media opacities.

Patient positioning / flow of exam:

Examine posterior thorax and lungs first:
Patient should be sitting with arms folded across chest with hand on opposite shoulders. *If patient unable to sit, even with assistance, have patient roll to one side and then then other for posterior exam.

Examine anterior thorax and lungs next: Patient may be sitting, however the supine position may be optimal position for people with breast tissue as this position allows breasts to be displaced laterally.

Inspection: Observe the rate, rhythm, depth, and effort of breathing including accessory muscle use
Examine the hands for clubbing, cyanosis
Examine intercostal spaces for concavity Inspect the shape and movement of the chest wall
Palpation: Palpate any painful or irregular areas of the chest wall

Test chest expansion: Palpate the chest anteriorly/laterally and posteriorly for respiratory expansion.

Palpate for tactile fremitus bilaterally:
• 4 posterior positions
• (anterior positions not required)
• Can use "oy" sounds or counting "one, two, three..." or "ninety-nine."
• Place hand on chest wall: Can use palms and fingertips, ball of hand, or ulnar surface of hand. (Use positioning that allows you to feel vibrations.)
• For documentation, note if tactile fremitus is increased/decreased or equal bilaterally. If it is increased/decreased, note the location.

Percussion: Percuss bilateral lung fields:
• 7 posterior locations
• 6 anterior and lateral locations
• Compare the same areas on each side starting with apices and progressing downwards
• For documentation, describe: o Quality of percussion note (dull, resonant, tympanitic)

Location of any variances in note quality

Measure diaphragmatic excursion at full inspiration and at full expiration

Auscultation: Auscultate bilateral lung fields:
• 7 posterior locations
• 6 anterior and lateral locations
• Compare the same areas on each side while patient breathing through mouth
• Listen for abnormal sounds. (If abnormal, evaluate for egophany.)
• In documentation, describe: breath sounds (vesicular, bronchovesicular, bronchial, tracheal) presence of adventitious sounds (crackles, wheezes/rhonchi, stridor, pleural rub) air movement (good or poor)

Which method is appropriate to ensure correct measurement of the brachial artery blood pressure?

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