Blood pressure (OSCE)

Taking a Blood Pressure

## Contents

* 1 General
* 2 Equipment
* 3 Positioning
* 4 Placement
* 5 Performance
* 6 Pitfalls
* 7 JNC-7 Classification
* 8 Other OSCE modules

## General[edit | edit source]

* No:
* smoking or caffeine x 30 mins
* constrictive clothing

* Yes:
* rest for ≥ 5 minutes
* breathing normal and relaxed

* During recording: no talking and patient’s legs uncrossed

## Equipment[edit | edit source]

* cuff size
* bladder width > 40 % of arm circumference
* length > 80% of arm circumference

## Positioning[edit | edit source]

* Level: devices and columns at eye level, patient’s arm held at heart level

## Placement[edit | edit source]

* lower edge of cuff ~ 3 cm above elbow crease
* bladder centered over brachial artery (palpate medial to biceps tendon)

## Performance[edit | edit source]

* palpate radial pulse (note arrythmias)
* inflate cuff to ~ 30 mm Hg above palpable pulse
* drop the pressure by 2 mm Hg / second (prolonged filling will lead to venous congestion, making the sounds harder to hear)
* repeat after ≥ 2 minutes of standing to assess for orthostatic hypotension (drop in 20/10)

* for all patients on the first visit, take at least 2 readings separated by 2 minutes
* if first 2 readings differ by > 5 mm Hg, another reading is indicated
* Elevated readings should be confirmed on 3 readings

## Pitfalls[edit | edit source]

* anxiety, pain
* arrhythmias
* wrong cuff size (too small overestimates, too large underestimates)
* Isolated office hypertension ('white coat' hypertension) (up to 25%)
* exercise

## JNC-7 Classification[edit | edit source]

(criteria for adults > 17 and not taking antihypertensives)

* Optimal
* Normal < 120 SBP and < 80 DBP
* Prehypertension 120-139 SBP or 80-89 DBP
* Hypertension Stage 1 140-159 SBP or 90-99 DBP
* Hypertension Stage 2 >or=160 or >or=100

## Other OSCE modules[edit | edit source]

* v
* t
* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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