The steps and processes used in measuring and managing a client's blood pressure and heart rate to support their well-being
Implications of blood pressure and heart/pulse rate measurements
If the client is diagnosed with high blood pressure or arrythmia (abnormal heart/pulse rate) monitoring their blood pressure is done regularly, usually each day in the morning and evening. The client's doctor will advise how often a person's BP and Pulse should be monitored. The support worker is responsible to understand and know the numbers to maintain an awareness of the client's condition and alert any changes or detect patterns. Blood pressure management strategies are implemented when required and tracking the blood pressure & heart/pulse rate results over time will also reveal if the changes that have been made are working.
How to measure BP and P Blood pressure and pulse is measured with an electronic blood pressure device (see video below). The electronic device measures the pressure of blood running through a person's arteries and the presence of a pulse. It gives blood pressure readings as the systolic blood pressure over the diastolic blood pressure in millimetres of mercury (mm) in a specific volume of blood (Hg). The frequency of blood pressure and pulse measurements for a client are directed by a doctor and oversight monitoring is provided by a registered nurse. 2.21 mins
How to use an electronic BP monitor/machine at home
Watch the video below
Make sure the person is sitting and use the left arm at rest.
Wrap the cuff around the left upper arm, ensuring the tube connection is placed over the brachial artery (inside of the arm just above the elbow bone).
Insert the tube end into the BP monitor/machine.
Press the start button. Ask the person to think of something relaxing or chat quietly.
The display panel will show the BP and the Heart Rate HR or Pulse.
Understanding the numbers
Click the blue link to read our training resource, Understanding Blood Pressure and Heart Rates. The resource relates to the blood pressure categories used in Australia. A support worker must know these numbers when caring for a client with medical conditions that affect their blood pressure.
How to record blood pressure measurements and heart/pulse rate readings BP & P measurements are taken by direct care staff and immediately recorded in a new and separate shift note.
The systolic measurement is the first reading or top number and is always written above the diastolic or in front of the diastolic, e.g., BP-120/80 mm Hg.
Heart/Pulse readings are recorded as a pulse - (and add the measurement), e.g., P-72.
Support Workers must make a new and separate shift note immediately after blood pressure and pulse measurements are taken.
Blood Pressure and Heart Rate - Signs, Symptoms, Causes and What To Do
1. HYPERtension = HIGH blood pressure
Refers to the pressure of blood against artery walls. High blood pressure can cause blood vessel damage, leading to heart disease, kidney disease, stroke, and other problems over time.
Signs and Symptoms of Hypertension
a pounding feeling in their head or chest
chest pain
a feeling of light-headedness or dizziness
severe headaches
difficulty breathing
nausea, vomiting
blurred vision
anxiety
difficulty breathing
Implications of Hypertension Most people with high blood pressure do not have symptoms, they may go years without knowing they have the condition. Hypertension is a serious condition and may cause heart attack or stroke, it is known as the 'silent killer'because many of the symptoms are common and often treated separately with over the counter medications.
Causes of hypertension
Common factors that can lead to high blood pressure include stress, anxiety, and a diet high in sugars, and high in sodium, unsaturated and monounsaturated fats and oils which are in many processed foods.
Chronic conditions include kidney and hormone problems, diabetes, and high cholesterol.
Family history, especially if parents or close relatives have high blood pressure.
What to do for Hypertension
take 10 deep breaths and relax
increase water intake if dehydrated (to normalise BP)
increase physical activity
limit alcohol
reduce stress
reduce sodium in diet
make a new and separate shift note to record measurement
report hypertension readings to the CCM or call HWH 24/7 1800 717 590
If a client's blood pressure is higher than 180/110 mm Hg and they are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision or difficulty speaking, do not wait to see if your pressure comes down on its own. Call the client's Clinical Care Manager, or the 24/7 - 1800 717 590 number.
In summary, it is an emergency if a client's blood pressure measurement is ABOVE 180/110 mm Hg. If the client has this reading you must escalate it immediately by reporting the measurement, and the signs and symptoms of HYPERtension verbally to the CCM or call the 24/7 - 1800 717 590 number.
2. HYPOtension = LOW blood pressure
People with low BP are a fall risk. Big drops in BP, such as those caused by uncontrolled bleeding, severe infections, or allergic reactions, can be life-threatening.
Symptoms of hypotension
Dizziness and fainting because the brain fails to receive enough blood.
Lightheadedness on standing
Blurred vision or fading vision
Nausea and sweating
Rapid shallow breathing
Fatigue
Feeling cold
Thirsty
Lack of concentration
Depression and confusion
Causes of hypotension
Age - Drops in blood pressure on standing or after eating occur primarily in adults older than 65. Neuralgia-mediated hypotension primarily affects children and younger adults.
Shock - Can cause low blood pressure, keep the person warm and elevate their legs.
Medications - People who take certain medications, for example, high blood pressure medications such as alpha-blockers, have a greater risk of low blood pressure.
Water pills (diuretics), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, others)
Alpha blockers, such as prazosin (Minipress)
Beta-blockers, such as atenolol (Tenormin) and propranolol (Inderal, Innopran XL, others)
Drugs for Parkinson's disease, such as pramipexole (Mirapex) or those containing levodopa
Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor) and imipramine (Tofranil)
Drugs for erectile dysfunction, including sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Alyq, Cialis), particularly when taken with the heart medication nitroglycerin (Nitrostat, others)
Certain diseases. Parkinson's disease, diabetes and some heart conditions increase your risk of developing low blood pressure.
Posture - sudden changes in a persons posture can cause hypotension. People at risk of orthostatic or postural hypotension are those who have been in bed for an extended period of time, or seated for many hours.
What to do for Hypotension
take 10 deep breaths to increase oxygen intake
keep warm
cross legs while sitting
take care when mobilising, as the client will feel lightheaded and their vision is blurred, they are a falls risk when their BP is low
dissolve half a teaspoon of salt in water and ask the client to drink it
add salt to meals
increase water intake
wear compression stockings on lower legs
make a new and separate shift note to record measurement
report hypotension readings to the CCM or call HWH 24/7 1800 717 590
the client may require IV fluids or a blood transfusion at a hospital
Orthostatic or Postural Hypotension Can occur for various reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders.
It is common for people with spinal injuries or those who spend excessive time in bed when they sit upright or are placed in their wheelchair they feel faint as the blood drains from their brain, Encourage deep breathing and assist the person in putting their head between their knees or on a pillow on their lap.
In summary, it is an emergency if a client's blood pressure measurement is BELOW 90/60 mm Hg. If the client has this reading you must escalate it immediately by verbally reporting the measurement, and the signs and symptoms of HYPOtension to the CCM or call the 24/7 - 1800 717 590 number.
3. Pulse (Heart Rates)
A normal resting heart rate (pulse) for adults ranges from 60 to 100 beats per minute.
Generally, a lower heart rate at rest implies more efficient heart function and better cardiovascular fitness. For example, a well-trained athlete might have a normal resting heart rate closer to 40 beats per minute.
The client may need emergency medical attention if:
a resting heart rate is consistently above 100 beats a minute (tachycardia)
or a resting heart rate that is below 60 beats a minute (bradycardia)
To measure heart rate, simply check a pulse.
Place your index and third fingers on your neck to the side of your windpipe.
To check your pulse at your wrist, place two fingers between the bone and the tendon over your radial artery — which is located on the thumb side of your wrist.
When you feel a pulse, count the number of beats in 15 seconds. Multiply this number by four to calculate the heart beats per minute. Record as P-(add the measurement) in a new in separate shift note.
Keep in mind that many factors can influence heart rate, including:
Age
Fitness and activity levels
Being a smoker
Having cardiovascular disease, high cholesterol or diabetes
Air temperature
Body position (standing up or lying down, for example)
Emotions
Body size
Medications
There is a wide range of normal, for example, a heart rate that is consistently above 100 beats a minute (tachycardia) is usual for a trained athlete. An unusually low heart rate may indicate an underlying problem, for example, a resting heart rate that is below 60 beats a minute (bradycardia) — especially with other signs or symptoms, such as fainting, dizziness or shortness of breath could indicate hypotension.
What to do for an abnormal Heart/Pulse Rate (Heart Arrhythmia) Make a new and separate shift note to record the measurement, and:
keep the person calm
keep talking to the person
keep the person warm
In summary, it is an emergency if a client's heart/pulse rate is BELOW 60 or ABOVE 100 beats per minute. If the client has this measurement, you must escalate it immediately by verbally reporting the measurement, and the signs and symptoms of Arrythmia to the CCM or call the 24/7 - 1800 717 590 number.
Changes that can be Made to Manage High Blood Pressure
High blood pressure (HBP, or hypertension) is a symptomless “silent killer” that quietly damages blood vessels and leads to serious health problems.
While there is no cure, using medications as prescribed and making lifestyle changes can enhance the client's quality of life and reduce their risk of heart disease, stroke, kidney disease and more.