Vital sign tutorial for all medical professionals
Before taking any patient’s vital signs, the medical professional must first wash their hands. Below is a short tutorial of many that demonstrates the proper method of hand washing using a technique called medical asepsis.
Hand hygiene is a simple thing and it’s the best way to prevent infection and illness.
Clean hands prevent infections. Keeping hands clean prevents illness at home, at school, and at work. Hand hygiene practices are key prevention measures in healthcare settings, in daycare facilities, in schools and public institutions, and for the safety of our food.
In healthcare settings, hand hygiene can prevent potentially fatal infections from spreading from patient to patient and from patient to healthcare worker and vice-versa.
On May 5, World Hand Hygiene Day is celebrated by the World Health Organization (WHO), CDC and other partners to encourage healthcare providers to promote and practice good hand hygiene measures to reduce the risk of infection among patients.
CDC has developed several hand hygiene resources for patients and healthcare providers.
Hand Hygiene Saves Lives: Patient Admission Video
To download the video and accompanying brochures and posters in English and Spanish, please visit Hand Hygiene in Healthcare Settings.
CDC partnered with the Association for Professionals in Infection Control and Epidemiology and Safe Care Campaign to develop and launch a hand hygiene video for patients and visitors in hospitals. The video teaches patients about the importance of practicing hand hygiene while in the hospital to help prevent infections. The video also seeks to empower patients by providing strategies they can use when asking their healthcare providers to practice hand hygiene.
Modeled after the video that airline passengers are required to view prior to take-off on a flight, this new video is intended to be shown to patients upon admission to the hospital. The goal is to inform patients at the beginning of their hospital stay about what they can do to help prevent infections throughout the duration of their stay.
The 5-minute video begins with a brief introduction on healthcare-associated infections. It is then narrated by a nurse character named Gayle who stresses the importance of hand hygiene for both patients and healthcare providers. There are two patient room scenes in which patients and visitors model the behavior of asking one another as well as their healthcare providers to perform hand hygiene – with positive results.
To download the video and accompanying brochures and posters in English and Spanish, please visit Hand Hygiene in Healthcare Settings.
Patients and visitors should take an active role and become involved in their healthcare by practicing and encouraging others to practice hand hygiene during their hospital stay.
Hand Hygiene Interactive Training Course
This online training course reviews the key concepts of hand hygiene and other standard precautions to prevent healthcare-associated infections. It is intended for healthcare providers and includes a self-paced navigation program that allows users to learn through both text and image-based pages. The course also includes several interactive activities and questions, which reemphasize the learning objectives throughout. A unique close-captioned 60-second video demonstrates the appropriate technique for handwashing mid-way through the course. At the conclusion of the course there are creative posters and screen savers available for download.
The training course is available at Hand Hygiene in Healthcare Settings.
More Information
Blood pressure explained;
Blood Pressure Explained
| Blood pressure level (mm Hg) | ||
|---|---|---|
| Category | Systolic | Diastolic |
| Normal | < 120 | < 80 |
| Prehypertension | 120–139 | 80–89 |
| High blood pressure | ||
| Stage 1 hypertension | 140–159 | 90–99 |
| Stage 2 hypertension | >=160 | >=100 |
Blood flow to the heart:
Sphygmomanometers
- There are three types of sphygmomanometers used to measure blood pressure: mercury, aneroid, and digital.
- Reading blood pressure by auscultation is considered the gold standard by the Heart, Lung and Blood Institute of the NIH.
Subject
- Position: supine, seated, standing.
- In seated position, the subject’s arm should be flexed.
- The flexed elbow should be at the level of the heart.
- If the subject is anxious, wait a few minutes before taking the pressure.
Procedures
- To begin blood pressure measurement, use a properly sized blood pressure cuff. The length of the cuff’s bladder should be at least equal to 80% of the circumference of the upper arm.
- Wrap the cuff around the upper arm with the cuff’s lower edge one inch above the antecubital fossa.
- Lightly press the stethoscope’s bell over the brachial artery just below the cuff’s edge. Some health care workers have difficulty using the bell in the antecubital fossa, so we suggest using the bell or the diaphragm to measure the blood pressure.
- Rapidly inflate the cuff to 180 mmHg. Release air from the cuff at a moderate rate (3mm/sec).
- Listen with the stethoscope and simultaneously observe the sphygmomanometer. The first knocking sound (Korotkoff) is the subject’s systolic pressure. When the knocking sound disappears, that is the diastolic pressure (such as 120/80).
- Record the pressure in both arms and note the difference; also record the subject’s position (supine), which arm was used, and the cuff size (small, standard or large adult cuff).
- If the subject’s pressure is elevated, measure blood pressure two additional times, waiting a few minutes between measurements.
- A BLOOD PRESSURE OF 180/120 mmHg OR MORE REQUIRES IMMEDIATE ATTENTION!
Precautions
- Aneroid and digital manometers may require periodic calibration.
- Use a larger cuff on obese or heavily muscled subjects.
- Use a smaller cuff for pediatric patients.
- For pediatric patients a lower blood pressure may indicate the presence of hypertension.
- Don’t place the cuff over clothing.
- Flex and support the patient’s arm.
- In some patients the Korotkoff sounds will disappear as the systolic pressure is bled down. After an interval, the Korotkoff sounds reappear. This interval is referred to as the “auscultatory gap.” This pathophysiologic occurrence can lead to a marked under-estimation of systolic pressure if the cuff pressure is not elevated enough. It is for this reason that the rapid inflation of the blood pressure cuff to 180 mmHg was recommended above. The “auscultatory gap” is felt to be associated with carotid atherosclerosis and a decrease in arterial compliance in patients with increased blood pressure.
Practice
- Use your aneroid and mercury sphygmomanometers simulators to practice your blood pressure measurement skills
- For pediatric patients, the NIH provides tables which use age, sex and height to interpret blood pressure findings.
Blood Pressure Reading
Blood Pressure> Auscultatory Method
The relaxed subject sits on a chair with the lower arm supported as before. The blood pressure cuff is placed on the subject’s right arm, allowing 1 inch between the bottom of the cuff and the crease of the elbow.
The brachial pulse is palpated just above the angle of the elbow (the “antecubital fossa”).
One group member puts on a stethoscope, with the earpieces on the headpiece angled forward. The recording end of the stethoscope is twisted, so that the diaphragm and not the bell is activated. This can be tested by tapping lightly on the diaphragm.
The diaphragm is placed over the brachial artery in the space between the bottom of the cuff and the crease of the elbow. At this point no sounds should be heard.
The cuff pressure is inflated quickly to a pressure about 30 mm Hg higher than the systolic pressure determined by the method of palpation. Then the air is let out of the cuff at a rate such that cuff pressure falls at a rate of about 5 mm Hg/sec.
At some point the person listening with the stethoscope will begin to hear sounds with each heartbeat. This point marks the systolic pressure.
The sounds are called Korotkoff sounds.
As the pressure is lowered further, the character of the Korotkoff sounds should change. At some point, the sounds will disappear.
The pressure reading at this point gives the diastolic pressure.
The subject should now lie on his or her back for five minutes. The systolic pressure and diastolic pressure are recorded. Then the subject stands up, and the pressures are immediately recorded once more.
Explanatory Notes
The laminar flow that normally occurs in arteries produces little vibration of the arterial wall and therefore no sounds. However, when an artery is partially constricted, blood flow becomes turbulent, causing the artery to vibrate and produce sounds.
When measuring blood pressure using the auscultation method, turbulent blood flow will occur when the cuff pressure is greater than the diastolic pressure and less than the systolic pressure. The “tapping” sounds associated with the turbulent flow are known as Korotkoff sounds. Remember that these sounds are not to be confused with the heart sounds produced by the opening and closing of the heart valves.
Summary of the auscultatory method:
Initially the cuff is inflated to a level higher than the systolic pressure. Thus the artery is completely compressed, there is no blood flow, and no sounds are heard. The cuff pressure is slowly decreased. At the point where the systolic pressure exceeds the cuff pressure, the Korotkoff sounds are first heard and blood passes in turbulent flow through the partially constricted artery. Korotkoff sounds will continue to be heard as the cuff pressure is further lowered. However, when the cuff pressure reaches diastolic pressure, the sounds disappear. Now at all points in time during the cardiac cycle, the blood pressure is greater than the cuff pressure, and the artery remains open.
JNC Classification of blood pressure in adults
Classification
BP (mm Hg)
Normal systolic: less than 120
Diastolic: less than 80
Pre-hypertension 120-139/80-89
Stage 1 hypertension 140-159 (systolic)
or
90-99 (diastolic)
Stage 2 hypertension equal or more than 160 (systolic)
equal or more than 100 (diastolic)
JNC: Joint National Committee on Prevention, Detection, Evaluation,
and treatment of high blood pressure
Errors in blood pressure readings:
The cuff is not of the proper size: if the cuff is too small the blood pressure readings may be artifactually high. If the cuff is too big, the readings may be artifactually low.
The cuff is positioned too loosely: the blood pressure may be artifactually high.
The centre of the cuff bladder is not positioned over the brachial artery.
The cuff is inflated slowly: a slow inflation causes venous congestion, which in turn causes the Korotkoff sounds to be faint; this results in false readings with the systolic value being too low and the diastolic reading too high.
If the cuff is re-inflated immediately after an initial reading (trying to re-check the reading): a rapid re-inflation could cause venous distension, the Korotkoff sounds become more muffled. The initial Korotkoff sound may be missed so the systolic reading would be falsely low, and the diastolic reading would be falsely high because the last Korotkoff sounds could not be heard.
Some important information regarding hand washing
CDC Feature: Wash Your Hands
Hand Hygiene in Healthcare Settings
Clean Hands Save Lives!
SAVE LIVES: Clean Your Hands
Handwashing After a Disaster
Handwashing and Nail Hygiene
CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. A US federal agency, CDC helps make the healthy choice the easy choice by putting science and prevention into action. CDC works to help people live longer, healthier and more productive lives.
Please watch the below video to help you understand blood pressure in more depth
