VOL: 97, ISSUE: 01, PAGE NO: 41
PHIL JEVON, RESUSCITATION TRAINING OFFICER, UNIVERSITY OF WOLVERHAMPTON
BEVERLEY EWENS, CONSULTANT NURSE, ICTU;JOHN HOLMES, SENIOR NURSE LECTURER, UNIVERSITY OF WOLVERHAMPTON
In healthy patients there is little difference between lying, sitting and standing blood pressure measurements. However in some patients, for example those with postural hypotension, a significant fall in blood pressure (20mmHg or more) can occur on standing. Postural hypotension can present with a clinical picture of dizziness, syncope and falls, and is more common in elderly people. Accurate measurement of the lying and standing blood pressure can help with diagnosis.
Routine measurements of the lying and standing blood pressures are advisable in all older patients, particularly if they are taking hypotension-inducing medication; for example, beta blockers or tricyclic antidepressants, and for any patient with unexplained falls. When undertaking lying and standing blood pressure measurements, the nurse must be alert to the possibility that the patient may collapse. It may be helpful to have another nurse on hand.
The full procedure for blood pressure measurement can be found in a previous series of Practical Procedures (Torrance and Semple, 1997a; b; c).
Mercury sphygmomanometers are used as a reference for determining the accuracy of automated monitors (Smith, 2000). However, there are environmental and health concerns about instruments containing mercury, and some trusts have banned their use. Both mercury sphygmomanometers and automatic monitors are illustrated ’here.