Blood Pressure and Heart Rate Assessment
Get an accurate BP and pulse — proper technique, what the numbers mean, and which readings need escalation.
Learning Objectives
- 1.Measure blood pressure with correct technique.
- 2.Recognize abnormal BP and heart rate values that matter.
- 3.Know which readings require provider notification.
Purpose
A blood pressure is only useful if it’s accurate. Poor technique creates false highs and lows that drive wrong decisions. Getting it right — and knowing what’s dangerous — is foundational cardiology nursing.
What to ask
- •Any caffeine, nicotine, or exercise in the last 30 minutes?
- •Did they take their BP/heart medications today?
- •Symptoms now: headache, chest pain, dizziness, vision changes?
- •What are their home readings running?
Technique (what to measure)
- •Patient seated 5 min, back supported, feet flat, arm at heart level.
- •Correct cuff size — a too-small cuff falsely raises BP.
- •No talking; no crossed legs.
- •Repeat and average if the first reading is high; check both arms on a new patient.
- •Count an irregular pulse manually for a full 60 seconds.
What the numbers mean
- •Normal <120/80; elevated 120–129/<80; stage 1 130–139/80–89; stage 2 ≥140/90.
- •Hypertensive crisis: ≥180 and/or ≥120 — recheck and escalate.
- •Heart rate: normal ~60–100; flag sustained <50 or >120.
Red flags
- •BP ≥180/120 WITH symptoms (chest pain, dyspnea, neuro changes, severe headache).
- •Symptomatic low BP (lightheaded, near-syncope), especially <90 systolic.
- •HR <40 or >150, or new irregular pulse with symptoms.
Escalate
A crisis-range BP with symptoms, or symptomatic brady/tachycardia, goes to the provider now (911/ED if severe). A high number alone without symptoms is rechecked and routed, not ignored.
What to document & send the provider
- •Reading(s), arm used, cuff size, position, and time.
- •Associated symptoms and recent meds.
- •Home BP trend and your recheck values.
Patient education script
- •"Sit quietly for 5 minutes before you check, feet flat, arm resting at heart level."
- •"Take it at the same times each day and write it down to bring in."
Spanish phrase
Please rest your arm here and try not to talk while I take your blood pressure.
Por favor descanse el brazo aquí y trate de no hablar mientras le tomo la presión.
por fah-VOR des-KAN-seh el BRAH-soh ah-KEE ee TRAH-teh deh noh ah-BLAR mee-EN-tras leh TOH-moh lah preh-SYON
Mini case
A patient’s BP reads 188/104. They feel fine, no symptoms. They rushed in and just drank coffee.
What now?
Show answer
Don’t panic or escalate emergently on one reading after coffee/rushing. Have them rest 5 minutes, recheck with correct technique; if still very high, route to the provider. Crisis-range numbers WITH symptoms are the emergency — this is a recheck-and-route.
Checklist
- Correct cuff size and position before measuring.
- Rechecked/averaged if elevated.
- Documented reading, arm, position, time, symptoms.
- Escalated crisis-range + symptoms appropriately.