Norman Hope Hospital
                                  Memorandum
TO: Key Hospital Personnel
     Chiefs Peds, Surgery, OB...
Norman Hope Hospital
                                           Instructional Module #37
                                 ...
Feedback #3: if you said “blood pressure cuff” and
“stethoscope” or “microphone” or “device for detecting pulse”
then you ...
HOW THE TEST WILL FEEL:

The pressure of the cuff on the arm is felt.

WHAT THE RISKS ARE:

There is no risk.

WHY THE TES...
not, read the passage again.
Criterion Test: Blood Pressure
1. What   does the chemical symbol “Hg” stand for?
     a.   High grade
     b.   Mercury
 ...
8. Approximately how long does it take a given drop of blood to
circulate throughout the body and return to the heart?
   ...
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Norman Hope

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Norman Hope

  1. 1. Norman Hope Hospital Memorandum TO: Key Hospital Personnel Chiefs Peds, Surgery, OB, Psych, Neurology, Radiology; Directors of Nursing, Finance, PR, Personnel, Custodial, Insurance FROM: Dr. Leonard H. McCoy, Hospital Administrator SUBJ: Blood Pressure Error Rate At our next monthly staff meeting, we need to see if we can figure out what is causing our high error rate in blood pressure readings taken by Nurse Aide personnel. As you may already be aware from the grapevine, we have had a number of near- disasters over the past months due to an unacceptably large error term in the blood pressure readings taken by our Nurse Aides. Whereas the acceptable error is plus-or-minus five points in both systolic and diastolic, we are seeing variances of over 40 points between readings taken by our R.N.’s and the Aides. In addition, some patients have lost sensation in their arms for long periods of time due to over tightening of cuffs. One woman was saved from amputation by heroic measures involving hot water, electro-stimulation, and experimental drugs. We have recruited these Aides, as you also may know, from Trinidad and Haiti due to a shortage of local applicants and availability of these people at very low wages. There may be a problem with our Aides, and we may have to fire them all and start over. Some of our staff claim that people from other countries may not be dependable enough for us. I should point out that their English skills put them at high-average for American high school graduates, and other academic indicators such as SAT scores seemed also quite good. Their motivation to do good work has been noted by both their instructors in our training classes and by their supervisors on the wards. We went to a great deal of trouble to develop training for our Aides. The blood pressure unit was developed with the assistance of Dr. Hans Blutdruck. Dr. Blutdruck developed an excellent instructional package which I understand will soon be part of a CD-ROM on home medicine to be published by Microsoft Corp. A copy of the instruction in print form is attached. A copy of the examination for blood pressure is also attached. Dr. Roentgen of our Radiology Dept. developed the test himself. The test consists of a 10- item multiple-choice instrument with a reliability index of .87 (KR-21) and a range of item difficulty and discrimination which is ideal for this type of instrument, according to Dr. Roentgen. To improve the test’s ability to discriminate among individuals (and to avoid “teaching to the test”), a broad range of content was included on many topics in blood pressure and related topics which were not treated in the instruction itself. This helped the test to produce a normal distribution of scores, from which we picked only the top third to continue as our employees. Again, however, even the top third of this group may not be good enough--I don’t know if the people we have hired is the problem or what. At any rate, we have a problem. Let us come together and see if we can solve it.
  2. 2. Norman Hope Hospital Instructional Module #37 HB/tjr 1/98 ver. 3.6.7 Blood Pressure RELATED TERMS: BP; systolic BP; diastolic BP; systolic blood pressure; diastolic blood pressure DEFINITION: Blood pressure is a measurement of the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries. The blood pressure is continually changing depending on activity, temperature, diet, emotional state, posture, physical state, and drugs. Practice: (using a piece of paper as a shield, reveal only the practice item, answer the item, and move the sheet down to reveal the feedback) Practice #1: The size and flexibility of ______________ affects blood pressure. Feedback #1: if you said “the arteries” you are correct. If not, read the passage again. Practice #2: The force of blood against the walls of the arteries is called __________. Feedback #2: if you said “blood pressure” you are correct! If not, read the passage again. HOW TO PREPARE FOR THE BP TEST: The test can be done at any time. When it is performed for comparison purposes, it is usually done after resting for at least 5 minutes. One needs to have a blood pressure cuff and a device for detecting the pulse in the artery (stethoscope or microphone). Practice #3: In order to take blood pressure, you need to have on hand two items of equipment: a _______________ , and a _____________
  3. 3. Feedback #3: if you said “blood pressure cuff” and “stethoscope” or “microphone” or “device for detecting pulse” then you are correct! If not, read the passage again.
  4. 4. HOW THE TEST WILL FEEL: The pressure of the cuff on the arm is felt. WHAT THE RISKS ARE: There is no risk. WHY THE TEST IS PERFORMED: Most people cannot sense if their blood pressure is high (hypertension) because there are usually no symptoms. High blood pressure increases the risk of heart failure, heart attack, stroke, and kidney failure. For people who have high blood pressure, it is a way of monitoring the effects medications and habits have on the blood pressure. Practice #4: A good example of a “symptomless” condition which patients can have is _________________ Feedback #4: if you said “high blood pressure” or “hypertension” then you are correct! If not, read the passage again. NORMAL VALUES: Generally, the systolic pressure is approximately 120 mm Hg and the diastolic pressure is approximately 70 to 80 mm Hg. Practice #5: Normal diastolic pressure is: ____________ Normal systolic pressure is: ___________ Feedback #5: if you said “70 to 80 mm Hg” on line one and 120 mm Hg on line two, then you are correct! If not, read the passage again. WHAT ABNORMAL RESULTS MEAN: Mild hypertension: diastolic pressure consistently 90 to 104 mm Hg Significant hypertension: systolic pressure above 200 mm Hg or diastolic pressure above 100 mm Hg. Practice #6: 90-104 mm Hg indicates: ___________________ over 100 mm Hg indicates: _________________ Feedback #6: if you said “mild hypertension” on line 1 and “significant hypertension” on line 2, then you are correct! If
  5. 5. not, read the passage again.
  6. 6. Criterion Test: Blood Pressure 1. What does the chemical symbol “Hg” stand for? a. High grade b. Mercury c. Helium glutamate d. Hydrogen gas 2. What does “mm” stand for? a. micro-mini b. massive mass c. millimeter d. micromilliamp 3. The term “systolic” refers to: a. pressure during heart beat b. pressure between heart beats c. an instrument to measure blood pressure d. a blood pressure reducing drug 4. The term “diastolic” refers to: a. pressure during heart beat b. pressure between heart beats c. an instrument to measure blood pressure d. a blood pressure reducing drug 5. A consistent diastolic reading of 90 to 104 mm Hg is generally considered to indicate: a. significant hypertension b. mild hypertension c. normal blood pressure d. brain death 6. A consistent diastolic reading over 100 mm Hg is generally considered to indicate: a. significant hypertension b. mild hypertension c. normal blood pressure d. brain death 7. How high a column of water would normal systolic blood pressure support? a. 4.783 inches b. 120 inches c. 5 1/2 feet d, 20 feet
  7. 7. 8. Approximately how long does it take a given drop of blood to circulate throughout the body and return to the heart? a. 5 seconds b. 1 minute c. 4 hours d. 3 weeks 9. Partial restriction of the renal arteries supplying the kidneys would be expected to: a. raise blood pressure b. lower blood pressure c. produce mild euphoria d. produce a craving for ice cream 10. The major blood group systems in humans include: 1. ABO, MN, P, Rhesus, Lutheran, Kell, Lewis, Duffy, Kidd 2. ABC, OK, Q, Chimp, Methodist, Tell, Martin, Tavern, Adultt 3. NBC, TX, R, Maque, Bhudist, Sell, Abbott, Fibber, Young 4. FOX, NM, S, Sasquatch, Hindu, Nell, Costello, Molly, Old

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