Blog Viewer

A 55-year-old woman presents with a headache and flashing lights. Why?

NursingSKL clinical tip

By NursingSKL
October 10, 2023
iStock/ajr_images; NursingSKL

Hypertension is one of the most prevalent conditions that we see as nurses and doctors. Hypertension can be considered to be primary or secondary. There are two very important things that you as a nurse need to consider when assessing a patient for blood-pressure issues:

  1. Perform a thorough examination to determine if there is a family or past history of either primary or secondary causes of hypertension (for instance, things like renal artery stenosis, pheochromocytoma and sleep apnea).
  2. Properly obtain your patient’s blood pressure through the following:
    • Take measurements using either a sphygmomanometer that is known to be accurate, a validated electronic device, or a recently calibrated aneroid device.
    • Use a cuff with an appropriate bladder size matched to the size of the arm.
    • When taking measurements manually with a sphygmomanometer, make sure that the patient is seated comfortably and has a five-minute rest period before taking readings. Take three readings, discard the first, and average the latter two.
    • When using automated office blood pressure devices, again, the patient should be seated comfortably (no specified rest period). Readings should be taken at one- or two-minute intervals. Take three readings, discard the first, and average the latter two.
    • Record the arm used and whether the patient was supine, sitting, or standing. Also record the heart rate.
    • In the case of arrhythmia, additional readings with auscultation may be required to estimate the average systolic and diastolic pressure. Isolated extra beats should be ignored. Note the rhythm and pulse rate.
    • Lastly, blood pressure (BP) should be taken in both arms on at least one visit and if one arm has a consistently higher pressure, that arm should be subsequently used for BP measurement and interpretation.

Clinical tip: In a patient with new onset hypertension, always ask questions to rule out the possibility of secondary causes.


In this video you will learn three critical questions that you need to ask any patient presenting with pins and needles.

This clinical tip was provided by NursingSKL, a collaborative initiative between leading doctors and nurses to improve nurses’ clinical skills. Go to to find out more, meet the faculty, and try our free Practicum on Diabetes Care.
All CNA members get a 25% member discount on NursingSKL’s practicums. Sign in to your CNA account and access NursingSKL on the Professional Benefits page.