Download blood pressure - Health Occupation Syllabus

Blood Pressure
Introduction
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TPR, BP
Certain factors can alter the reading causing
an inaccurate measurement
Treatment can be based on BP readings if not
read correctly this could be harmful to the
resident
Practice= Proficient
BLOOD PRESSURE (BP)
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The amount of force exerted against the walls of
an artery by the blood
Blood Pressure Measurement consists of measuring
the Systolic and Diastolic pressures
Terms and Definitions
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Systolic Pressure- amount of force it takes to pump
blood out of the heart into the arterial circulation
(top number)
Diastolic Pressure- the pressure in the arteries
when the heart is at rest (bottom number)
Mm Hg- Measurements of millimeters of mercury;
unit of measurement used when taking BP
Sphygmomanometer- instrument used to measure
BP that consists of a cuff that is applied to the
upper arm and a measuring device
Stethoscope- instrument used to listen to the
sounds produced by the heart, lungs and other body
organs
BLOOD PRESSURE
Systole
• Period of heart muscle contraction
• Systolic Pressure- highest pressure,
represents the amount of force it takes to
pump blood out of the heart into the arteries
• Top number
• Blood is being sent to the lungs et the rest of
the body
• Normal systolic reading is 120 mm of mercury
• Normal range is 100 to 150 mm of
mercury
• Sphygmomanometer gauge when the first
sound is heard
BLOOD PRESSURE
Diastole
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Period of heart muscle relaxation
Represents the Constant pressure that is in the walls of
the arteries when the heart is at rest
Least pressure, Bottom number of the BP reading
Blood has moved into the capillaries et veins so the
volume of blood in the arteries has decreased
Normal diastolic reading is 80 mm of mercury
Normal range 60-90 mm of mercury
Adults- when the sound stops or becomes faint
Child- when the sound changes or becomes muffled
BLOOD PRESSURE
Pulse Pressure
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Difference between systolic et diastolic pressure
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Important indicator of health et tone of arterial
walls
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Normal range for pulse pressure in adults is 3050mm Hg
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Ex- Systolic pressure 120 mm Hg and the
Diastolic is 80 mm Hg, the pulse pressure is 40
mm Hg (120 minus 80= 40)
BLOOD PRESSURE
Hypertension, or High Blood Pressure
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Consistent BP measurements above the normal
systolic (150 mm Hg) or diastolic (90 mm Hg)
pressures
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Common Causes- stress, anxiety, obesity, high
salt intake, aging, kidney disease, thyroid
deficiency, et vascular conditions such as
arteriosclerosis ( narrowing of arteries)
BLOOD PRESSURE
Hypotension or Low Blood Pressure
• Condition in which systolic BP is below 100 mm
Hg and diastolic pressure is below 60 mm Hg
diastolic
• Occurs with heart failure, dehydration,
depression, severe burns, hemorrhage, and
shock
Factors Influencing Blood Pressures
Readings
• Force of the heartbeat
• Resistance of the arterial system
• Elasticity of the arteries
• Volume of blood in the arteries
Factors that May Increase Blood
Pressures
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Strong emotions (excitement, anxiety,
nervous tension, fear, anger)
Moderate pain
Some medications (ex. Antihistamines,
antidysrhythmics)
Stimulant drugs, smoking, caffeine
Exercise
Eating
Obesity
Some disease conditions
Factors that May Decrease
Blood Pressures
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Rest or sleep
Clinical Depression
Depressant drugs
Shock
Hemorrhage
Excessive loss of blood
Severe pain
Some medications (ex. Diuretics,
antihypertensives, some antihistamines
BLOOD PRESSURES Are Recorded as
Fractions
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Systolic top number or numerator
Diastolic bottom number or denominator
Example: systolic of 120, et diastolic of 80 is
120/80
Exception occurs when heart sounds are muffled
or heard to zero or very low levels while taking
an adults blood pressure
• First sound is recorded as systolic
• Change in sound noted as diastolic
• Zero or very low number is noted in fraction
• Ex systolic 120, change in sound 76,
continuation of sound 0 as 120/76/0
Equipment Used to Take a Blood
Pressure Reading
Mercury sphygmomanometer
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Upright gauge with a straight column of
numbers
Dial is marked from 0-300
Each line represents 2 mm of Hg
Must be placed on flat, level surface or
mounted on wall
Level of mercury should be at zero when
viewed at eye level if manometer is calibrated
correctly
Mercury Manometer
Figure 9.1 – Mercury Sphygmomanometer
Equipment Used to Take a Blood
Pressure Reading
Aneroid sphygmomanometer
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Round gauge with spring type arrow pointing
to numbers
Calibrated in mm of mercury
Dial is marked off in units of measurements
of 20-300; 0 is the center bottom of the
gauge
Each small line represents 2 mm of mercury
Gauge should be positioned at eye level for
correct reading
Aneroid
Sphygmomanometer
Figure 9.2 – Aneroid Sphygmomanometer
Equipment Used to Take a Blood
Pressure Reading
Cuff
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Long, narrow piece of fabric that is wrapped around the arm
with Velcro
Compression bag or bladder within cuff, fills with air when
bulb is pumped, applies pressure to artery that stops blood
flow
Cuff should be placed where center of the bag is over the
brachial artery about 1 inch above elbow. Use appropriate
size
Apply to bare upper arm
Tubing connects cuff to manometer et bulb.
Turn valve on bulb clockwise to allow cuff to inflate,
counterclockwise to deflate
Equipment Used to Take a
Blood Pressure Reading
Cuff
Size et placement of sphygmomanometer cuff
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Cuffs that are too narrow or too wide cause inaccurate
readings
Width of cuff should be approx 20 percent wider than
the diameter or width of the pt upper arm
Sm cuff false high reading
Lg cuff false low reading
Equipment Used to Take a Blood
Pressure Reading
Stethoscope
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Instrument that amplifies sound
Ear pieces face forward
Use flat diaphragm side, do not use thumb
Do not put too much pressure on
stethoscope it will put pressure on artery
Always clean ear pieces and diaphragm
with alcohol
Stethoscope
Figure 9.3 - Stethoscope
Factors to Follow For Accurate Blood
Pressure Readings
American Heart Association recommendations
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Pt should sit quietly for at least 5 minutes
before BP is taken
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Two separate readings should be taken et
then averaged
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Minimum wait of 30 seconds between
readings
Factors to Follow For Accurate
BLOOD PRESSURE Readings
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Pts should be seated or lying comfortably
Forearm supported or on flat surface, heart level
Area of the arm covered by the cuff should be at
heart level
Arm must be free of constricting clothing, apply
to bare arm
Deflated cuff should be placed on arm with the
center of the rubber band directly over brachial
artery
Lower edge of cuff should be 1 to 1 ½ inches
above the antecubital area (bend of the elbow)
Measuring the Blood Pressure
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BP should NEVER be taken on an arm with an IV
infusion, dialysis shunt or cast
If a resident has had breast surgery or a
mastectomy a BP reading should NOT be taken
on that arm!!
BP should NEVER be taken on an arm that is paralyzed
Lying down (usually lower)
Sitting position
Standing position ( usually highest)
**Use LEFT ARM when possible it is closest to the
heart
Quiet room, turn down TV, radio
BLOOD PRESSURE
Place stethoscope bell/diaphragm correctly
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Place over the brachial artery at the anticubital area
Hold securely but with little pressure possible
Make sure ear pieces are pointed forward while
placing them into the ears
Record all required information
a)
Record reading as a fraction
b)
Example: Date, Time BP 122/76. Your signature
et title
Summary
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Vital signs are a major indication of
body function.
An abnormal blood pressure can
indicate disease
Palpatory Systolic Pressure
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Should be determined to avoid over inflation of cuff
Position cuff correctly on arm
Locate radial pulse, keep finger tips on radial pulse
Inflate cuff until radial pulse disappears
Inflate cuff 30 mm Hg above this point
Slowly release pressure on cuff while watching gauge
Note the reading on the gauge when the radial pulse is
felt again
This reading is the palpatory systolic pressure
Deflate cuff completely to 0 mm Hg
Palpatory Systolic Pressure
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Wait 30-60 seconds to allow blood flow to
resume completely
Ask the pt to raise the arm et flex fingers to
promote blood flow
When you are ready to measure blood
pressure, inflate the cuff 30 mm Hg above
the palpatory systolic pressure
Ex Palpatory systolic pressure was 120 mm,
inflate the cuff to 150 mm Hg