2Blood pressure is the force of blood against the arterial walls. Responsible for the flow of blood.Blood pressure is the result of:- The pumping action of the heart.- Resistance of the blood vessels.- Volume of blood.
3Blood pressure also depends on: Distance from the heart.Would B/P in the legs be lower or higher than in the arm?
4Pumping Action of the Heart Systolic Phase-SystoleVentricles ContractBlood flows to the body
5Pumping Action of the Heart Diastolic Phase – DiastoleHeart relaxes
6Blood Pressure is Elevated by: Sex and age of the patient.Exercise, eating, emotionsStimulantsObesityArteriorsclerosisDiabetesPainHeredity factorsSome drugs
7Blood Pressure is lowered by: FastingRestDepressantsWeight lossLoss of blood or shockDiuretics
8Blood Pressure is: Recorded as an improper fraction. 120/80 Numerator equals systolic pressure, the first sound you will hear.Denominator equals diastolic pressure, the last sound you will hear.
9Blood Pressure Sounds are: Auscultated through a stethoscopeSounds are correlated with the readings on a sphygmomanometer.Blood pressure is recorded in milligrams of mercury. (mm HG)
10Blood Pressure Variations Determine baseline- From medical record- From systolic palpated pressureHypertension – High blood pressureHypotension – Low blood pressureOrthostatic hypotension – decrease in B/P with position change from supine to erect.
18Positioning for BPIdeally have the patient seated and their arm at heart level. Make sure that they do not have any tight clothing which may constrict their arm.
19Locate the brachial pulse Palpate in the antecubital fossa for the point of maximal pulsation of the brachial artery.
20Positioning of Blood Pressure Cuff Cuff applied directly over skin (not through clothes)Clothes artificially raises blood pressureCenter inflatable bladder over brachial arteryPosition lower cuff border 1 inch above antecubital space
21Estimation of systolic pressure The examiner should assess the estimated systolic pressure. To do this, palpate the patient’s radial pulse. Now inflate the cuff until you feel the exact point when the pulse disappears. The point on the manometer at this moment represents the estimated systolic pressure.
22Assessment of systolic & diastolic pressure Place your stethoscope over the brachial artery area. Now inflatean extra 30mmHg worth of pressure above the estimate systolic pressure (e.g. if the estimate systolic pressure was 120mmHg – inflate the cuff to 150mmHg).
24Now slowly release the pressure in the cuff by using the valve. The pressure should be reduced at a rate of 2-3mmHg per second. The point where consecutive tapping noises (i.e. Korotkoff phase 1) occur you should read off the pressure on the manometer – i.e. the systolic pressure.
25When the consecutive heart beat sounds finally disappear (i. e When the consecutive heart beat sounds finally disappear (i.e. Korotkoff phase 5), read off the measurement on the manometer. This represents the diastolic pressure.
26Trouble-shooting False high reading - Cuff too small - Cuff too loose - Slow cuff release- Column or dial not at eye level- Anxiety or recent exercise
27False low reading- Incorrect position of arm…be sureto position at the level of the heart Failure to notice auscultatory gap:Sounds fade out for 10 to 15 mm Hg then return– Inaudibility of low volume sounds– Column or dial not at eye level
28systolic & diastolic pressure, Blood pressure values• Systolic normal range 90 – 140 mm HgDiastolic normal range 60 – 90 mm HgPulse pressure: difference betweensystolic & diastolic pressure,approximately 40 mm Hg
29Blood pressure readings… Use same arm forreadings• Do not take B/P onarm with:– An IV– Paralysis– Injury– A – V shunt– Edema